A novel clinical applicable bed-side tool for assessing conditioning pain modulation: proof-of-concept

2020 ◽  
Vol 20 (4) ◽  
pp. 801-807
Author(s):  
Lars Arendt-Nielsen ◽  
Jesper Bie Larsen ◽  
Stine Rasmussen ◽  
Malene Krogh ◽  
Laura Borg ◽  
...  
Keyword(s):  
Pain Modulation ◽  
Clinical Settings ◽  
Proof Of Concept ◽  
Finger Nail ◽  
Tonic Stimulus ◽  
Pressure Pain Thresholds ◽  
Custom Made ◽  
The Individual ◽  
Descending Pain Modulation ◽  
Finger Pressure

AbstractBackground and aimsIn recent years, focus on assessing descending pain modulation or conditioning pain modulation (CPM) has emerged in patients with chronic pain. This requires reliable and simple to use bed-side tools to be applied in the clinic. The aim of the present pilot study was to develop and provide proof-of-concept of a simple clinically applicable bed-side tool for assessing CPM.MethodsA group of 26 healthy volunteers participated in the experiment. Pressure pain thresholds (PPT) were assessed as test stimuli from the lower leg before, during and 5 min after delivering the conditioning tonic painful pressure stimulation. The tonic stimulus was delivered for 2 min by a custom-made spring-loaded finger pressure device applying a fixed pressure (2.2 kg) to the index finger nail. The pain intensity provoked by the tonic stimulus was continuously recorded on a 0–10 cm Visual Analog Scale (VAS).ResultsThe median tonic pain stimulus intensity was 6.7 cm (interquartile range: 4.6–8.4 cm) on the 10 cm VAS. The mean PPT increased significantly (P = 0.034) by 55 ± 126 kPa from 518 ± 173 kPa before to 573 ± 228 kPa during conditioning stimulation. When analyzing the individual CPM responses (increases in PPT), a distribution of positive and negative CPM responders was observed with 69% of the individuals classified as positive CPM responders (increased PPTs = anti-nociceptive) and the rest as negative CPM responders (no or decreased PPTs = Pro-nociceptive). This particular responder distribution explains the large variation in the averaged CPM responses observed in many CPM studies. The strongest positive CPM response was an increase of 418 kPa and the strongest negative CPM response was a decrease of 140 kPa.ConclusionsThe present newly developed conditioning pain stimulator provides a simple, applicable tool for routine CPM assessment in clinical practice. Further, reporting averaged CPM effects should be replaced by categorizing volunteers/patients into anti-nociceptive and pro-nociceptive CPM groups.ImplicationsThe finger pressure device provided moderate-to-high pain intensities and was useful for inducing conditioning stimuli. Therefore, the finger pressure device could be a useful bed-side method for measuring CPM in clinical settings with limited time available. Future bed-side studies involving patient populations are warranted to determine the usefulness of the method.

scholarly journals The Individual Recovery Outcomes Counter: preliminary validation of a personal recovery measure

2013 ◽  
Vol 37 (7) ◽  
pp. 221-227 ◽  
Author(s):  
Bridey Monger ◽  
Scott M. Hardie ◽  
Robin Ion ◽  
Jane Cumming ◽  
Nigel Henderson
Keyword(s):  
Internal Consistency ◽  
Recovery Factor ◽  
Clinical Settings ◽  
Service Users ◽  
Validity And Reliability ◽  
Personal Recovery ◽  
Preliminary Validation ◽  
Service Outcomes ◽  
High Internal Consistency ◽  
The Individual

Aims and methodThe Individual Recovery Outcomes Counter (I.ROC) is to date the only recovery outcomes instrument developed in Scotland. This paper describes the steps taken to initially assess its validity and reliability, including factorial analysis, internal consistency and a correlation benchmarking analysis.ResultsThe I.ROC tool showed high internal consistency. Exploratory factor analysis indicated a two-factor structure comprising intrapersonal recovery (factor 1) and interpersonal recovery (factor 2), explaining between them over 50% of the variance in I.ROC scores. There were no redundant items and all loaded on at least one of the factors. The I.ROC significantly correlated with widely used existing instruments assessing both personal recovery and clinical outcomes.Clinical implicationsI.ROC is a valid and reliable measure of recovery in mental health, preferred by service users when compared with well-established instruments. It could be used in clinical settings to map individual recovery, providing feedback for service users and helping to assess service outcomes.

