Non-specific Pain Research Articles

ID: 200399 Peripheral Brachial Plexus Nerve Stimulation in Coagulopathic Patient Who Responded to Median Nerve Modulation

Through the basis of Gate Control Theory first described by Gate and Melzack (1) as well as the advancement of ultrasound capabilities, Peripheral Nerve Stimulation (PNS) has emerged as a novel treatment modality for a variety of intractable pain conditions resistant to current, first-line therapies. One such condition includes Complex Regional Pain Syndrome (CRPS), which involves non-specific pain that is disproportionate in time or degree to the typical course of a specific trauma or lesion and often includes abnormal sensory, vasomotor, and/or trophic findings with a variable progression over time [2]. Given the challenges often faced by clinicians in treating CRPS, PNS is gaining greater utilization with the goal of decreasing pain and restoring function for patients suffering from this condition.

Multimodality Imaging Evaluation of a Unilateral Madelung Deformity

A Filipino female teenager with gross deformity of her right wrist, came as an outpatient for radiographic evaluation nonspecific pain and numbness after prolonged repetitive, active wrist movements like writing and clapping, are noted with no history of trauma, infection, or surgical intervention of the aforementioned wrist.

Management of non-specific thoracic spine pain: a cross-sectional study among physiotherapists

BackgroundThe thoracic area has mainly been neglected in research compared to the lumbar and cervical regions. No clinical practice guidelines (CPGs) for non-specific thoracic spine pain (TSP) have been compiled. Therefore, it can be argued that the absence of specific CPGs raises questions about the management of non-specific TSP. Hence, this study aimed at determining the management of non-specific TSP among physiotherapists in Italy.MethodsA web cross-sectional survey investigating physiotherapists’ management of non-specific TSP was conducted. The survey instrument was divided into three sections. The first section obtained participants’ characteristics. The second section determined participants’ agreement with 29 statements regarding the clinical management of non-specific TSP utilising a five-point Likert scale. Participants who partially or completely agreed (scores 4–5) were considered to agree with the statements. A ≥ 70% of agreement with a statement was considered as consensus according to previous literature. The third section asked the participants to indicate how often they adopted several treatments to manage non-specific TSP with a 5-point scale (always – often – sometimes – rarely - never). The frequencies of answers were calculated, and a visual representation through a bar chart was reported. The online version of the survey instrument was delivered through the newsletter of the Italian Association of Physiotherapists and the postgraduate master’s degree in Rheumatic and Musculoskeletal Rehabilitation of the University of Genova (Genova, Italy).ResultsIn total, 424 physiotherapists (mean age (SD): 35.1 years (10.5); 50% women) completed the survey. In the second section, physiotherapists achieved consensus for 22/29 statements. Those statements addressed the importance of psychosocial factors, exercise, education, and manual therapy techniques in managing non-specific TSP. In the third section, 79.7% of participants indicated they would always adopt a multimodal treatment (education, therapeutic exercise, manual therapy), followed by education and information (72.9%), therapeutic exercise (62.0%), soft tissue manual therapy (27.1%), and manual therapy (16.5%).ConclusionsStudy participants considered fundamentally using a multimodal programme based on education, exercise and manual therapy to manage non-specific TSP. This approach aligns with the CPGs for other chronic musculoskeletal pain than non-specific TSP.

Instrumental methods for assessing the state of the paravertebral lumbar muscles in patients with lumbosacral radiculopathy and nonspecific muscle-skeletal pain

Neurological examination plays the main role in diagnostic and management of radiculopathies. In addition, the instrumental methods could be used for diagnosis of the morphological and functional state of paraspinal muscles. Paraspinal muscles are symmetrical back muscles surrounding the spinal column and supporting it. Magnetic resonance imaging (MRI) as well as needle electromyography (EMG) and ultrasound are used for instrumental diagnosis of paraspinal muscles conditions. We provide the review on the current scope of studies on radiculopathies and non-specific back pain. MRI is the principle standard for radiculopathy diagnosis, but other methods such as muscle ultrasound and needle electromyography are also used here. MRI is characterized by a high cost, and it is impossible to carry it out if there are magnetic objects present in the patient’s body. EMG and ultrasound both are not sufficient enough to study the level of the fatty replacement of the paraspinal muscle, while this parameter is quite significant for measuring a radiculopathy outcome. Thus, we consider it rational to recommend using these methods in combination. Indications for the combined examination may be such complex cases as anatomical anomalies of spinal roots, atypical disease pattern.

