Effect of Foot Orthoses in Children With Symptomatic Flexible Flatfoot Based on Ultrasonography of the Ankle Invertor and Evertor Muscles

Objective To examine the changes in the cross-sectional area (CSA) ratio of the ankle invertors and evertors following rigid foot orthosis (RFO) application in children with symptomatic flexible flatfoot and to determine the correlation between the degree of change in CSA ratio and pain-severity after RFO application.Methods We included 24 children with symptomatic flexible flatfoot without comorbidities and measured the CSAs of tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) using ultrasonography, resting calcaneal stance position (RCSP) angle, calcaneal pitch (CP), Meary’s angle, talonavicular coverage angle, and talocalcaneal angle using radiography, and foot function index (FFI) at baseline and 12 months after RFO application. We analyzed 48 data by measuring both feet of 24 children. The CSA ratios, the ratio of CSA of each muscle to the sum of CSA of TA, TP, and PL, were also compared. Correlations between the degree of change in FFI, each muscle’s CSA ratio, RCSP angle, and radiographic measurements were investigated.Results Following RFO application, significant increase in the PL ratio and CP and significant decrease in the RCSP angle, FFI total, pain, and disability scores were observed. The degree of change in the total score, pain, and disability score of FFI were significantly correlated with the degree of change in the PL ratio and RCSP angle.Conclusion RFOs applied to children with symptomatic flexible flatfoot might reduce the compensatory activities of the ankle invertors, thereby increasing the PL ratio, and pain decreases as the PL ratio increases.

A group-based chronic pain intervention using the Unlearn Your Pain method: A retrospective one-arm cohort study

LAY SUMMARY Chronic pain is a frequent occurrence in military and Veteran populations. This study examined whether a group-based chronic pain treatment using the Unlearn Your Pain method was effective in reducing chronic pain in 21 military and Veteran participants. Participants completed measures of pain before and after engaging in the treatment, and results showed participants experienced large reductions in total pain and pain-related catastrophizing and moderate reductions in pain-related disability and pain-related fear of movement after completing the treatment. A smaller group of the participants completed the measures again eight weeks after completing treatment, and the size of their improvements was even greater. This study offers preliminary support for the Unlearn Your Pain method offered in a group format to military and Veteran populations. Further study is warranted.

Palliative Care in Inflammatory Bowel Disease: A New Partnership

Background Palliative care is being increasingly recognized for benefitting patients with a wide spectrum of chronic serious medical conditions. Methods Care models and principles of palliative care for patient with inflammatory bowel disease were explored. Results The use of a structured and systematic approach for emotionally laden conversations and the “Total Pain” paradigm are examples of palliative care expertise that can be applied through either primary or consultative palliative care models. Conclusions Palliative care should be considered in clinical practice and as a topic for further scholarly investigation to further define its role and benefits.

An Examination of the Prevalence of Injury and the Pain and Disability in Specialized Positions of the Elite Players of Iran's Youth Premier League Volleyball

Introduction: Volleyball is considered one of the most exciting and popular sports throughout the world and as this has rapid and explosive movements in various directions, the size of the forces involved in such movements can result in injuries. Regarding this, the study tried to examine the injuries and the degree of disability pain, particularly in specialized volleyball positions in the eighth most harmful sport in the world of sports. Materials and Methods: The study was retrospective descriptive examining the acute injury, chronic injury, and the pain and disability among the players. The population was all the elite players of the Premier League of Iranian boys' youth volleyball. The number of players willing to cooperate in this study was 81. Data was collected by the interviewer using Cornell and Nordic questionnaires and then the collected data was analyzed using descriptive statistical tests in SPSS 24 and Excel software. Results: The highest rates of acute and chronic injuries regarding the specialized position of the players were in the position (opposite) in the shoulders at 23.61 and 33.33% of the total, respectively, in the position of libero in the back area, respectively, as 15.87 and 8.33% of the total. Moreover, the rates of these injuries - acute and chronic - in outside hitter position were in the arm and elbow at 71.11 and 80% of the total, respectively, in the setter position in the back area at 16.67 and 25% of the total, and finally in the middle blocker position, the highest rate of acute injury was in the neck area with 47.78% and chronic injury in the ankle and thigh as 66.67% of the total. However, overall, the most injury belongs to the positions of outside hitter and middle blocker. However, the highest percentage of pain and disability were related to musculoskeletal problems in the lower limbs was 40.45% of the total pain and disability and in the lower limbs the highest pain and disability was observed in the knees with 20.58%. The second rate of pain and disability was in the upper limbs of athletes as 35.08%. The highest pain and disability was observed with a large difference of 18.43% in the shoulders, then 18.22% in the trunk and 13.53% in the waist. Conclusion: By studying the prevalence of injuries to athletes in specialized positions of each sport, one can plan athletes' training programs to prevent injuries and even enhance them creating better efficiency for them. Keywords: Volleyball, musculoskeletal injury, pain and disability

