Monday, 31 May 2010
An Integrated Motor Imagery Program to Improve Functional Task Performance in Neurorehabilitation: A Single-Blind Randomized Controlled Trial
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Biopsychosocialist
Being a 'biopsychosocialist' gives me a way of thinking about the differing influences on a person's perception of pain and working out why the brain feels threatened in different contexts.
Is Temporomandibular Pain in Chronic Whiplash-Associated Disorders Part of a More Widespread Pain Syndrome?
Check out this website I found at journals.lww.com
12 Events That Will Change Everything
From the June 2010 Scientific American Magazine | 17 comments
12 Events That Will Change Everything ( Preview )
In addition to reacting to news as it breaks, we work to anticipate what will happen. Here we contemplate 12 possibilities and rate their likelihood of happening by 2050
By The Editors, Charles Q. Choi, George Musser, John Matson, Philip Yam, David Biello, Michael Moyer, Larry Greenemeier, Katherine Harmon and Robin Lloyd
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Charlie Rose Brain Series Episode Eight
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Sunday, 30 May 2010
Facial Expressions of Mice in Pain
May 12, 2010 | 19 comments
Facial Expressions of Mice in Pain
Recent research has found that mice make humanlike facial expressions when they are in pain. Christie Nicholson reports
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We know someone is in pain just by looking at their face. Winced eyes, grimacing smile. We recognize it immediately. But can we see pain in nonhuman faces?
Well, recent research published in the journal Nature Methods shows that mice show the facial expressions of pain just like humans do.
Scientists injected mice with inflammatory drugs, which led to pain similar to a headache or a swollen finger. Then they videotaped the mice and had the video images analyzed by expert facial-expression decoders. The researchers scored five distinct mouse pain expressions. Eyes close and squint, nose bulges, cheeks bulge and mice also pull back their little round ears and move their whiskers. All of this led to the creation of a "mouse grimace scale".
It's a bit surprising that this is the first study of facial expressions of pain in nonhumans. Prior to this, scientists detected pain in mice from reflex reactions, like heat to the tail makes the tail flick.
Next up is to see whether this scale can translate to other mammals. Pain research depends on mouse studies, so having a method to measure a mouse's pain will help researchers understand chronic and spontaneous pain in humans.
This research also opens up the possibility of studying mouse social behavior, like to see if mice respond to the facial cues of other mice. Won't that be interesting—to see if or how a mouse consoles another mouse in pain?
—Christie Nicholson
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Panic Attacks as a Problem of pH
peskymonkey
"My heart starts to race, I can't breathe, I get all sweaty, and I feel very scared - like I am about to die."
This is how one of my patients recently described her panic attacks. Her diagnosis is panic disorder. The cause of this condition is still not understood, but we have long known that the vulnerability to panic disorder is strongly genetic. Now, a recent study from the laboratory of John Wemmie at the University of Iowa may have revealed an important new clue to the underlying cause of recurring panic attacks: It may, in effect, be a problem of pH -- of acidity at key junctures in the brain.
The amygdala, an almond-shaped structure deep in the brain, has a critical role in the circuits that control the experience of fear, both instinctive fear (like being afraid of snakes or large carnivores) and fear that is learned from life experiences. The Iowa study shows that a very basic metabolic factor, pH -- acidity -- also has an essential role in fear.
In general, the pH of our brain is carefully regulated. A large increase or decrease in brain acidity can seriously disrupt brain functioning. This new study indicates that pH can sometimes rise and fall in synapses, the points of communication between individual neurons in the brain. Some synapses include specialized proteins that "sense" acidity. These proteins (called "'acid-sensing ion channels", or ASICs) stimulate neurons when increased acid is detected.
The Iowa study shows that genetically modified mice lacking these acid-sensing proteins have a greatly reduced capacity to show either instinctive or learned fear. When the researchers restored the ASIC gene only in the amygdala of these genetically modified mice, they observed a normalization of fear behaviors. So their studies suggest that the ability to detect changes in synaptic pH in the amygdala is essential for normal fear behavior.
The Iowa paper also examined another element in the panic equation: Carbon dioxide. Carbon dioxide acts like an acid in the body and the brain. Several of the experiments described in the Iowa paper showed that inhaling elevated concentrations of carbon dioxide triggered strong fear reactions in normal mice, and that some of these fear reactions required the presence of the acid-sensing protein in the amygdala.These experiments are especially relevant to understanding panic disorder. One of the most consistent findings in patients with panic disorder is that they are unusually sensitive to carbon dioxide inhalation and other laboratory procedures that increase brain acidity. Most patients with panic disorder will experience a panic attack when they inhale air containing 35% carbon dioxide, while most healthy volunteers will not.
