Teenager With Disabling Leg Pain

2021 ◽  
pp. 179-186
Author(s):  
Daniel M. Doleys ◽  
Nicholas D. Doleys
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Dietary Supplements ◽  
Dietary Habits ◽  
Food Selection ◽  
Treatment Options ◽  
Age Groups ◽  
Leg Pain ◽  
Younger Age

The incidence and prevalence of chronic pain among children and adolescents appears to be increasing. The treatment options are limited. Understandably, one would want to minimize, if not avoid, long-term use of opioids. There are a number of modality and nonopioid therapies available. One approach often overlooked and underutilized, with all age groups, in the use of nutritional and dietary supplements. Many painful conditions, especially neuropathic pain, can be initialed and maintained by neuroinflammatory substances. Certain nutritional and dietary supplements can alter the effect of these substances and the abnormal neuronal functioning associated with pain. Unfortunately, the increased incidence of obesity, even among the younger age groups, reflects a continued trend toward poor dietary habits and food selection. This, along with other lifestyle issues, results in a population that is more vulnerable to developing painful disorders. For this reason, nutritional pain management should be given serious consideration.

scholarly journals The Safety and Effect of Local Botulinumtoxin A Injections for Long-Term Management of Chronic Pain in Post-Herpetic Neuralgia: Literature Review and Cases Report Treated with Incobotulinumtoxin A

2021 ◽  
Vol 11 (8) ◽  
pp. 758
Author(s):  
Songjin Ri ◽  
Anatol Kivi ◽  
Jörg Wissel
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Adverse Events ◽  
Case Reports ◽  
Pain Reduction ◽  
Post Herpetic Neuralgia ◽  
Botulinumtoxin A ◽  
Incobotulinumtoxin A ◽  
Term Management

There are few reports on the safety and effectiveness of long-term botulinumtoxin A (BoNT A) therapy in severe chronic pain of post-herpetic neuralgia (PHN). The literature was searched with the term “neuropathic pain” and “botulinum” on PubMed (up to 29 February 2020). Pain was assessed with the Visual Analogue Scale (VAS) before and after BoNT A therapy. A total of 10 clinical trials and six case reports including 251 patients with PHN were presented. They showed that BoNT A therapy had significant pain reduction (up to 30–50%) and improvement in quality of life. The effect duration seems to be correlated with BoNT A doses injected per injection site. Intervals between BoNT A injections were 10–14 weeks. No adverse events were reported in cases and clinical studies, even in the two pregnant women, whose babies were healthy. The repeated (≥6 times) intra/subcutaneous injections of incobotulinumtoxin A (Xeomin®, Merz Pharmaceuticals, Germany) over the two years of our three cases showed marked pain reduction and no adverse events. Adjunctive local BoNT A injection is a promising option for severe PHN, as a safe and effective therapy in long-term management for chronic neuropathic pain. Its effect size and -duration seem to be depended on the dose of BoNT A injected per each point.

Educational Session: Managing Chronic Myeloid Leukemia as a Chronic Disease

Hematology ◽  
2011 ◽  
Vol 2011 (1) ◽  
pp. 128-135 ◽  
Author(s):  
Andreas Hochhaus
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Blast Crisis ◽  
Treatment Options ◽  
Age Groups ◽  
Continuous Treatment ◽  
Symptomatic Therapy ◽  
Therapeutic Success

Abstract Elucidation of the pathogenesis of chronic myeloid leukemia (CML) and the introduction of tyrosine kinase inhibitors (TKIs) has transformed this disease from being invariably fatal to being the type of leukemia with the best prognosis. Median survival associated with CML is estimated at > 20 years. Nevertheless, blast crisis occurs at an incidence of 1%-2% per year, and once this has occurred, treatment options are limited and survival is short. Due to the overall therapeutic success, the prevalence of CML is gradually increasing. The optimal management of this disease includes access to modern therapies and standardized surveillance methods for all patients, which will certainly create challenges. Furthermore, all available TKIs show mild but frequent side effects that may require symptomatic therapy. Adherence to therapy is the key prerequisite for efficacy of the drugs and for long-term success. Comprehensive information on the nature of the disease and the need for the continuous treatment using the appropriate dosages and timely information on efficacy data are key factors for optimal compliance. Standardized laboratory methods are required to provide optimal surveillance according to current recommendations. CML occurs in all age groups. Despite a median age of 55-60 years, particular challenges are the management of the disease in children, young women with the wish to get pregnant, and older patients. The main challenges in the long-term management of CML patients are discussed in this review.

