Permanent Pain Research Articles

Novel pathomorphologic classification of capsulo-articular lesions of the pubic symphysis in athletes to predict treatment and outcome.

Radiographic abnormalities of the symphysis as well as the formation of accessory clefts, indicating injury at the rectus-adductor aponeurosis, reportedly relate to longstanding groin pain in athletes. However, yet, no systematic classification for clinical and scientific purposes exists. We aimed to (1) create a radiographic classification based on symphysography; (2) test intra- and interobserver reliability; (3) characterise clinical significance of the morphologic patterns by evaluating success of injection therapy. We retrospectively reviewed symphysography, AP radiographs, and MRI of the pelvis from 70 consecutive competitive athletes, with chronic groin pain. Symphysographs were evaluated for intra- and interobserver variance using cohen's kappa statistics. Morphologic studies of the different contrast distribution patterns and their clinical and radiological correlation with symptom relief were investigated. All patients were followed up to evaluate immediate and long-term response to the initial therapeutic injection with steroid. Four reproducible symphysographic patterns were identified: type 0, no changes; type 1, symphyseal disk degeneration; types 2a with unilateral clefts, bilateral clefts (2b), suprapubic clefts (2c); and type 3, with expanded or multidirectional clefts. Analysis revealed excellent intra (0.94)-and interobserver (0.90) reliability. Our findings showed that 78.6% of our patients had significant short-term improvement enabling early resumption of physiotherapy, only in types 1 and 2 (p = 0.001), while type 0 and 3 did not respond. At follow-up, only 21.8% had permanent pain relief. Regarding the detection of pathologic clefts with symphysography, sensitivity (88%) and specifity (77%) were superior to that of MRI. A reproducible symphysography-based classification of distinct morphologic patterns is proposed. It serves as a predictive tool for response to injection therapy in a select group of pathologic lesions. Complete recovery after injection can only be expected in a lesser percentage, as this might indicate surgical treatment for long-term non-responders.

Treatment of subacute osteoporotic vertebral compression fractures with percutaneous vertebroplasty: A case report

Introduction. Percutaneous vertebroplasty (PVP), as a mini-invasive approach in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs), provides stabilization of the spine and relives pain. The most commonly it is applied in the 3?6 weeks before bending of the spine. Complete cessation of pain is easier to achieve if you treat ?less mature? fractures. The aim of the report is to show that PVP is effective and safe for old fractures too. Case report. A 77-old patient suffered from a stable compression fracture of 3th lumbar (L3) vertebral body after minor trauma. This fracture was clinically and radiologically diagnosed. The conservative treatment that included lumbo-sacral orthosis (LSO), analgesic drugs and physical therapy, was primarily applied due to permanent pain and type of fracture. After a period of two months, pain persisted, but it was localized in a thoracic spinal segment with radiologically diagnosed fractured bodies of 8th (Th8) and 10th (Th10), thoracic vertebra without neurological deficit. Thoraco-lumbo-sacral orthosis (TLSO) was prescribed and after six months the indication for vertebroplasty of the Th8 and Th10 vertebral body was given. The pain relief had been achieved and the patient was discharged from the Clinic for Orthopedics on the postoperative day 2, and was symptom free during the follow-up period. Conclusion. In patients with stable OVCFs, PVP is an effective therapy for reducing pain and improving mobility of 6 months old fractures.

Current treatments for anal condylomata acuminata.

Condylomata acuminata are the most common sexually transmitted disease worldwide. They are not usually a serious problem, but it causes emotional distress to patient and physician alike because of its marked tendency to recurrence. The presence of anogenital warts mandates treatment, also for potential degeneration of the lesions. A review of the literature has been performed to analyze proposed treatments for anogenital warts. Many treatments have been employed. They include cytotoxic agents, immunomodulation and physical ablation. The choice of the appropriate treatment varies depending on the number, size, and location of warts. Complications of various treatments are rare but include permanent depigmentation, itching, pain, scarring, bleeding, anal stenosis or incontinence and sepsis. The therapy of these lesions can sometimes be very painful and expensive, and therapy should not be worse than the disease. No specific antiviral treatment is currently available, and no consensus has been reached on the appropriate treatment for anogenital warts. No data are available to indicate whether treatment eliminates infectivity, the primary aim of treatment being to remove the lesions. There is a paucity of published randomized trials. Despite the introduction of antiviral treatments such as interferon, immunomodulating agents or imiquimod, surgical destruction or removal remains the treatment of choice.