Interestingly, the close relatives of panic patients will also panic during carbon dioxide inhalation, even if they have never suffered from an anxiety disorder. A hypersensitivity to acid in the brain appears to be part of the inherited vulnerability to panic attacks. The recent studies in mice lacking the ASIC protein add further credence to this understanding of why some people are more prone to having panic attacks.The Iowa findings might help explain the significance of another curious observation: patients with panic disorder tend to generate excess lactic acid in their brains. Scientists have long hypothesized that an abnormality affecting basic cellular metabolism or pH lay at the heart of the genetic vulnerability to panic disorder. One of the products of glucose metabolism is lactic acid, or lactate. Lactate is constantly being produced and consumed during brain activity, but if it accumulates in the brain, it will make the brain more acidic. Recent studies have shown that patients with panic disorder consistently build up excess lactate in their brains during ordinary mental activities. The results of the Iowa studies suggest that one of the triggers for “spontaneous” panic attacks in patients with panic disorder might be lactic acid accumulating in acid-sensitive fear circuits.
Although there are several effective treatments available for people with panic disorder, current treatments do not work for all patients. It is unlikely that any of the current treatments specifically act on the underlying genetic vulnerability in panic disorder patients. The new studies show that brain pH changes are a crucial part of the mechanism of many fear behaviors. At present, no available medications affect the responses of acid-sensing ion channels in the brain. It may be possible to develop medications that inhibit these ASICs or otherwise modify the metabolic or neurochemical pathways involved in the regulation of fear and anxiety by brain acidity.For example, one of the many beneficial effects of aerobic exercise training (like running or cycling) is that metabolically active tissues (including the brain) become more efficient at consuming -- removing -- lactic acid. There is growing evidence that exercise training has powerful anti-anxiety and anti-panic effects. This invites the speculation that exercise training may reduce anxiety in part by improving the brain's ability to prevent excess acid accumulation in acid-sensitive brain regions involved in fear. If experiments support this idea, then specific exercise training regimens could be designed to take maximum advantage of this anti-anxiety mechanism.
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Down's eyes are clue to Alzheimer's disease
EYE tests could one day be used for the early detection of Alzheimer's disease, thanks to the discovery of a link between the amount of a characteristic protein in the brain and levels of the same protein in the eye.
Virtually everyone with Down's syndrome goes on to develop symptoms of Alzheimer's. When Lee Goldstein of Boston University School of Medicine and colleagues examined lens and brain tissue during post-mortems of people with Down's, they found that brain levels of amyloid protein correlated with those in the eye (PLoS One, DOI: 10.1371/journal.pone.0010659).
Clumps of amyloid protein in the brain are associated with Alzheimer's in the rest of the population, so Goldstein suggests that scanning people's eyes might be a non-invasive way to diagnose Alzheimer's, before other symptoms become apparent.
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Mechanism Points To Acupuncture Pain Relief
May 30, 2010 | 0 comments
Mechanism Points To Acupuncture Pain Relief
In mice, inserting and rotating acupuncture needles releases adenosine, which blocks pain signals. Karen Hopkin reports.
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Research on acupuncture just got a shot in the arm. Well, a needle near the knee, actually. Because a study in the journal Nature Neuroscience [Maiken Nedergaard et al] has uncovered a mechanism that could explain how this traditional healing process can help reduce pain.
Acupuncture has long been tried against all sorts of ailments, from aches and pains to infertility. And though the Western world treats the procedure with some skepticism, it’s actually endorsed by the World Health Organization for a couple dozen different conditions. But how can sticking needles in your skin be good for you?
Scientists tried the technique on mice that had a pain in the paw, inserting and rotating the needles in the mouse version of one of the most effective acupoints in Chinese medicine. And they found that the tissues around the treated acupoint get flooded with adenosine, a chemical that provides relief by preventing pain signals from reaching the brain.
This biochemical blockade reduced the animals’ discomfort, as did treating them with drugs that boost the amount of adenosine in the tissue. The scientists say the pain relief stems from the body’s natural response to minor tissue injury. So acupuncture’s analgesic effect may have finally been pinned down.
—Karen Hopkin
[The above text is an exact transcript of this podcast]
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Autologous Chondrocyte Implantation: A Long-term Follow-up
Abstract
Background: The medium-term results of autologous chondrocyte implantation (ACI) have shown good to excellent outcomes for the majority of patients. However, no long-term results 10 to 20 years after the surgery have been reported.