Güterabwägung in Zeiten der Covid-19-Pandemie

Zusammenfassung: Die Covid-19-Pandemie und der politische Umgang mit ihr beeinflussen sämtliche Bereiche des gesellschaftlichen Lebens auf vielfältige Weise. Ziel dieses Artikels ist es, eine Güterabwägung am Beispiel schwerkranker Kinder und ihrer Familien als vulnerabler Gruppe durchzuführen, um politische Entscheidungen ethisch zu reflektieren. Dafür wird herausgearbeitet, was die Kinderpalliativmedizin im Vergleich zu anderen medizinischen Fachbereichen auszeichnet, und dargestellt, dass ihr Fokus auf der Linderung des „Total Pain“ nach Cicely Saunders liegt. Anhand einer Kasuistik wird ersichtlich, dass die Kinderpalliativmedizin aus diesem Grund durch die vielfältigen Einflüsse der Pandemie auf die physische, psychische, soziale und spirituelle Dimension betreuter Familien vor besondere Herausforderungen gestellt wird. In diesem Zuge wird ebenfalls erläutert, dass Familien mit kinderpalliativmedizinischem Bedarf im Kontext der Covid-19-Pandemie als vulnerable Gruppe angesehen werden können und weshalb die Notwendigkeit einer ausführlichen Güterabwägung besteht. Im Rahmen einer anschließenden ethischen Diskussion wird eine derartige Güterabwägung unter der Einschränkung von Unsicherheit durchgeführt und auf die Problematik der politischen Situation als eines „tragischen Dilemmas“ eingegangen.

The effect of obesity on pain severity and pain interference

Aim: Obesity is one of the most prevalent comorbidities associated with chronic pain, which can severely interfere with daily living and increase utilization of clinical resources. We hypothesized that a higher level of obesity, measured by BMI, would be associated with increased pain severity (intensity) and interference (pain related disability). Materials & methods: Participant data was pulled from a multisite chronic pain outpatient database and categorized based on BMI. Results: A total of 2509 patients were included in the study. We found significant differences between BMI groups for all pain severity scores (worst, least, average, current) and total pain interference score. Obese patients had significantly higher scores than normal weight patients. Conclusion: We found obesity to be associated with increased pain severity and pain interference.

Pain treatment and prevention in pediatric palliative care

Annually, at least 21 million children could benefit from pediatric palliative care (PPC) and 8 million would need specialized PPC services. In the USA alone, more than 40,000 children aged 0–19 years die annually; 55% of them are infants younger than 1 year of age. Pain is common, under-recognized, and under-treated, especially in children with progressive neurodegenerative and chromosomal conditions with central nervous system impairment. Unrelieved pain is also common in children with advanced serious illness during the end-of-life period, and, when treated, the therapy is commonly ineffective. Treating pain in children with serious illness is not profoundly different than advanced pain management for children with complex acute conditions or diseases such as major trauma, burns, cancer, or those with sickle cell disease in vaso-occlusive crisis. It is important to appreciate that children with serious illness are more likely to simultaneously suffer from acute pain, neuropathic pain, visceral pain, total pain, and chronic pain. As such, multimodal analgesic (i.e., multiple agents, interventions, rehabilitation, psychological modalities, and integrative (“nonpharmacologic,” e.g., behavioral, physiological, and psychological) therapies that act synergistically for more effective pediatric pain and symptom control with fewer side effects than a single analgesic or modality must be employed. Opioids, such as morphine, fentanyl, hydromorphone, oxycodone, and methadone, remain the mainstay medications to effectively treat pain in children with serious illness. However, medications alone are often insufficient for optimal pain control. In fact, the paradigm shift away from “medications only” toward offering “multimodal analgesia” to children with serious illness experiencing pain, including addressing chronic pain/primary pain disorders and total pain has become a “game changer” in advancing PPC to ensure that patients can live as long as possible, as well as possible.