Ureteral Reimplantation or Percutaneous Nephrostomy: Which One Is Better in Management of Complete Ureteral Obstruction Due to Advanced Prostate Cancer?

Background: The present study aims at evaluating the safety and efficacy of ureteral reimplantation and its influence on quality of life in the complete ureteral obstruction due to prostate cancer. Methods: In a prospective randomized study, 86 patients with complete ureteral obstruction were randomized into 2 groups: group 1 (ureteral reimplantation) and group 2 (nephrostomy). Biochemical values, complications, and survival of patients were recorded. Results: The mean age of patients were 72.20 ± 7.77 and 74.26 ± 7.56 years in group 1 and group 2, respectively (P ₌ 0.21). The mean decrease in Creatinine values were not significant between 2 groups (P = 0.639). The mean survival of patients after intervention were 22.42 ± 0.87 months in group1 and 20.48 ± 0.65 in group 2 (P = 0.0001). No major complications were happened in group 1. Main delayed complications in group 1 were ureteral stricture at the anastomosis point 20% (n = 8), UTI 27.5% (n = 11), and permanent pain at the operation site 15% (n = 6). In group 2, 100% of patients had experienced complications, including: febrile UTI 65.2% (n = 30), perirenal abscess 10.8% (n = 5), dislodgement of nephrostomy tube 30.4% (n = 14), local inflammation and dermatitis of nephrostomy tract 54.3% (n = 25), and hemorrhage during nephrostomy placement 4.3 (n = 2). Likewise, all of them (100%) had social inconvenience, local pain and discomfort in tract and sutures of tube, urine leakage and odor, and need to regular replacement of tube. Conclusions: Reimplantation is a safe and effective option in the management of complete ureteral obstruction due to advanced prostate cancer with significant benefits in overall survival and patient satisfaction.

Chronic Testicular and Groin Pain: Pathway to Relief.

The management of patients suffering with chronic testicular and groin pain is very challenging. With increased awareness of men's health, more patients and clinicians are open to talk about this complex problem that affects over 100,000 men/year. The pathogenesis of chronic orchialgia is still not clear, but there are several postulated theories. Treatment options include conservative medical therapy with NSAIDs, antidepressants, anticonvulsants, and narcotics. Surgical options such as targeted microsurgical denervation and microcryoablation can provide permanent durable pain relief. The goal of this article is to review and discuss the management of patients with chronic orchialgia using currently available literature.

Complications of orbital endoimplantation in the Eye Clinic of the Lithuanian University of Health Sciences.

The aim of the study was to analyse the rate of complications of orbital endoimplantation in patients operated from 2002 to 2014 at the Eye Clinic of the Lithuanian University of Health Sciences and to compare it with the results in the literature. Enucleation must be performed very carefully in order to prevent any additional trauma, infection, deformation, and to create an optimal conjunctival socket. However, complications occur despite efforts and qualified surgeons. The most common complications described in the literature are thinning and cysts of the conjunctiva, a foreign body reaction, secretion, symblepharons, fornix deficiency, ptosis, permanent pain, dislocation, migration and protrusion of the implant, a primary or secondary infection, and implant extrusion.From 2002 to 2014, 128 patients underwent orbital endoimplantation surgery at the Eye Clinic. The most common complications were conjunctival erosion (five patients, or 2.9%), cysts (nine patients, or 7%), and implant extrusion (five patients, or 2.9%). The type and rate of complications were very similar to the data in the literature.

Conservative interventions for treating middle third clavicle fractures in adolescents and adults.