Is Age the New Class? Economic Crisis and Demographics in European Politics

2016 ◽  
Vol 43 (1) ◽  
pp. 59-71 ◽  
Author(s):  
Jan Erk
Keyword(s):  
Age Groups ◽  
The Political ◽  
Economic Downturn ◽  
New Class ◽  
Political Landscape ◽  
Younger Age ◽  
Material Interests ◽  
Post War ◽  
The Welfare State

As the crisis turns into long-term economic downturn, younger age-groups in Europe seem to be hit with higher levels of unemployment while the welfare state is steadily shrinking. The young have suddenly become a social group united by collective material interests, but does this translate into a sense of a collective political interest? The paper examines to what extent the dominant class-based social science of the post-war years can help us understand the politics of age-groups. The analysis highlights four changes since post-war years: the workplace has changed, impacting socialization; modern media has changed, impacting mobilization; the political landscape is fairly institutionalized, tempering the possibilities for new political concerns to find voice; and those who would define and articulate the political priorities of the young are leaving the Old Continent.

scholarly journals Predictive Value of Technical Throwing Skills on Nomination Status in Youth and Long-Term Career Attainment in Handball

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Till Koopmann ◽  
Franziska Lath ◽  
Dirk Büsch ◽  
Jörg Schorer
Keyword(s):  
Logistic Regression ◽  
National Level ◽  
Age Groups ◽  
Age Group ◽  
Regression Analyses ◽  
Chi Square ◽  
Career Attainment ◽  
Future Performance ◽  
Younger Age

Abstract Background Research on talent in sports aims to identify predictors of future performance. This study retrospectively investigated 1) relationships between young handball field players’ technical throwing skills and (a) their potential nomination to youth national teams and (b) their long-term career attainment 10 years later, and 2) associations between nomination status and career attainment. Results Results from retrospectively predicting nomination status and career attainment using logistic regression analyses show that technical throwing skills were partly able to explain players’ nomination status (Nagelkerke R2: females 9.2%, males 13.1%) and career attainment (Nagelkerke R2: 9.8% for female players). Here, variables throwing velocity and time on exercise showed statistically significant effects. In addition, nomination status and career attainment were shown to be associated using chi-square tests (w of .37 and .23 for female and male players, respectively) and nomination status as a predictor increased the prediction of career attainment remarkably (Nagelkerke R2: females 20.3%, males 12.7%). Conclusions Given these results, basic technical throwing skills may serve rather as a prerequisite in this age group on national level, emphasizing its importance already on lower levels and in younger age groups. Furthermore, advantages from entering the national TID system early especially for females are discussed.

Chronic neuropathic pain after traumatic peripheral nerve injuries in the upper extremity: prevalence, demographic and surgical determinants, impact on health and on pain medication

2019 ◽  
Vol 20 (1) ◽  
pp. 95-108
Author(s):  
Adriana Miclescu ◽  
Antje Straatmann ◽  
Panagiota Gkatziani ◽  
Stephen Butler ◽  
Rolf Karlsten ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Upper Extremity ◽  
Nerve Injury ◽  
Persistent Pain ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Chronic Neuropathic Pain ◽  
Younger Age