Gastric Large-Cell Neuroendocrine Carcinoma Presenting as Perforation Peritonitis: a Rare Case Report

Gastric neuroendocrine carcinomas (GNECs) are rare tumors characterized by an aggressive clinical course, rapid progression, metastatic dissemination, and poor prognosis. Due to overlapping radiological features and small pre-operative biopsy specimens, they are frequently misdiagnosed as adenocarcinoma in the pre-operative period. These tumors are generally asymptomatic or present with non-specific symptoms like epigastric pain or discomfort, weight loss, and loss of appetite. However, GNECs presenting as perforation peritonitis are rarely reported in the literature. A 60-year-old man presented to the emergency department with complaints of pain upper abdomen with loss of weight and appetite for four months. He had an endoscopic biopsy report suggestive of antral growth reported as poorly differentiated adenocarcinoma. Radiological investigations were notable for the presence of a malignant lesion in the stomach with perforation. Subtotal gastrectomy with D1 lymph node resection was done. Specimen pathology confirmed poorly differentiated high grade large cell neuroendocrine carcinoma. This article emphasizes the importance of considering GNEC as a differential diagnosis for gastric adenocarcinoma despite overlapping radiological features and challenges with pre-operative diagnosis due to its aggressive nature and to allow for appropriate management.

New pharmaconutraceutical Chondroguard®TRIO for the prevention of musculoskeletal diseases and nutritional support for patients with osteoarthritis and nonspecific back pain: an assessment of clinical options. Resolution of the Multidisciplinary Expert Council

In recent decades, there has been an increase in the prevalence and medical and social burden of osteoarthritis (OA) and nonspecific back pain in all countries of the world. The First Multidisciplinary Bilateral Russia-Uzbekistan Expert Council presented innovations in the prognosing, personalized prevention and adjuvant therapy of degenerative-dystrophic diseases of the joints and spine, the evidence base for the effectiveness and safety of the use of drugs that modify the course of OA (Disease-modifying osteoarthritis drugs, DMOADs): chondroitin sulfate, glucosamine sulfate, undenatured type II collagen for adjuvant pharmaconutraceutical support – prevention and adjuvant therapy (treatment) of OA and nonspecific lumbosacral pain. The expert counsil resolution presents an optimized algorithm for the management, prevention and adjuvant therapy of OA and non-specific back pain, maintaining the function of healthy joints after intense physical activity with the inclusion of the drug Chondroguard solution for intra-articular and intramuscular administration (INN – chondroitin sulfate) and a new pharmaconutraceutical from the DMOADs group – TRIO trademark Chondroguard® (Chondroguard®TRIO).

Cortical Desmoid of the Distal Femur-Incidentaloma or Insertional Tendinopathy?