Clavicle (collarbone) fractures account for around 4% of all fractures. Most (76%) clavicle fractures involve the middle-third section of the clavicle. Treatment of these fractures is usually non-surgical (conservative). Commonly used treatments are arm slings, strapping and figure-of-eight bandages.This is an update of a Cochrane review first published in 2009 and updated in 2014. To evaluate the effects (benefits and harms) of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE (from 1966), Embase (from 1980), LILACS (from 1982), trial registers, orthopaedic proceedings and reference lists of articles. We applied no language or publication restrictions. The date of the last search was 5 January 2016. Randomised and quasi-randomised controlled trials testing conservative interventions for treating adolescents and adults with acute middle third clavicle fractures. The primary outcomes were shoulder function or disability, pain and treatment failure. For this update, two review authors selected eligible trials, independently assessed risk of bias and cross-checked data extraction. We calculated risk ratios and 95% confidence intervals for dichotomous variables, and mean differences and 95% confidence intervals for continuous variables. There was very limited pooling of data. We included four trials in this review with 416 participants, who were aged 14 years or above. One new trial was included in this update.Very low quality evidence was available from three trials (296 participants) that compared the figure-of-eight bandage with an arm sling for treating acute middle third clavicle fractures. The three trials were underpowered and compromised by poor methodology. Shoulder function was assessed in different ways in the three trials (data for 51, 61 and 152 participants); each trial provided very low quality evidence of similar shoulder function in the two groups. Pooled data from two trials (203 participants) showed no clinical difference between groups after two weeks in pain (visual analogue scale: 0 (no pain) to 10 (worst pain); mean difference (MD) 0.43, 95% confidence interval (CI) -0.35 to 1.21; I² = 74%; very low quality evidence). A third trial (61 participants) provided very low quality evidence based on a non-validated scoring system of more pain and discomfort during the course of treatment in the figure-of-eight group. Treatment failure, measured in terms of subsequent surgery, was not reported in two trials; the third trial (152 participants) reported one participant in the arm sling group had surgery for secondary plexus nerve palsy. There was very low quality evidence from one trial (148 participants) of little difference in time to clinical fracture healing (MD 0.2 weeks, 95% CI -0.11 to 0.51); data from four non-symptomatic non-unions in the figure-of-eight group were not included. The very low evidence quality data for individual adverse outcomes (poor cosmetic appearance; change in allocated treatment due to pain and discomfort, worsened fracture position on healing; shortening > 15 mm; non-symptomatic non-union and permanent pain) did not confirm a difference between the two groups. There was no clear between group difference in the time to return to school or work activities (MD -0.12 weeks, 95% CI -0.69 to 0.45; 176 participants; very low quality evidence).Moderate quality evidence was available from one trial (120 participants; reporting data for 101 participants), which evaluated therapeutic ultrasound. This trial was at low risk of bias but was underpowered and did not report on shoulder function or quality of life. The trial found no evidence of a difference between low-intensity pulsed ultrasound and placebo in pain, treatment failure (subsequent surgery: 6/52 versus 5/49; RR 1.13, 95% CI 0.37 to 3.47), the time to clinical fracture healing (MD -0.32 days, 95% CI -5.85 to 5.21), adverse events (one case of skin irritation was reported in each group) or time to resume previous activities. The current evidence available from randomised controlled trials is insufficient to determine which methods of conservative treatment are the most appropriate for acute middle third clavicle fractures in adolescents and adults. Further research is warranted.