Hypothesis: Autologous chondrocyte implantation provides a durable solution to the treatment of full-thickness cartilage lesions of the knee, maintaining good clinical results even 10 to 20 years after implantation.
Study Design: Case series; Level of evidence, 4.
Methods: In this uncontrolled study, questionnaires with the Lysholm, Tegner-Wallgren, Brittberg-Peterson, modified Cincinnati (Noyes), and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were sent to 341 patients. Preoperative Lysholm, Tegner-Wallgren, and Brittberg-Peterson scores were also retrieved when possible from patients’ files. The patients were asked to grade their status during the past 10 years as better, worse, or unchanged. Finally, they were asked if they would do the operation again.
Results: There were 224 of 341 patients who replied to our posted questionnaires and were assessed. The mean cartilage lesion size was 5.3 cm2. Ten to 20 years after the implantation (mean, 12.8 years), 74% of the patients reported their status as better or the same as the previous years. There were 92% who were satisfied and would have the ACI again. The Lysholm, Tegner-Wallgren, and Brittberg-Peterson scores were improved compared with the preoperative values. The average Lysholm score improved from 60.3 preoperatively to 69.5 postoperatively, the Tegner from 7.2 to 8.2, and the Brittberg-Peterson from 59.4 to 40.9. At the final measurement, the KOOS score was on average 74.8 for pain, 63 for symptoms, 81 for activities of daily living (ADL), 41.5 for sports, and 49.3 for quality of life (QOL). The average Noyes score was 5.4. Patients with bipolar lesions had a worse final outcome than patients with multiple unipolar lesions. The presence of meniscal injuries before ACI or history of bone marrow procedures before the implantation did not appear to affect the final outcomes. The age at the time of the operation or the size of lesion did not seem to correlate with the final outcome.
Conclusion: Autologous chondrocyte implantation has emerged as an effective and durable solution for the treatment of large full-thickness cartilage and osteochondral lesions of the knee joint. Our study suggests that the clinical and functional outcomes remain high even 10 to 20 years after the implantation.
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Stress Fractures of the Metacarpal Bones in Adolescent Tennis Players: A Case Series
Abstract
Background: There are 12 reported cases of metacarpal stress fractures in athletes, with only 4 of them involving the second metacarpal.
Purpose: The authors describe stress fracture of the second metacarpal bone in teenaged tennis players and the relationship with sport intensity and type of grip used. They also demonstrate that magnetic resonance imaging is the diagnostic study of choice to differentiate this entity from the most common cause of pain in this region of the hand in tennis players—the carpal boss.
Study Design: Case series; Level of evidence, 4.
Methods: Seven adolescent tennis players (mean age, 16.5 years; 6 female, 1 male) with dorsal hand pain produced by playing tennis were examined by radiographs and initial magnetic resonance imaging. In 2 cases, bone scintigraphy was performed. In the first 2 cases, the presumptive diagnosis was a carpal boss, but with this experience, the diagnostic evaluation of the last 5 cases was oriented toward a stress reaction at this level. Radiologic follow-up was performed. The authors also evaluated the grip type used by each tennis player.
Results: Clinical evaluation and imaging studies resulted in a diagnosis of stress injury of the second metatarsal in 6 of 7 cases, with the seventh case involving the third metacarpal. Initial imaging was positive in 3 cases, revealing an increased signal in the marrow without hairline crack and cortical thickening of the shaft or simply an increased signal in the marrow. In all cases, there was a history of recent increase in the sport training load. Six of the 7 tennis players were using a semi-Western or Western grip.
Conclusion: Stress fractures of the second metacarpal are characteristic of adolescent tennis players and are associated with an increased intensity of tennis play and may be associated with use of the semi-Western or Western grip. Magnetic resonance imaging is the most useful tool for obtaining a definitive diagnosis.
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Lateral Elbow Tendinopathy: Correlation of Ultrasound Findings With Pain and Functional Disability
Abstract
Background: Lateral elbow tendinopathy is a common condition often diagnosed by ultrasound. Debate exists regarding which ultrasound findings correlate with disease severity and prognosis.
Hypothesis: Sonographic predictors for tendon healing in patients with lateral elbow tendinopathy can be found by correlating initial ultrasound findings with subsequent changes in pain and functional disability scores after a period of nonoperative management.
Study Design: Cohort study (prognosis); Level of evidence, 2.
Methods: Sixty-two elbows (34 right, 28 left) in 62 patients (30 male, 32 female) with a clinical diagnosis of lateral elbow tendinopathy underwent sonographic evaluation of the common extensor origin after assessment with a validated outcome measure, the Patient-Rated Tennis Elbow Evaluation (PRTEE). After 6 months of nonoperative standardized treatment (physiotherapy with eccentric loading), the PRTEE questionnaire was repeated.
