A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study

Background Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. Methods A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression. Results A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021). Conclusions Upper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery. Trial registration The study was registered in Clinical trial with the ID number: NCT03389204.

Diseases of the Musculoskeletal System and Rheumatic Diseases: Prevention and Rehabilitation in Modern Conditions

The article examines approaches to the prevention of diseases of the musculoskeletal system and rheumatic diseases, as well as to the rehabilitation of such patients. It is this type of disease that has a negative impact on the quality of life of most people, since it not only makes it difficult for them to move in space, but also worsens the general state of health due to pain, which may manifest to a greater or lesser extent. Treatment of diseases of the musculoskeletal system is a rather long-term process, for this reason, the prevention of such diseases seems very relevant, since it not only allows the patient to avoid prolonged pain, but also reduces the financial burden in the field of insurance medicine, since the need for expensive medical and physiotherapy treatment for such patients is eliminated. Rehabilitation of patients with this diagnosis also makes it possible to reduce the time to restore their health and return to a full life. Accordingly, the tasks set in the work meet the requirements of today and will contribute to improving the effectiveness of preventive measures for patients suffering from diseases of the musculoskeletal system.

Would high-dose corticosteroid addition to multimodal cocktail periarticular injection contribute to prolonged pain control and better recovery following total knee arthroplasty?: study protocol for a randomized controlled trial

Background Enhanced recovery following total knee arthroplasty (TKA) has been advocated to enhance postoperative recovery. Multimodal cocktail periarticular injection (MCPI) use for pain control in TKA has gained wide acceptance. MCPI-containing corticosteroids are believed to be an effective solution owing to their local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence regarding its benefits. This trial aims to compare MCPI with a high dose of corticosteroid, normal dose of corticosteroid, and non-corticosteroid during TKA, to assess the effectiveness of MCPI containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects and provide evidence that high-dose corticosteroids result in prolonged pain control and better recovery following TKA. Methods This is a double-blinded, randomized, placebo-controlled study. A total of 234 patients scheduled for TKA will be recruited. During surgery, before wound closure, 80 ml of the cocktail analgesic will be injected into the muscle and joint capsule for local infiltration analgesia; the participants will be randomly assigned to three groups to receive a high dose of betamethasone MCPI (group H), normal dose of betamethasone MCPI (group N), and non-betamethasone MCPI (group C). The following indices will be recorded and analyzed: the strongest knee pain experienced during 90° flexion at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1 min walking ability; and circumference around the patella at 2, 5, 14, and 30 days after surgery; Knee Society knee score at 14 days and 30 days after surgery; C-reactive protein and blood sedimentation; blood sugar 2, 5, 14, and 30 days following surgery; rescue analgesic consumption; and adverse events. If any participant withdraws from the trial, an intention-to-treat analysis will be performed. Discussion The results of this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and adverse events, as well as provide evidence on the efficacy of high-dose corticosteroids in prolonged pain control and better recovery following TKA. Trial registration Chinese Clinical Trial Registry, ChiCTR2000038671. Registered on September 27, 2020.

Stress, distress, its types and correction

Chronic and acute, physiological, psychological and informational stress are considered. It is noted that stress is a protective reaction of the body in response to a very strong emotional, physical or psychological action from the outside. Instead, distress develops as a result of: prolonged inability to meet their physiological needs, unpleasant, sad and threatening changes in life, unusual, inappropriate living conditions, body damage, illness, injury, prolonged pain or negative emotions. The best way to deal with stress is to prevent it: regular walks in the fresh air, sports, adequate sleep and more. ADAPTOL® anxiolytic helps to curb excessive anxiety and irritability, to restore strength after the transferred stress.

Prolonged Pain Reliably Slows Peak Alpha Frequency by Reducing Fast Alpha Power

The relationship between the 8-12 Hz alpha rhythm, the predominant oscillatory activity of the brain, and pain remains unclear. In healthy individuals, acute, noxious stimuli suppress alpha power while patients with chronic pain demonstrate both enhanced alpha power and slowing of the peak alpha frequency (PAF). To investigate these apparent differences, EEG was recorded from healthy individuals while they completed two models of prolonged pain, Phasic Heat Pain and Capsaicin Heat Pain, at two testing visits occurring roughly 8 weeks apart. We report that PAF is reliably slowed and that alpha power is reliably decreased in response to prolonged pain. Furthermore, we show that alpha power changes, but not PAF changes, are fully reversed with stimulus removal suggesting that PAF slowing reflects pain associated states such as sensitization rather than the presence of ongoing pain. Finally, we provide evidence that changes to alpha power and PAF are due to power decreases in the fast (10-12 Hz) range of the alpha rhythm. This frequency dependent pain response aligns with the hypothesis that the alpha rhythm is composed of multiple, independent oscillators, and suggest that modulation of a putative fast oscillator may represent a promising therapeutic target for treating ongoing pain. In sum, we provide strong evidence that PAF is reliably slowed during prolonged pain and additionally identify a mechanism, fast alpha Power, which is responsible for these PAF changes.

The role for regional anesthesia in medical emergencies during deep space flight

As humanity presses the boundaries of space exploration and prepares for long-term interplanetary travel, including to Mars, advanced planning for the safety and health of the crewmembers requires a multidisciplinary approach. In particular, in the event of a survivable medical emergency requiring an interventional procedure or prolonged pain management, such as traumatic limb injury or rib fracture, anesthetic protocols that are both safe and straightforward to execute must be in place. In this daring discourse, we discuss particular considerations related to the use of regional techniques in space and present the rationale that regional anesthesia techniques may be the safest option in many medical emergencies encountered during prolonged space flight.

The role of cognitive and affective flexibility in individual differences in the experience of experimentally induced heat pain

Adaptation to the context in which we experience pain requires cognitive flexibility (CF) and affective flexibility (AF). Deficits in both flexibility types may be precursors of more intense and prolonged pain. This study aimed to examine the relation between CF and AF, and the experience of experimentally induced pain. Furthermore, correlations between behavioral and self-report measures of flexibility were explored. CF and AF were assessed with task-switching paradigms, using neutral (numbers ranging from 1 to 9, excluding 5) or affective stimuli (positive and negative pictures), respectively. Pain sensitivity measures, such as pain threshold (°C), pain tolerance (°C), and retrospective pain experience ratings (Visual Analog Scale) were assessed for an experimentally induced heat pain stimulus. Self-reported CF was measured with a questionnaire. Results demonstrated no associations between the flexibility constructs and any of the pain outcome measures. Correlations between the behavioral and self-report measures of CF were absent or weak at best. Current results are discussed against the background of methodological considerations and prior empirical research findings, suggesting the contribution of AF in especially the recovery from pain.

Traction apophysitis

Overuse injuries are undoubtedly one of the most frequent cause of pain in adolescent athletes which can result in limitation in sport activities and competition, prolonged pain and psychological consequences. We see different forms of this condition regarding the anatomical region at insertion sites of major tendons. Usually we treat conditions of the lower extremities like Osgood-Schlatter or Sinding-Larssen-Johansson disease. We diagnose less frequently overuse injuries of the upper extremities like Little League shoulder or elbow. Commonly they present with pain after activities and limitation in range of motion. Each form has to be treated slightly differently, initially with resting, followed by physical or local therapy. Besides presenting the most important and usual forms of traction apophysitis, we emphasize the aspects of prevention and point out some ideas regarding training techniques.