The cortical desmoid (DFCI) of the posteromedial femoral condyle is considered an asymptomatic incidental finding in adolescents without clinical relevance. The aim of this study was to evaluate the clinical relevance of DFCI from both a tumor orthopedic and sports medicine point of view. n = 23 patients (13.74 ± 2.74 years; nineteen female, four male) with DFCI of the posteromedial femoral condyle were included. A localized posteromedial knee pain on exertion was differentiated from non-specific knee pain. Symptom duration, additional pathologies, number of MRIs, sports activity and training intensity, downtime, therapeutic modalities, and relief/remission of symptoms were documented. The Tegner activity scale (TAS) and Lysholm score (LS) were collected. The influence of specific posteromedial pain, MRI presence of paratendinous cysts, sports level as well as physiotherapy on downtime and LS/TAS was statistically analyzed. 100% reported knee symptoms at initial presentation. A localized posteromedial pain was documented in 52%. In 16/23 (70%) additional functional pathologies were diagnosed. Patients were physically highly active with high training intensities (6.52 ± 5.87 h/week) and performance level (65% competitive vs. 35% recreational). Patients underwent 1.91 ± 0.97 MRIs (max four). Symptom duration was 10.48 ± 11.02 weeks. A follow-up examination was performed after 12.62 ± 10.41 months (n = two lost to follow-up). 17/21 had physiotherapy, on average 17.06 ± 13.33 units. Overall downtime was 13.39 ± 12.50 weeks, the return-to-sports (RTS) rate 81%. 100%/38% reported a relief/remission of complaints. LS was 93.29 ± 7.95, median TAS before onset of knee complaints/at follow-up 7 (6-7)/7 (5-7). Specific posteromedial pain, presence of paratendinous cysts, sports level and physiotherapy had no significant influence on downtime and outcome parameters (n.s.). DFCI as a pathognomonic finding is recurrently encountered in the MRIs of children and adolescents. This knowledge is essential to spare patients from overtreatment. Contrary to the literature, the present results implicate a clinical relevance of DFCI particularly in those who are physically highly active with localized pain on exertion. Structured physiotherapy as basic treatment is recommended.

Análisis sobre la prescripción de benzodiazepinas por médicos de familia en una muestra en Río de Janeiro

This qualitative study researched the determinants influencing family physician’s decision on benzodiazepine prescription in a primary care setting, in the city of Rio de Janeiro. An analysis was sought to be elaborated, on how the prescription is negotiated between physician and user. Twelve general practitioners settled in primary care were recruited, gave acceptance signing free and informed consent form, responding to a semi-structured questionnaire that was recorded and transcribed verbatim for analysis, from August to December 2017. The questionnaire addressed physicians' perception of complaints in benzodiazepines users, and alternatives offered instead of medicines. Anxiety and insomnia were cited as the most frequent reasons for use. There was also mention of nonspecific somatic complaints, chronic pain, arterial hypertension, and dependence. Most physicians proposed the therapeutic alliance as a mechanism for offering alternatives to reduce the chronic use of benzodiazepines, despite this intervention achieving a low success rate. Longitudinal care was evidenced as a guiding principle. The analysis of the meanings attributed to BZD, as unveiled in this work, promotes a discussion about the place of medication in culture and its consequences in the approach to psychological and mental suffering.

Analysis of the prescription of benzodiazepines by family physicians in a sample in Rio de Janeiro

This qualitative study researched the determinants influencing family physician’s decision on benzodiazepine prescription in a primary care setting, in the city of Rio de Janeiro. An analysis was sought to be elaborated, on how the prescription is negotiated between physician and user. Twelve general practitioners settled in primary care were recruited, gave acceptance signing free and informed consent form, responding to a semi-structured questionnaire that was recorded and transcribed verbatim for analysis, from August to December 2017. The questionnaire addressed physicians' perception of complaints in benzodiazepines users, and alternatives offered instead of medicines. Anxiety and insomnia were cited as the most frequent reasons for use. There was also mention of nonspecific somatic complaints, chronic pain, arterial hypertension, and dependence. Most physicians proposed the therapeutic alliance as a mechanism for offering alternatives to reduce the chronic use of benzodiazepines, despite this intervention achieving a low success rate. Longitudinal care was evidenced as a guiding principle. The analysis of the meanings attributed to BZD, as unveiled in this work, promotes a discussion about the place of medication in culture and its consequences in the approach to psychological and mental suffering.