Interest of punch skin grafting for the treatment of painful ulcers

Skin leg ulcers are chronic painful wounds. The treatment of these ulcers is crucial for patients because pain has a significant impact on their daily lives. The analgesic effect of punch skin grafting (PSG) for the treatment of painful ulcers is not well described. The objective of the study is to assess the level of pain in patients with an ulcerated wound and to see if there is an analgesic effect of PSG. A single-center, non-interventional study conducted in hospitalized patients with one or several ulcer(s) of any type and which has been painful for more than six weeks. Pain was assessed before, the day after a PSG and then on the way out of hospital by a questionnaire and a numeric pain rating scale. Permanent pain and pain peaks were identified. Forty-one patients were included (23 men and 18 women) with a mean age of 73±21 years, 36% (n=15) with arterial ulcers, 36% (n=15) with venous ulcers, 12% (n=5) with necrotic angiodermatitis, 12% (n=5) with mixed ulcers and 4% (n=2) with "other ulcers" (due to infection and use of hydroxycarbamide). On day 1 of PSG, patients showed an improvement in terms of permanent pain (77%, n=24/31) and pain peaks (90%, n=37/41) respectively and 90% (n=28/31) and 95% (n=39/41) on the last day at hospital. Reduction in the use of strong opioids was found in 13 patients (81%). Punch skin grafting is a simple and validated treatment, which can reduce or eliminate pain related to ulcers. It has an effect on permanent pain and pain peaks. Its efficiency is particularly demonstrated on venous ulcers and mixed ulcers but also initially painful ulcers such as necrotic angiodermatitis or arterial ulcers.

Intérêt de la greffe cutanée en pastilles dans la prise en charge d’ulcères algiques

Skin leg ulcers are chronic painful wounds. The treatment of these ulcers is crucial for patients because pain has a significant impact on their daily lives. The analgesic effect of punch skin grafting (PSG) for the treatment of painful ulcers is not well described. The objective of the study is to assess the level of pain in patients with an ulcerated wound and to see if there is an analgesic effect of PSG. It was a single-center, non-interventional study conducted in hospitalized patients with one or several ulcer(s) of any type and which has been painful for more than six weeks. Pain was assessed before, the day after a PSG and then on the way out of hospital by a questionnaire and a numeric pain rating scale. Permanent pain and pain peaks were identified. Forty one patients were included (23 men and 18 women) with mean age of 73±21 years, 36% (n=15) with arterial ulcers, 36% (n=15) with venous ulcers, 12% (n=5) with necrotic angiodermatitis, 12% (n=5) with mixed ulcers and 4% (n=2) with "other ulcers" (due to infection and use of Hydroxycarbamide). On day 1 of PSG, patients showed an improvement in terms of permanent pain (77%, n=24/31) and pain peaks (90%, n=37/41) respectively and 90% (n=28/31) and 95% (n=39/41) on the last day at hospital. Reduction in the use of strong opioids was found in 13 patients (81%). Punch skin grafting is a simple and validated treatment, which can reduce or eliminate pain related to ulcers. It has an effect on permanent pain and pain peaks. Its efficacy is particularly demonstrated on venous ulcers and mixed ulcers but also initially painful ulcers such as necrotic angiodermatitis or arterial ulcers.

Long-Term Outcomes in the Treatment of Classical Trigeminal Neuralgia by Gamma Knife Radiosurgery: A Retrospective Study in Patients With Minimum 2-Year Follow-up.

Gamma knife radiosurgery (GKRS) is one of the alternatives for treatment for classical trigeminal neuralgia (TN). To retrospectively analyze long-term outcomes for TN using GKRS achieved at our institution. One hundred seventeen patients with medically refractory TN treated by GKRS at our institution were followed up between 1993 and 2011. Mean maximum dose was 86.5 Gy (range: 80-90 Gy; median: 90 Gy). Clinical response was defined based on the Burchiel classification. We considered classes I and II as a complete response. For toxicity, we use the Barrow Neurological Institute facial numbness scale. Mean duration of follow-up was 66 months (range: 24-171 months). Complete response at last follow-up in our patients was 81%, with an excellent response while off medication in 52%. Pain-free rates without medication (class I) were 85% at 3 years (confidence interval [CI]: 78%-94%), 81% at 5 years (CI: 72%-91%), and 76% at 7 years (CI: 65%-90%). Complete response rates (classes I-II) were 91% at 3 years (CI: 86%-97%), 86% at 5 years (CI: 79%-93%), and 82% at 7 years (CI: 72%-93%). Poor treatment response rates differed significantly between patients who had undergone previous surgery and were refractory to management with medication prior to GKRS. New or worsening facial numbness was reported in 32.5% (30% score II and 2.5% score III). No anesthesia dolorosa was reported. Permanent recurrence pain rate was 12%. GKRS achieved favorable outcomes compared with surgery in terms of pain relief and complication rates in our cohort of patients, notwithstanding decreasing pain-free survival rates over time. We consider GKRS to be an initial treatment in the management of medically intractable TN in selected patients. CI, confidence intervalGKRS, gamma knife radiosurgeryMVD, microvascular decompressionRS, radiosurgeryTN, trigeminal neuralgia.