AbstractBackground and aimsAside from the long term side effects of a nerve injury in the upper extremity with devastating consequences there is often the problem of chronic neuropathic pain. The studies concerning the prevalence of persistent pain of neuropathic origin after peripheral nerve injuries are sparse. The prevalence and risk factors associated with chronic neuropathic pain after nerve injuries in the upper extremity were assessed.MethodsA standardized data collection template was employed prospectively and retrospectively for all patients with traumatic nerve injuries accepted at the Hand Surgery Department, Uppsala, Sweden between 2010 and 2018. The template included demographic data, pain diagnosis, type of injured nerve, level of injury, date of the lesion and repair, type of procedure, reoperation, time since the procedure, S-LANSS questionnaire (Self report-Leeds Assessment of Neuropathic Symptoms and Signs), RAND-36 (Item short form health survey), QuickDASH (Disability of Shoulder, Arm and Hand) and additional questionnaires concerned medication, pain intensity were sent to 1,051 patients with nerve injuries. Partial proportional odds models were used to investigate the association between persistent pain and potential predictors.ResultsMore than half of the patients undergoing a surgical procedure developed persistent pain. Prevalence of neuropathic pain was 73% of the patients with pain (S-LANSS ≥ 12 or more). Multivariate analysis indicated that injury of a major nerve OR 1.6 (p = 0.013), years from surgery OR 0.91 (p = 0.01), younger age OR 0.7 (p < 0.001), were the main factors for predicting pain after surgery. The type of the nerve injured was the strongest predictor for chronic pain with major nerves associated with more pain (p = 0.019).ConclusionsA high prevalence of chronic pain and neuropathic pain with a negative impact on quality of life and disability were found in patients after traumatic nerve injury. Major nerve injury, younger age and less time from surgery were predictors for chronic pain.

Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009

Blood ◽  
2012 ◽  
Vol 119 (4) ◽  
pp. 990-996 ◽  
Author(s):  
Jan Sjöberg ◽  
Cat Halthur ◽  
Sigurdur Y. Kristinsson ◽  
Ola Landgren ◽  
Ulla Axdorph Nygell ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Treatment Options ◽  
Age Groups ◽  
Relative Survival ◽  
Population Based ◽  
Term Treatment ◽  
Cure Rate ◽  
Population Based Study ◽  
Long Term Treatment

Abstract In recent decades, attention has focused on reducing long-term, treatment-related morbidity and mortality in Hodgkin lymphoma (HL). In the present study, we looked for trends in relative survival for all patients diagnosed with HL in Sweden from 1973-2009 (N = 6949; 3985 men and 2964 women; median age, 45 years) and followed up for death until the end of 2010. Patients were categorized into 6 age groups and 5 calendar periods (1973-1979, 1980-1986, 1987-1994, 1994-2000, and 2001-2009). Relative survival improved in all age groups, with the greatest improvement in patients 51-65 years of age (P < .0005). A plateau in relative survival was observed in patients below 65 years of age during the last calendar period, suggesting a reduced long-term, treatment-related mortality. The 10-year relative survival for patients diagnosed in 2000-2009 was 0.95, 0.96, 0.93, 0.80, and 0.44 for the age groups 0-18, 19-35, 36-50, 51-65, and 66-80, respectively. Therefore, despite progress, age at diagnosis remains an important prognostic factor (P < .0005). Advances in therapy for patients with limited and advanced-stage HL have contributed to an increasing cure rate. In addition, our findings support that long-term mortality of HL therapy has decreased. Elderly HL patients still do poorly, and targeted treatment options associated with fewer side effects will advance the clinical HL field.