ABDOMINAL WALL SCAR ENDOMETRIOSIS AFTER CESAREAN SECTION; A RARE CASE REPORT WITH MULTI FOCUS

Endometriosis is described as the presence of functional endometrial tissue outside the uterine cavity. Scar endometriosis (SE) is a rare condition which usually develops after gynecologic operations involving the uterus and fallopian tubes. The symptoms are usually nonspecific and cyclic incisional pain increasing by menstruation is the most common symptom. Diagnosis of the disease can be difficult and may be confusing with various other post-surgical conditions. Histopathological examination reveals the final diagnosis. This article presents a case with cesarian SE of which the largest reaches 5x4x3 cm with multiple foci. Scar endometriosis should be considered in the differential diagnosis of abdominal wall masses in the patients with a history of abdominal surgery and cyclic painful solid mass.

A 22-year-old Woman with Chronic Back Pain

Low back pain, categorized as nociceptive, neuropathic, or nociplastic, is the leading cause of disability in terms of years lived among young people. The lumbar spine may produce specific or non-specific pain. Treatment depends on the underlying cause of low back pain. This review discusses the classification, prevalence, diagnosis, and treatment of low back pain in young adults.

The efficacy of acceptance and commitment therapy for chronic pain: A three-level meta-analysis and a trial sequential analysis of randomized controlled trials

The current study included randomized controlled trials (RCTs) to assess the benefits of Acceptance and commitment therapy (ACT) for chronic pain. Searches were conducted in Web of Science, PsycINFO, PubMed, Scopus, Cochrane Library, and Embase from inception until September 30, 2022. Thirty-three RCTs, including 2293 participants, were included. Small to medium effect sizes for pain intensity/physical function favoring ACT were found both at post-treatment (pain intensity: g = 0.44; physical function: g = 0.59) and follow-up (pain intensity: g = 0.34; physical function: g = 0.56). The effect sizes on psychological outcomes were significant at post-treatment (depression: g = 0.43; anxiety: g = 0.43; quality of life: g = 0.45) and follow-up (depression: g = 0.43; anxiety: g = 0.35; quality of life: g = 0.43). The results of the trial sequential analyses indicated that pooled estimates were unlikely to be incidental findings, as effects of multiple testing were controlled and power was adequate. Face-to-face ACT yielded significantly larger effects on physical outcomes than internet-delivered ACT. Participants with chronic headache and fibromyalgia showed greater benefit from ACT compared to those with non-specific pain or mixed pain. In addition, the longer the follow-up duration, the smaller the effect sizes for pain intensity/physical function at follow-up. The present meta-analysis suggests sufficient evidence for the significant benefits of ACT for people with chronic pain.

Methotrexate in generalized myasthenia gravis: a systematic review.

Current myasthenia gravis guidelines recommend the use of azathioprine as first-line steroid sparing agent. However, due to its high cost, compliance to azathioprine is low in developing countries. To determine the efficacy and safety of the cheaper methotrexate as an alternative immunosuppressant, Medline/Pubmed, Embase and Cochrane databases and references were searched for clinical trials and observational studies using the search terms: "Myasthenia OR Myasthenia Gravis OR anti AchR antibody positive Myasthenia Gravis OR anti-MuSK antibody Myasthenia Gravis OR MG" AND "Methotrexate". Of 78 possible articles, only 4 were selected using the following eligibility criteria: population: generalized MG patients; intervention: methotrexate; and outcome: effectiveness, steroid sparing efficacy and adverse effects. Two clinical trials and one observational study noted improvement in different MG outcomes in patients given methotrexate. While one randomized controlled clinical trial concluded that methotrexate has no steroid sparing benefit, a single blinded clinical trial established that methotrexate was a better steroid sparing agent than azathioprine starting at 10th month of use. Adverse effects were rare with non-specific pain and elevated transaminases as the most common complaints. Based on available evidence, MTX may be a safe and effective alternative to AZA as steroid sparing agent in developing countries.

Healthcare cost burden of acute chest pain presentations

BackgroundThis study aimed to estimate the direct healthcare cost burden of acute chest pain attendances presenting to ambulance in Victoria, Australia, and to identify key cost drivers especially among low-risk...