Results: The mean pretreatment PRTEE was 78 (range, 51-97) and posttreatment score was 29 (range, 0-91). This difference in means was found to be significant (P < .0001). A positive correlation was identified between the presence of a lateral collateral ligament tear (P < .0001) and the size of the largest intrasubstance tear (P < .0001) and poor outcome. A negative correlation was identified with amount of hypoechogenicity (P = .0009). No correlation was found with age, sex, side, duration of symptoms, thickness of tendon, or amount of neovascularity.
Conclusion: The size of intrasubstance tears and presence of a lateral collateral ligament tear on ultrasound can be used to assess lateral elbow tendinopathy severity, indicate those who may not respond to nonoperative therapy, and potentially guide more invasive treatment. Those patients with a large intrasubstance tear or tears identified on ultrasound are less likely to respond to nonoperative treatment. Presence of neovascularity has little correlation with change in pain severity or functional disability and may be a poor predictor of prognosis.
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Peaceful monkeys chill out before the feeding frenzy
IF YOU think a fight is about to kick off, you might try to calm everyone down and defuse the tension. Some monkeys do the same thing.
Tufted capuchin monkeys can anticipate situations that are likely to cause fights, and pre-emptively groom each other to prevent them.
Eugenia Polizzi di Sorrentino of Liverpool John Moores University, UK, and colleagues studied a group of captive tufted capuchins. They were fed at the same time every day, leading to squabbles over the food.
The team found that the monkeys groomed each other much more in the 30 minutes before feeding time, and that this led to fewer attacks during feeding (Animal Behaviour, DOI: 10.1016/j.anbehav.2010.04.008). Subordinate monkeys groomed dominants to get permission to feed next to them, and dominants groomed subordinates as a signal that they would tolerate them.
Phyllis Lee of the University of Stirling, UK, thinks the findings provide evidence that the monkeys can plan for the future. "They're anticipating a social stressor and taking action to prevent it," Lee says.
Polizzi di Sorrentino disagrees. The capuchins are anticipating a future source of stress, becoming stressed about it in advance, and then grooming each other to relieve the tension, she says.
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Thursday, 27 May 2010
Slow-release NSAIDs pose greater risk of GI bleeding
ScienceDaily (May 26, 2010) — A study conducted at the Spanish Centre for Pharmacoepidemiological Research revealed that the risk of gastrointestinal complications due to nonsteroidal anti-inflammatory drug (NSAID) use varies by specific NSAID administered and by dosage. The study further determined that NSAIDs with a long half-life or slow-release formulation are associated with a greater risk of GI bleeding or perforation. Study findings are published in the June issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology.
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NSAIDs such as Advil, Motrin and Aleve, are drugs that treat pain and inflammation by blocking the action of two cyclooxygenase (COX) enzymes. COX-2 promotes inflammation, but COX-1 protects the lining of the stomach. If an NSAID inhibits both COX-1 and COX-2, GI bleeding and ulcers can result.
According to the American College of Gastroenterology, it has long been recognized that persons using NSAIDs are at a significantly increased risk of gastrointestinal complications, for instance, injury to the intestinal lining that can result in ulcers and/or gastrointestinal bleeding. With millions taking NSAID pain medications every day, it is estimated that more than 100,000 Americans are hospitalized each year and between 15,000 and 20,000 Americans die each year from ulcers and gastrointestinal bleeding linked to NSAID use.
To reduce the morbidity associated with NSAIDs, specific estimates for individual drugs and individual groups of patients with different risk profiles are needed. This study assessed the risk of upper GI bleeding and perforation among individual NSAIDs and analyzed the correlation between this risk and the degree of inhibition of whole blood COX-1 and COX-2 in vitro.
The research team conducted a systematic review of nine observational studies on NSAIDs and upper GI bleeding/perforation published between 2000 and 2008. The article criteria was 1) report case-control or cohort studies evaluating traditional NSAID or coxib use and upper GI bleeding/perforation in the general population, and 2) provide either an estimate or enough data to estimate a relative risk comparing NSAID users with nonusers. The pooled relative risk (RR) estimates of upper GI bleeding/perforation for individual NSAIDs was calculated, as well as whether the degree of inhibition of whole blood COX-1 and COX-2 in vitro by average circulating concentrations predicted the RR of upper GI bleeding/perforation.