A multi-facet pain survey of psychosocial complaints among patients with long-standing non-malignant pain

2017 ◽  
Vol 17 (1) ◽  
pp. 68-76
Author(s):  
Leif Peterson ◽  
Jesper Lundgren ◽  
Sven G. Carlsson
Keyword(s):  
Chronic Pain ◽  
Factor Analysis ◽  
Perceived Control ◽  
Assessment Tool ◽  
Daily Life ◽  
Treatment Options ◽  
Psychosocial Distress ◽  
Present Condition ◽  
Future Prospects

AbstractBackground and aimsPsychometric inventories and scales intended to measure cognitive, emotional and behavioural concomitants of pain are typically constructed by deducting items from theoretically derived concepts related to pain states, e.g. social support, perceived control, depressiveness, and catas- trophizing. The aim of this study was to design a clinically useful, generic pain distress inventory - The Multi-Facet Pain Survey (MFPS) - inductively derived from psychological and social complaints reported by a study group of individuals with severe chronic nonmalignant pain.MethodsExtensive clinical interviews with hospitalized chronic pain patients were made by clinical psychologists. The purpose was to highlight the patients’ pain histories and their beliefs and feelings about the pain, and to determine factors possibly influencing their rehabilitation potential. The types of distress reported were sorted into categories with a procedure similar to content analysis. Distress reports were converted to statements, forming items in a questionnaire, the Multi-Facet Pain Survey.ResultsOur analyses supported a distress structure including 15 categories, or “facets”, comprising in all 190 types of psychosocial distress. Ten of the facets denote beliefs about the present condition and aspects of distress experienced in daily life (e.g. cognitive problems); three facets reflect the illness history, and two the patient’s views on future prospects. To improve the clinical utility, we shortened the scale into a 53 items inventory. A factor analysis of these 53 items revealed four clinically meaningful factors: (1) stress-related exhaustion; (2) impact of pain on daily life; (3) self-inefficacy in regard to future prospects; and (4) negative experiences of health care. While the second factor represents distress directly related to the pain, the first factor reflects long-term exhaustion effects of the pain condition similar to those seen in individuals exposed to long periods of stress. Items loading in the third factor reflect a pessimistic outlook on the future. The content validity of the scale was explored by predicting and testing correlations between the 15 MFPS facets, and the Symptom Checklist (SCL-90) and the West Haven Yale Multidimensional Pain Inventory (MPI). Some of the MFPS facets showed little or no agreement with any of the subscales of the comparison measures. The homogeneity was satisfactory both for facets and factors.ConclusionsThe Multi-Facet Pain Survey (MFPS) facets cover a broad array of experienced psychosocial distress in patients with severe, longstanding pain. Some facets of psychosocial impact of longstanding pain states shown in the qualitatively derived distress facets, or by the latent factors found in the factor analysis, may complement our understanding of the long-term impact of pain. Consequently, MFPS may improve the assessment of psychological and social complaints and complications in patients with chronic pain.ImplicationsThe MFPS will hopefully be an assessment tool supporting the psychological contribu-tion to a biopsychosocial evaluation of patients with severe, longstanding pain. By exposing a broadrange of suffering, MFPS may contribute to alternative treatment options and a better prognosis of future rehabilitation.

scholarly journals Should we vaccinate the better seroconverters or the most vulnerable? Game changing insights for COVID-19 vaccine prioritization policies

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Antoine AbdelMassih ◽  
Meryam El Shershaby ◽  
Hanya Gaber ◽  
Menna Habib ◽  
Nada Gamal ◽  
...  
Keyword(s):  
Ethical Dilemma ◽  
Seroconversion Rate ◽  
Age Groups ◽  
Main Body ◽  
Rapid Rise ◽  
Long Term Effects ◽  
Fast Tracking ◽  
Younger Age ◽  
Cellular Mediated Immunity

Abstract Background With the rapid rise in COVID 19 cases incomparable to the number of vaccinations available, there has been a demand to prioritize the older age groups receiving the vaccine as they have more risk of morbidity and mortality and thus better outcome from vaccination. Main body Some studies showed a lower seroconversion rate in older group patients; thus, we discuss the necessity to reprioritize vaccinations to younger age groups who have better seroconversion rates, but we may face some ethical dilemma that could hinder our hypothesis. Decreased seroconversion rates in adults are attributable to immuno-senescence which involves a decrease in humoral and cellular-mediated immunity with age. Despite this fact, there remains some ethical dilemma that can hinder widespread vaccination of younger generations, the most important of which is the unknown long-term effects of COVID-19 vaccines due their fast-tracking under the pressure of the pandemic. Short conclusion Prioritizing children vaccination against COVID-19 seems an interesting strategy that can help in containing the pandemic. Resolving some ethical dilemma needs to be done before implementing such strategy.