scholarly journals EGCG Prevents the Loss of Pontine Noradrenergic Neurons Induced by Diabetes: A Role in Diabetic Neuropathic Pain

2012 ◽  
Vol 18 (S5) ◽  
pp. 5-6 ◽  
Author(s):  
Carla Morgado ◽  
João Silva ◽  
André Miranda ◽  
Patrícia Pereira-Terra ◽  
Diogo Raposo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Diabetic Rats ◽  
Pain Modulation ◽  
Diabetic Patients ◽  
Spontaneous Pain ◽  
Noradrenergic Neurons ◽  
Diabetic Neuropathic Pain ◽  
Descending Pain Modulation ◽  
Pain Responses

Diabetes is a major health problem with an alarming increasing prevalence, and is the most frequent cause of neuropathy worldwide. Neuropathy affects 50–60% of diabetic patients, being a major life-quality impairment for a quarter of these patients. Diabetic neuropathic pain (DNP) is characterized by spontaneous pain, mechanical hyperalgesia and tactile allodynia and is accompanied by functional and neurochemical changes at the peripheral nerves, spinal cord and supraspinal pain control areas. Regarding the effects of diabetic neuropathy in the central somatossensory system, it was shown that streptozotocin (STZ)-diabetic rats present spontaneous hyperactivity and hyperexcitability of spinal nociceptive neurons, which may be subserving the exacerbated pain responses. The spinal functional changes and pain may be due to increased peripheral input(2), changes in spinal nociceptive modulatory mechanisms and altered supraspinal descending pain modulation. Noradrenergic descending pain modulation seems to be impaired since STZ-diabetic rats present decreased numbers of noradrenergic neurons at the A5 and A7 pontine cell groups, along with lower levels of noradrenaline at the spinal cord and higher behavioral responses to pain. This is consistent with the strong noradrenergic projection from A5 and A7 neurons to the spinal dorsal horn and the modulation of nociceptive transmission by local release of noradrenaline. The mechanisms underlying the decrease in noradrenergic neurons in the brainstem during diabetes remain unclear. Our recent findings that diabetes induces oxidative stress damage in neurons from those areas, lead us to hypothesize that it may contribute to their loss. Thereafter, with the present study we aimed to evaluate the effects of Epigallocathechin Gallate (EGCG), a potent antioxidant present in green tea, on spinal noradrenaline levels, on A5 and A7 noradrenergic neurons and on behavioral pain responses of STZ-diabetic rats.

scholarly journals Concept analysis of adherence

2019 ◽  
Vol 6 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Chun-Mei Lyu ◽  
Li Zhang
Keyword(s):  
Concept Analysis ◽  
Lifestyle Changes ◽  
Chronic Illnesses ◽  
Self Report ◽  
Clinical Settings ◽  
Measurement Tools ◽  
Health Related ◽  
Valid Instrument ◽  
The Individual ◽  
Improve Health

Abstract Objective To explore the concept of adherence in the context of rehabilitation of patients with chronic illnesses. This concept analysis is helpful in predicting health behaviors and intentions including physical activity and dietary behaviors in patients with chronic illnesses. Methods The framework of Walker and Avant was used to analyze the concept of adherence. Results Adherence is defined as the extent to which a person’s behavior, such as taking medication, following a diet, and/or executing lifestyle changes, corresponds to agreed recommendations from a health-care provider. The antecedents of adherence are the biomedical status of the individual, social support, self-efficacy, and education. Self-report questionnaires and patient self-reporting are the most common measurement tools of adherence. Thus, the reliable and valid instrument of monitoring adherence in the clinical settings is challenging. Conclusions Analyzing the concept of adherence is necessary to help understand how best to promote adherence to improve health-related outcomes.

scholarly journals Extracting Interface Correlations from the Pair Distribution Function of Composite Materials

2021 ◽  
Author(s):  
Harry Geddes ◽  
Henry D. Hutchinson ◽  
Alex R Ha ◽  
Nicholas P. Funnell ◽  
Andrew Goodwin
Keyword(s):  
Distribution Function ◽  
Pair Distribution Function ◽  
Functional Materials ◽  
Model System ◽  
Complex Mixtures ◽  
Proof Of Concept ◽  
X Ray ◽  
The Individual ◽  
Theory And Experiment ◽  
Matrix Factorisation

<div> <div> <div> <p>Using a non-negative matrix factorisation (NMF) approach, we show how the pair distribution function (PDF) of complex mixtures can be deconvolved into the contributions from the individual phase components and also the interface between phases. Our focus is on the model system Fe||Fe3O4. We establish proof-of-concept using idealised PDF data generated from established theory-driven models of the Fe||Fe3O4 interface. Using X-ray PDF measurements for corroded Fe samples, and employing our newly-developed NMF analysis, we extract the experimental interface PDF (‘iPDF’) for this same system. We find excellent agreement between theory and experiment. The implications of our results in the broader context of interface characterisation for complex functional materials are discussed. </p> </div> </div> </div>

The periaqueductal gray and descending pain modulation: why should we study them and what role do they play in chronic pain?