Long-Term Clinical Outcome of Peripheral Nerve Stimulation for Chronic Headache and Complication Prevention.

BackgroundSubcutaneous peripheral nerve stimulation (PNS) has emerged as a useful tool in the treatment of intractable headaches. However, complications such as skin erosion, infection and lead migration have adversely affected clinical outcome, and occasionally led to treatment cessation.ObjectivesHere we report the results of peripheral nerve stimulator implantation performed on 24 patients with various chronic headaches at our center over a period of 9 years. We describe the complications of the procedure and their prevention with a modified surgical technique.Patients and MethodsWe searched our database for patients with chronic refractory headaches who had undergone PNS. Patients were assessed before being considered for PNS, and their pain characteristics were reviewed. Following a successful trial, patients were implanted with a permanent peripheral nerve stimulator. Selection of target nerves was based on headache diagnosis and head pain characteristics. Patients were followed for an average of 4.9 years. Headache characteristics before and after treatment were compared.ResultsTwenty four patients were included in the study. All patients reported on improvement in head pain intensity, duration and frequency three months after permanent device implantation Mean total pain index (TPI) decreased significantly, from 516 ± 131 before the procedure to 74.8 ± 61.6 at the last follow up (P < 0.00001). There were no acute post-operative infections. Three patients had their stimulator removed. The self-rated treatment satisfaction was excellent in 54% of the patients, very good or good in 42%, and fair in 4%.ConclusionsOur results support the use of PNS in some patients with refractory chronic headaches. Appropriate surgical planning and technique are important to achieve good clinical outcome and to minimize complications.

Thoracoscopic splanchnicectomy for the relief of chronic pancreatic pain

Chronic pancreatitis may cause disabling pain unresponsive to oral analgesics and/or drainage procedures. Radiological guided coeliac plexus ablation is beneficial, although it is only a temporary method for pain relief. Bilateral splanchnicectomy provides a more permanent pain relief method with minimum morbidity if performed by thoracoscopy. The results of twenty one thoracoscopic splanchnicectomies performed at the university surgical unit, Peradeniya, Sri Lanka from January 2011 to June 2015 were analysed to evaluate the surgical technique and to quantify the efficacy of pain relief. All had an acceptable operating time, no measurable blood loss, no conversions to open surgery, no intercostal drainage, early mobilization and feeding. All had an average pain score of 8-10 pre-operatively. This was reduced to 1 or no pain on post-operative day one in all patients. Eighteen patients out of 21 (86%) remained pain free during follow up; follow up ranged from one month to forty eight months. Bilateral thoracoscopic splanchnicectomy is safe and provides effective relief of chronic agonizing pancreatic pain.

Organ manifestations and long-term outcome of Fabry disease in patients with the GLA haplotype D313Y

ObjectivesThe severity of Fabry disease is dependent on the type of mutation in the α-galactosidase A (AgalA) encoding gene (GLA). This study focused on the impact of the GLA haplotype...