scholarly journals The Role of Destination Experience in the Sustainability of the Image of the Tourist Destination

2021 ◽  
Author(s):  
Olimpia Ban ◽  
Adrian Hatos ◽  
Laurențiu Droj ◽  
Carmen Toderascu
Keyword(s):  
Brand Image ◽  
Age Groups ◽  
Destination Image ◽  
Tourist Destination ◽  
Good Image ◽  
Remarkable Increase ◽  
Dangerous Situation ◽  
Younger Age

The concept of destination image is closely related to the brand image of the destination. A good image is a step in branding the destination. The image of the destination can be a primary, sec-ondary or global one, the latter incorporating the first two. The sustainability of a positive image of the destination is based on both a positive secondary image and a positive global image. The purpose of this research is to analyze separately the two types of images for a given tourist des-tination that has registered in recent years a remarkable increase in the number of visitors. The research is based on a questionnaire-based survey of a sample of 607 people. The collected data were processed with SPSS and the results show significant differences between the two types of images (secondary image and global image), a dangerous situation in the medium and long term for destination management. The nuances in the perception of the image of the destination on the two types of respondents (who experienced respectively who did not experience the destination) can be explained by the aggressive strategy of promoting the tourist destination, but inefficient strategy for younger age groups. The study allows the formulation of conclusions and measures to correct the situation.

scholarly journals Dorsal Root Ganglion Stimulation for the Management of Chronic Neuropathic Pain: A Retrospective Case Series during Four Years follow-up in a Single Center

2020 ◽  
Vol 13 (1) ◽  
pp. 35-41
Author(s):  
Alfonso Papa ◽  
Elisabetta Saracco ◽  
Maria Teresa Di Dato ◽  
Pietro Buonavolontà ◽  
Anna Maria Salzano ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Data Collection ◽  
Dorsal Root ◽  
Case Series ◽  
Chronic Neuropathic Pain ◽  
Neuropathic Pain Syndrome

Objectives: The dorsal root ganglion (DRG) is involved in the transduction of pain signals to the central nervous system (CNS) and undergoes a number of physiopathological changes during chronic pain. The purpose of this data collection was to evaluate the long-term safety and efficacy of DRG stimulation for the treatment of chronic pain and its impact on functional aspects. Materials and Methods: Forty-four subjects with non-reactive chronic neuropathic pain syndrome were implanted with DRG stimulation. Patients were evaluated at baseline as well as at 15, and 30 days, and at 3, 6, 12, 24, 36 and 48 months after medical intervention/surgery using the Visual Analogic Scale (VAS), which measures pain intensity, and the Oswestry Scale, for the estimation of disability (ODI). Results: After four years of simulation, VAS and ODI showed a statistically significant reduction throughout the follow-up period. The average pain relief obtained after 48 months of treatment was 74.1% ± 3.4. Conclusion: The results of this data collection demonstrate the feasibility of DRG stimulation, the correspondence between the clinical indications at the DRG implant and what is commonly found in the literature on this technique.(18,20) Patients defined as clinical responders to DRG stimulation and so implanted with definitive IPG showed a sustained and long term efficacy. Eight patients had previously been implanted with a traditional SCS without any clinically relevant efficacy; they were then explained for unsatisfactory results. Six of them (75%) were later implanted with DRG, with long-term effectiveness. Another advantage of this therapy is the absence of positional effects and lead migration. The adverse events proved to be independent of the anatomical level of insertion; moreover, this series of cases show a lower incidence of lead migration than reported in the literature. In summary, DRGs have been ignored for too long, probably due to the technical difficulty of reaching their deep, almost extra-spinal anatomical position.

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