The analysis suggests that NSAID-associated upper GI toxicity is the result of two pharmacologic features: drug exposure and sparing of COX-1 activity. These findings support the notion that there are multifactorial determinants in the risk of upper GI bleeding/perforation among NSAID users, including clinical background, use of concomitant medications, or a possible genetic susceptibility.
Study leader Luis A. García Rodríguez, M.D. states, "We showed that persistent exposure to the drug is an important independent determinant; in fact, drugs with a long half-life or slow-release formulation were associated overall with a greater risk than NSAIDs with a short half-life. We observed the lowest GI toxicity with coxibs, i.e., celecoxib and rofecoxib, which supports the notion that sparing of COX-1 in the GI tract and possibly in platelets translates clinically to a lower upper GI risk."
Story Source:
Adapted from materials provided by Wiley-Blackwell, via EurekAlert!, a service of AAAS.
Journal Reference:
- Elvira L. Massó-González, Paola Patrignani, Stefania Tacconelli, Luis A. García-Rodríguez. Variability of risk of upper gastrointestinal bleeding among nonsteroidal anti-inflammatory drugs. Arthritis & Rheumatism, 2010; DOI: 10.1002/art.27412
Note: If no author is given, the source is cited instead.
via sciencedaily.com
Effectiveness of a questionnaire based intervention programme on the prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers: A cluster randomised controlled trial in an occupational setting
Effectiveness of a questionnaire based intervention programme on the prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers: A cluster randomised controlled trial in an occupational setting Spekle, Erwin M Hoozemans, Marco JM Blatter, Birgitte M Heinrich, Judith van der Beek, Allard J Knol, Dirk L Bongers, Paulien M van Dieen, Jaap H info:doi/10.1186/1471-2474-11-99 BMC Musculoskeletal Disorders 2010, 11:99 2010-05-27 BMC Musculoskeletal Disorders 2010-05-27 11 1 Research article 99 -->Research article
Effectiveness of a questionnaire based intervention programme on the prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers: A cluster randomised controlled trial in an occupational setting
Erwin M Spekle
, Marco JM Hoozemans
, Birgitte M Blatter
, Judith Heinrich
, Allard J van der Beek
, Dirk L Knol
, Paulien M Bongers
and Jaap H van Dieen
BMC Musculoskeletal Disorders 2010, 11:99doi:10.1186/1471-2474-11-99
Published: 27 May 2010
Wednesday, 26 May 2010
Review of pain management practices for cirrhosis patients
ScienceDaily (May 26, 2010) — In the May issue of Mayo Clinic Proceedings, physician experts review current practices for pain management in cirrhotic patients. The physician experts reviewed all current literature available on PubMed and MEDLINE with no limits in the search to recommend a uniform and practical guide to approaching analgesia in the cirrhotic patients.
See Also:
- Liver Disease
- Today's Healthcare
- Chronic Illness
- Pain Control
- Diseases and Conditions
- Wounds and Healing
Cirrhosis is a substantial public health problem, accounting for approximately 770,000 deaths annually and, according to autopsy studies, affecting 4.5 percent to 9.5 percent of the global population. "Pain management in patients with cirrhosis is a difficult clinical challenge for health care professionals, and few prospective studies have offered an evidence-based approach," says Kymberly Watt, M.D., Department of Gastroenterology and Hepatology at Mayo Clinic.
No evidence-based guidelines exist on the use of analgesics in patients with liver disease and cirrhosis, says Dr. Watt. From her findings in the current literature, her recommendation for long-term acetaminophen use in cirrhotic patients (not actively drinking alcohol) is for reduced dosing at 2 to 3 grams per day. For short-term use or one-time dosing, patient should not exceed 4 grams total per day but the proposed new FDA guidelines (yet to be finalized) may recommend a maximum daily dosage of 2.6 grams per day for anyone.
In addition, the review article states that NSAIDs (nonsteroidal anti-inflammatory drugs) and opioids may be used in patients with chronic liver disease without cirrhosis. "NSAIDs should be avoided in those with both compensated and decompensated cirrhosis, primarily because of the risk of acute renal failure due to prostaglandin inhibition," says Dr. Watt.
"When appropriate, anticonvulsants and antidepressants are options worthy of exploration in chronic neuropathic pain management in patients with advanced liver disease. Diligent follow-up for toxicity, adverse effects and complications is necessary," adds Dr. Watt.
"In patients with end-stage liver disease, adverse events from analgesics are frequent, potentially fatal and often avoidable. This review underscores the scarcity of prospective studies that have assessed the safety of various analgesics in patients with advanced hepatic dysfunction," says Dr. Watt.