2015 ◽  
Vol 114 (4) ◽  
pp. 2080-2083 ◽  
Author(s):  
Kasey S. Hemington ◽  
Marie-Andrée Coulombe
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Functional Connectivity ◽  
Recent Literature ◽  
Chronic Back Pain ◽  
Periaqueductal Gray ◽  
Pain Modulation ◽  
Pain Research ◽  
Descending Pain Modulation ◽  
Pain Patients

In this Neuro Forum we discuss the significance of a recent study by Yu et al. ( Neuroimage Clin 6: 100–108, 2014). The authors examined functional connectivity of a key node of the descending pain modulation pathway, the periaqueductal gray (PAG), in chronic back pain patients. Altered PAG connectivity to pain-related regions was found; we place results within the context of recent literature and emphasize the importance of understanding the descending component of pain in pain research.

Point-of-care ultrasound in a multiplace hyperbaric chamber

2021 ◽  
pp. 221-226
Author(s):  
Kirsten Hornbeak ◽  
◽  
Jay Duchnick ◽  
Anthony Medak ◽  
Peter Lindholm ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Electronic Devices ◽  
Point Of Care Ultrasound ◽  
Clinical Settings ◽  
Proof Of Concept ◽  
Safety Standards ◽  
Patient Assessments ◽  
Hyperbaric Environment ◽  
Hbo2 Therapy

Historically, electronic devices have been generally prohibited during hyperbaric oxygen (HBO2) therapy due to risk of fire in a pressurized, oxygen-rich environment. Point-of-care ultrasound (POCUS), however, has emerged as a useful imaging modality in diverse clinical settings. Hyperbaric chambers treating critically ill patients would benefit from the application of POCUS at pressure to make real-time patient assessments. Thus far, POCUS during HBO2 therapy has been limited due to required equipment modifications to meet safety standards. Here we demonstrate proof of concept, safety, and successful performance of an off-the-shelf handheld POCUS system (SonoSite iViz) in a clinical hyperbaric environment without need for modification.

scholarly journals Bracing in clubfoot: do we know enough?

2019 ◽  
Vol 13 (3) ◽  
pp. 258-264 ◽  
Author(s):  
C. Alves
Keyword(s):  
Randomized Clinical Trials ◽  
Current Knowledge ◽  
Healthcare Providers ◽  
Ponseti Method ◽  
Level Of Evidence ◽  
Achilles Tenotomy ◽  
Advantages And Disadvantages ◽  
Serial Casting ◽  
Custom Made ◽  
The Individual

Purpose The Ponseti method is widely used in clubfoot treatment. Long-term follow-up shows high patient satisfaction and excellent functional outcomes. Clubfoot tendency to relapse is a problem yet to solve. Given the importance of bracing in relapse prevention, we ought to discuss current knowledge and controversies about bracing. Methods We describe types of braces used, with its advantages and disadvantages, suggesting bracing schedules and duration. We identify bracing problems and pinpoint strategies to promote adherence to bracing. Results When treating a clubfoot by the Ponseti method, the corrected foot should be held in an abducted and dorsiflexed position, in a foot abduction brace (FAB), with two shoes connected by a bar. The brace is applied after the clubfoot has been completely corrected by manipulation, serial casting and possibly Achilles tenotomy. Bracing is recommended until four to five years of age and needs to be fitted to the individual patient, based on age, associated relapse rate and timing when correction was finished. Parental non-adherence to FAB use can affect 34% to 61% of children and results in five- to 17-fold higher odds of relapse. In patients who have recurrent adherence problems, a unilateral lower leg custom-made orthosis can be considered as a salvage option. Healthcare providers must communicate with patients regarding brace wearing, set proper expectations and ensure accurate use. Conclusion Bracing is essential for preventing clubfoot relapse. Daily duration and length of bracing required to prevent recurrence is still unknown. Prospective randomized clinical trials may bring important data that will influence clinicians’ and families’ choices regarding bracing. Level of Evidence V

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