Effect of non-specific neck pain on the path of the instantaneous axis of rotation of the neck during its flexion-extension movement

Non-specific neck pain is a common musculoskeletal disorder with a high prevalence and involves impaired joint movement pattern. Therefore, this study aimed to compare the trajectory of the instantaneous axis of rotation(IAR) in flexion-extension movements of the neck between people with and without nonspecific neck pain, using functional data analysis techniques. Furthermore, possible relationships between neck kinematics and perceived pain and disability were explored.Seventy-three volunteers participated in this cross-sectional study. They were allocated in a non-specific pain group (PG, n = 28) and a control group (CG, n = 45). A cyclic flexion-extension movement was assessed by a video photogrammetry system and numerical and functional variables were computed to analyze IAR trajectory during movement. Moreover, to explore possible relationships of these variables with pain and neck disability, a visual analogue scale (VAS) and the neck disability index (NDI) were used.The instantaneous axis of rotation trajectory during the flexion-extension cyclic movement described a path like Greek letter rho both in the CG and the PG, but this trajectory was shorter and displaced upward in the PG, compared to the CG. A reduction of the displacement range and a rise in the vertical position of the IAR were related to VAS and NDI scores.Non-specific neck pain is associated with a higher location of the instantaneous axis of rotation and a decrease in length of the path traveled during the flexion-extension movement. This study contributes to a better description of neck movement in people with non-specific neck pain, which would help to plan an individualized treatment.

Skeletal Muscle and Fat Mass Reflect Chronic Pain in Older Adult.

Objectives: The prevalence of chronic pain increases with age. It has been reported that chronic pain is associated with sarcopenia and obesity. Age-related skeletal muscle loss and fat gain are known to occur due to chronic inflammation. The aim of this study was to analyze how skeletal muscle and fat, caused by chronic inflammation due to aging, regulate the development of geriatric chronic pain. Methods: The results of skeletal muscle and fat mass, 412 participants aged ≥65 years with non-specific chronic pain lasting ≥6 months, including low back, neck, and knee pain, was compared with the control without chronic pain. Body composition threshold regulating chronic pain was calculated. Results: A significantly lower skeletal muscle mass index and higher body fat percentage were observed in patients with chronic pain than that in the control. The muscle fat ratio (MFR) was significantly lower in the chronic pain group than in the control group. When the MFR threshold related to chronic pain was calculated by sex, it was 2.984 for men and 1.867 for women. Conclusions: Evaluation of the body composition of elderly patients with non-specific chronic pain revealed that the MFR was useful as an index related to chronic pain.

Atypical Hypothenar Hammer Syndrome Mimicking A Peripheral Nerve Tumor

An aneurysm is an abnormal focal dilatation of a blood vessel that increases its width by more than 50%. They are divided into true and pseudo-aneurysms. Ulnar artery pseudoaneurysm that causes pain, numbness and cold intolerance in the hypothenar region and develops after repetitive trauma has been named hypothenar hammer syndrome. Hypothenar hammer syndrome is a rare clinical entity that occurs more frequently in males and in the dominant hand as a result of repetitive trauma. Patient history and clinical examination are very important in the diagnosis of this disease, which is seen as an occupational disease and is associated with some sports branches. However, it can also occur with a single blunt trauma, in the non-dominant hand and regardless of occupation. Ultrasonography, Doppler, magnetic resonance and angiography help us to visualize an aneurysm. Although activity regulation and various medications are used among the treatments, surgical treatment is at the forefront in the presence of chronic pain and compression symptoms due to the mass. In the presence of signs of vascular insufficiency or a palpable pulsatile mass in the hand, this rare syndrome may be easy to diagnose and manage. But, in atypical cases, such as our case with no symptoms other than nonspecific pain in the hand, the aneurysm causing hypothenar hammer syndrome may mimic a peripheral nerve tumor.