Story Source:
Adapted from materials provided by Mayo Clinic.
Journal Reference:
- N. Chandok, K. D. S. Watt. Pain Management in the Cirrhotic Patient: The Clinical Challenge. Mayo Clinic Proceedings, 2010; 85 (5): 451 DOI: 10.4065/mcp.2009.0534
Note: If no author is given, the source is cited instead.
via sciencedaily.com
Mirror box therapy & CBT for CRPS type 1, three case studies
In 2007 Tichelaar et al published a paper describing three case studies where mirror box therapy was combined with CBT. They measured pain (VAS), range of motion, muscle strength and regions that were allodynic (pain in response to a stimulus that is not normally painful) and hyperalgesic (increased response to painful stimuli) before, during and after the interventions. The authors found that indeed there were some positive changes, for example reduced pain at rest and increased range of motion.
Of course from three case studies we cannot draw strong conclusions but it seems sensible in certain cases to use the combined approach. Indeed the Stanton-Hicks model recommends physical therapy, psychology and medicine as an integrated model of care for CRPS. Pain is understood in a modern sense to be a multisystem output from the body requiring a biopsychosocial approach that considers the biology of the condition, the psychological influences and the social consequences. Thinking of pain in this way is beneficial in terms of being able to understand the presentation, explai the symptom profile, select appropriate treatment techniques and draw upon the skill mix of physiotherapy, psychology and medicine as required.
Mirror box therapy added to cognitive behavioural therapy in three chronic complex regional pain syndrome type 1 patients: a pilot study. Tichelaar et al. (2007) Int J Rehabil Res 30:181-188
Of course from three case studies we cannot draw strong conclusions but it seems sensible in certain cases to use the combined approach. Indeed the Stanton-Hicks model recommends physical therapy, psychology and medicine as an integrated model of care for CRPS. Pain is understood in a modern sense to be a multisystem output from the body requiring a biopsychosocial approach that considers the biology of the condition, the psychological influences and the social consequences. Thinking of pain in this way is beneficial in terms of being able to understand the presentation, explai the symptom profile, select appropriate treatment techniques and draw upon the skill mix of physiotherapy, psychology and medicine as required.
Mirror box therapy added to cognitive behavioural therapy in three chronic complex regional pain syndrome type 1 patients: a pilot study. Tichelaar et al. (2007) Int J Rehabil Res 30:181-188
TENS & Sports Injuries
TENS is a safe and non-invasive treatment modality that involves the application of a low-voltage electrical current to the skin to afford pain relief. Originally TENS was based on Melzack & Wall's 'Gate Theory of Pain' whereby stimulation of large peripheral nerves would block the danger signals from the smaller nerves that send danger signals to the spinal cord. We now understand far more about how TENS works including effects upon the central nervous system and the different chemicals that are released throughout the nervous system that underpin pain relief.
For both acute and chronic sports injuries TENS can play a role in relieving the painful symptoms. Of course when we injure ourselves it is completely normal for it to hurt on the basis that pain is a protective measure and a warning sign. However, to control the symptoms with TENS makes for greater comfort, facilitating normal movement and recovery. TENS has also been linked with promoting tissue healing which would be advantageous following a sports injury.
The settings on the TENS machine are important and therefore one should seek guidance on the most appropriate parameters and location for the pads following a sports injury.'
For product information go to: https://www.tenscare.co.uk/
For both acute and chronic sports injuries TENS can play a role in relieving the painful symptoms. Of course when we injure ourselves it is completely normal for it to hurt on the basis that pain is a protective measure and a warning sign. However, to control the symptoms with TENS makes for greater comfort, facilitating normal movement and recovery. TENS has also been linked with promoting tissue healing which would be advantageous following a sports injury.
The settings on the TENS machine are important and therefore one should seek guidance on the most appropriate parameters and location for the pads following a sports injury.'
For product information go to: https://www.tenscare.co.uk/
Intelligent therapies with virtual reality for the psychological treatment of patients suffering from fibromyalgia
ScienceDaily (May 24, 2010) — Researchers of the Labpsictec at the Universitat Jaume I of Castellon (UJI) and the LahHuman Group at the Universidad Politecnica of Valencia (UPV) and the University of Valencia (UVEG) have developed a new therapy based on the use of mobile devices and virtual reality for the psychological treatment of patients suffering from fibromyalgia.
See Also:
This therapy is currently being validated by researchers of the UJI and the University of the Balearic Islands (UIB) with a group of 24 patients and it counts on the essential collaboration of the Rheumatology Department of the Hospital General of Castellón, supervised by the medical doctor Belmonte.
Fibromyalgia is a complex and chronic pain syndrome which causes generalized pain and deep exhaustion, among other symptoms. It is a serious public health problem, more usual among adult women, and which causes significant negative psychological effects. In fact, 35% of affected patients suffer from depressive and anxious syndrome.
"Our aim is to achieve that woman patients learn strategies to face the pain which are an alternative to those they use and which are adaptive in order to improve their physical and mental state and their quality of life," points out Beatriz Rey, researcher of the LabHuman of the UPV.
The method developed by the researchers is made of three applications. The first one is an evaluation system of the chronic pain key factors through mobile devices. It is based on a commercial PDA and a made-to-measure device. The device monitors the degree of physical activity (accelerometer) and communicates with the PDA via Bluethooth.
The PDA runs an application that offers some questions the patient has to answer three times a week: intensity of pain (on a scale from 0 to 10), intensity of fatigue (on a scale from 0 to 10) and mood (on a scale from 1 to 7; in this case, the application shows a series of emoticons). The answers to each three questions are stored in the PDA. When the user goes to the medical office, the PDA can be synchonized with the computer of the medical and the data can be stored in a server.
It has been designed a new version of the Virtual Reality system EMMA to induce positive emotions on woman patients that works together with this system. "The psychologist supervises the group sessions using a system of unique screen projection," points out Azucena García-Palacios researcher of the Labpsitec of the UJI.
Those sessions are carefully guided and use contents (texts, sounds, videos, music and images, etc) selected to induce positive emotions. The therapist is present during the session and guides its development. During each session, the system helps the woman patients to consider a feasible objective they must fulfil before taking part on the next one. Woman patients will follow a treatment of three weeks with two sessions a week for making an evaluation of the system.
The therapy also has an application of telepsychology (intelligent therapy) through mobile devices in order patients to continue the treatment out of the doctor's office, such as from home. "The application is run in the PDA and also allows watching videos on the screen. The videos are fragments of the treatment sessions with EMMA, which are used to induce positive emotions along sessions," points Rosa Baños of the UVEG.
Story Source:
Adapted from materials provided by Universitat Jaume I, via AlphaGalileo.
Note: If no author is given, the source is cited instead.
via sciencedaily.com
NHS 'reorganisation' is outlined
By Branwen Jeffries Health Correspondent, BBC NewsAn independent board will set NHS priorities
The NHS in England is to be reorganised with Strategic Health Authorities downgraded, the government has confirmed.
The 10 existing authorities plan health services and training for healthcare professionals.
The Lib Dem manifesto described them as the least effective part of the health service, and promised to abolish them.
The coalition government has now confirmed an independent board for the NHS which will set priorities.
A spokesman for the Department of Health said: "The board will combine functions currently provided by the Department of Health and Strategic Health Authorities, and deliver these in a much more streamlined way.
"So the remit of SHAs will change - the board will exercise its functions through the regional offices that will report directly to the chief executive."
Vital roleIn the meantime, Strategic Health Authorities would continue to have a vital role in delivering financial control and performance, and driving improvements in quality and productivity, he said.
"They will play a key role in creating an NHS that is able to focus on outcomes and deliver through strong commissioning.
Continue reading the main storyKaren Jennings Head of health at UnisonSHAs play a vital role in making sure that there are no shortfalls or gaps in healthcare provision across a region and nationally and in overseeing standards
"The process of change will begin with SHAs themselves, where there will be a clearer split between their commissioner and provider responsibilities."
At a local level, groups of GPs will be asked to take on greater responsibility for organising care. The government is expected begin negotiations with the British Medical Association to allow that to happen.
The health service in England has been promised real-term increases in its budget every year of this parliament by the coalition.
It is thought the political price to be paid for that will be very significant cuts at the Department of Health in Whitehall.
Managers at the most senior level in the NHS have been told changes could happen within the next two years. Strategic Health Authorities, which plan staff numbers and services at a regional level, would become outposts of the new board.
Karen Jennings, head of health at Unison, said: "SHAs play a vital role in making sure that there are no shortfalls or gaps in healthcare provision across a region and nationally and in overseeing standards."
Local planning in the NHS, currently done by Primary Care Trusts would also change, if family doctors took over part of that work.
Primary Care Trusts were created by the Labour government, and in their relatively short history have already been reorganised. In 2006 the numbers of PCTs was halved to 152, a process which doctors criticised at the time for leading to a period of upheaval and indecisiveness.
Any major changes in the NHS in England will come at a time when it is grappling with trying to find £15bn to £20bn of savings by 2014.