Case report on chronic non-bacterial osteomyelitis (CNO) and review of literature

Introduction: Chronic Non-Bacterial Osteomyelitis (CNO) is a rare inflammatory disorder not related to any infectious disease characterized by focal aseptic inflammation with a self-limiting, relapsing course of disease with female predominance and usually observed in paediatric age groups diagnosed by clinical, radiological and histopathological findings after ruling out all other differentials.Case Report: A case of 6 year old female which presented with non-specific bone pain in the metadiaphyseal region of proximal humerus. X-rays had osteolytic lesions in the metadiaphyseal region and with a history of trivial trauma and no positive history of autoimmunity. Conclusion: CNO is difficult to identify and no consensus exist on diagnosis and treatment modality. Multifocal bone lesions with characteristic radiological findings are very suggestive of CNO. But dilemma with unifocal lesion with no corroborative findings. In such cases diagnosis is achieved with exclusion. No data exist on best treatment option after Non-Steroidal Anti-Inflammatory Drugs failure. But excision biopsy with complete curettage in unifocal lesions gives immediate symptom relief and long term good outcome without a background of identifiable auto-immune disease.

Basic Research Protocol: Exome Sequencing in Adults With Loin Pain Hematuria Syndrome: A Pilot Study.

Loin pain hematuria syndrome (LPHS) is a poorly understood clinical syndrome characterized by hematuria and either unilateral or bilateral severe kidney pain in the absence of identifiable urological disease. Loin pain hematuria syndrome imposes a significant health and economic impact with a loss of productivity and quality of life in a young population. Owing to an incomplete understanding of its pathophysiology, treatment has been limited to nonspecific pain management. Nearly 60 years after its initial description, we are no further ahead in understanding the molecular pathways involved in LPHS. To outline the study design for exome sequencing in adults with LPHS and their families. In this single-center case series, 24 patients with LPHS and 2 additional first-degree family members per participant will be recruited. DNA extracted from venous blood samples will undergo exome sequencing on the Illumina NovaSeq 6000 System at 100× depth and will be assessed for pathogenic variants in genes associated with hematuria (number of genes in: glomerular endothelium [n = 10] and basement membrane [n = 8]), and pain pathways (number of genes in: pain transduction [n = 17], conduction [n = 8], synaptic transmission [n = 37], and modulation [n = 27]). We will further examine identified potentially pathogenic variants that co-segregate with LPHS features among affected families. This pilot study may identify new directions for an investigation into the molecular mechanisms underlying LPHS.

Microfilariae infection by Acanthocheilonema reconditum and Dirofilaria immitis and their molecular detection in a dog with lymphoma: Case report

Objective: Microfilariae parasites are common in tropical regions, and some species are reported as potentially zoonotic. The diagnosis of filarial infection in dogs by cytology or hematologic tech¬niques showed lower sensibility and specificity, which may result in misdiagnosis. Thus, molecular techniques seem to be an alternative to identifying and detecting microfilariae infections. On the other hand, lymphoma is one of the main tumors in domestic animals, with a high prevalence in domestic canines. This study aims to report a mixed infection with microfilariae in a dog with lymphoma, emphasizing its diagnosis and the possible role of this infection in the development of the neoplasia. Materials and Methods: An 8-year-old male mixed breed dog was referred to consultation due to the presence of lethargy, recumbency, skin ulceration lesions, nonspecific pain manifestations, emesis, myoclonus in the left temporalis muscle, and seizures. Routine blood and biochemistry tests were normal, and cytology of the skin evidenced a microfilariae infection. The dog died due to a cardiorespiratory arrest, and tissue sampling was done for histopathology and molecular analysis at the necropsy examination. Results: Skin lesions were related to a microfilarial pyogranuloma related to Acanthocheilonema reconditum. Histopathology of the spleen and liver revealed a diffuse lymphoma composed of blast cells and large lymphocytes, distributed diffusely in the parenchyma and surrounding the vasculature. In the skin, microfilariae were seen in some superficial capillaries. Conclusion: This study describes a microfilariae mixed infection with A. reconditum and Dirofilaria immitis in a dog with a lymphoma and its molecular detection. To the knowledge of the authors, this is the first report of a mixed microfilariae infection in a tumor of a dog and highlights the use of molecular techniques, i.e., polymerase chain reaction, for an accurate diagnosis.