The Conservatives and Liberal Democrats had previously said they would try to avoid major restructuring.
via news.bbc.co.uk
Alzheimer's: Forestalling the Darkness with New Approaches
EARLY INTERVENTION: The incidence of Alzheimer's disease continues to rise as the population ages. New techniques to track the disease before symptoms arise may allow for testing of drugs before it's too late.
iStockphoto
Key Concepts
- The incidence of Alzheimer’s disease continues to rise as the population ages, but effective treatments are lacking.
- Some new drugs may have failed because they were tried too late.
- New techniques to track the disease before symptoms arise may allow testing of drugs at a stage when they may be more effective.
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In his magical-realist masterpiece One Hundred Years of Solitude, Colombian author Gabriel García Márquez takes the reader to the mythical jungle village of Macondo, where, in one oft-recounted scene, residents suffer from a disease that causes them to lose all memory. The malady erases “the name and notion of things and finally the identity of people.” The symptoms persist until a traveling gypsy turns up with a drink “of a gentle color” that returns them to health.
In a 21st-century parallel to the townspeople of Macondo, a few hundred residents from Medellín, Colombia, and nearby coffee-growing areas may get a chance to assist in the search for something akin to a real-life version of the gypsy’s concoction. Medellín and its environs are home to the world’s largest contingent of individuals with a hereditary form of Alzheimer’s disease. Members of 25 extended families, with 5,000 members, develop early-onset Alzheimer’s, usually before the age of 50, if they harbor an aberrant version of a particular gene.
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A Head Full of Mirrors
Yet another addition to the bucketload of literature on mirror neurons – this one by folks at UCLA. These guys inserted electrodes into the accessible brain areas of 21 patients who were having brain surgery for their epilepsy. Once the electrodes were in place and the patient was (presumably) sitting up in bed a relatively happy camper, they recorded activity from specific sets of brain cells, during three different conditions: performing a hand or facial movement, observing a 3 second video of a hand or facial movement, or reading a cue to move their hand or face but refraining from doing so. They recorded activity in groups of brain cells in several brain areas – amygdala, hippocampus; entorhinal cortex; parahippocampal gyrus; supplementary motor area; dorsal aspect of anterior cingulate; and rostral aspect of anterior cingulate. They categorised brain cells according to whether they only fired when the patient performed the movement; only when the patient observed the movement; during both observation and execution (the classic ‘mirror neuron’ idea); fired during observation of a frown and execution of a smile, or the other way around – these were called ‘non-matching neurons’. In short, between 6% and 14% of the brain cells were categorised as ‘mirror neurons’ (active during both performance and observation of a particular hand of facial movement). Similar proportions of non-matching brain cells were observed.
The authors conclude:
These findings suggest the existence of multiple systems in the human brain endowed with neural mirroring mechanisms for flexible integration and differentiation of the perceptual and motor aspects of actions performed by self and others
I think this means that they think there may be at least two mirror systems – one that gets excited when we observe a movement in a manner consistent with doing that movement and one that gets excited when we observe a movement in a manner that inhibits that movement.
It is certainly pretty sophisticated and elegant research – recording electrical activity within the brain. I am intrigued by a couple of things. I would have expected the fact that all of these data are from a group of people who had clear neurological dysfunction, sufficiently severe to warrant brain surgery, would be relevant to our interpretation of this. I am also intrigued that although which brain cells were included was determined by clinical parameters to do with the patients’ epilepsy, there were mirror neurons (and the rest) in all of them. It seems we might have these mirror systems all over the brain – do we indeed have a head full of mirrors? Pat Wall probably wouldn’t be surprised by that idea – he firmly believed that we only perceive things according to what we might do about them (not HIS idea but the idea to which he subscribed). I like the way these recent data fit into the metaphor of the brain as an orchestra – clearly these ‘mirror’ brain cells contribute to the perception or observation or interpretation of an observed movement AND to the execution of the movement and probably to a bunch of other things too – just like musicians contribute to many songs. I like the metaphor because it provides an angle to convince patients that their brain cells, like their muscles, can be trained. Clearly we don’t know which ones and we can’t prove the theory in each patient but it is, I think, an elegant scaffold on which to hang some of what we do in rehabilitation. Anyway, off topic. If you can take on the tricky analysis and fancy pants language, the paper is well worth a read.
Mukamel R, Ekstrom AD, Kaplan J, Iacoboni M, & Fried I (2010). Single-Neuron Responses in Humans during Execution and Observation of Actions. Current biology : CB PMID: 20381353Share and Enjoy:
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