Diagnostical Challenges of Tumor-Like Conditions of Cervical Neural Arch in Childhood

Introduction Neck pain is a rare symptom in childhood. However, if exists permanently, require a thorough checkup, because very often some serious pathology it is in the background. We present two consecutive cases of young patients with neck pain, where the differential diagnosis was challenging, and has proved two different tumor-like pathologies. Material and Methods The first case concerns a 17 years old boy, who represents a pain localizing to the scruff region, mainly during night and to have a rest. MR imaging showed a high intensity changes on T2-weighted, and low intensity changes on T1-weighted pictures at the top of C.7. spinous process. According to SPECT/CT and bone scan an osteoid osteoma was suspected. The second case concerns a 7 years old boy, who had been complaining for few months a temporary, however a sharp pain also at the scruff region, consequently during extension of the neck. MR showed especially on STIR pictures edema at the region of C.4, 5. spinous process. Bone scan proved a slightly increased uptake, also with the suspicion of osteoid osteoma, however the CT scan was negative. Results In the first case, based on the results of the radiological examinations, we have decided on “en bloc” resection of the malformation. The histology revealed pigmented villonodular synovitis (PVNS), which is according to the literature a really rare finding in this region, and require surgical solution. After the surgery, the patient became complaint free, with full function of his neck. On one year follow up MRI was negative regarding recurrence. On the second case pediatricians have excluded any organic rheumatologic disease, and although the inflammatory laboratory tests (We, CRP) were negative, they reckon the malformation as a chronic osteomyelitis and administered a prolonged antibiotic course under strict control for ten weeks. Because of the continuous improvement of the young boy during this therapy, biopsy was not necessary. After three months the patient became also complaint free, and the one year follow up MRI also revealed a normal status. Conclusion In case of permanent neck pain in childhood it is mandatory to perform a thorough checkup to find the reason behind these complaints to be able to exclude any tumor, or tumor-like malformations. If there are any morphological changes on the radiological examinations, the differential diagnosis could be very challenging, requiring individual therapeutical plan. The first proposed examination should have to be MR imaging.

Protecting Workers from Step Voltage Hazards

Occupational accidents still occur, despite technical developments in the occupational safety field at large. The experience of being harmed at work can be devastating, with profound consequences for employees, their families, friends, and work colleagues. Many consequences cannot be measured directly, such as pain suffered. However, the economic burden can be estimated [1]?[4]. Wages lost depends on the duration of illness and the worker?s disability rate. The more that work disability reduces an affected worker?s actual income, and that income diverges from projected earnings trajectory prior to the injury, the larger the economic consequences. A significant impact?on workers? productivity also increases the risk of dismissal. A permanently incapacitated worker is no longer able to contribute to the community and has to be supported by the society in many cases. Occupational accidents worsen previously existing health problems. Some injuries cause permanent chronic pain, which means the worker will need pain management and counseling services. Even after physical recovery, the consequences of a workplace accident may not cease. Employees may show higher rates of psychological problems, drug abuse, sleep ?disorders, changes in food consumption and body weight, and marital difficulties. Some of these workers need psychiatric assistance to overcome their problems. They may become isolated, estranged from their community, and depressed. Isolation and estrangement can become permanent. Often injured workers feel they are not supported by their friends and family or by the company, the local authorities, and social services. Better support results in better rehabilitation outcomes and an easier return to work and community life.

Factors Determining Outcome After Trigeminal Nerve Surgery for Neuropathic Pain

Most patients who seek relief from trigeminal neuropathic pain by trigeminal microneurosurgery techniques do not show permanent pain relief after surgery. However, a small number of patients have permanent relief after surgery. The objective of this study was to determine factors that might be associated with the resolution, decrease, or recurrence of neuropathic pain after trigeminal nerve surgery in those patients who present with neuropathic pain before surgery. An ambispective study design was used to assess patients who underwent trigeminal nerve repair of the inferior alveolar and lingual nerve who had documented neuropathic pain before surgery from 2006 through 2014. The primary endpoint was the difference in pain intensity at 3, 6, and 12months after surgery compared with presurgical intensity levels. Explanatory variables, including age at surgery, gender, site of nerve injury, etiology of nerve injury, classification of nerve injury, duration from injury to repair, health comorbidities, and type of repair performed, were evaluated as potential factors in the outcomes. Wilcoxon signed rank analysis was used to compare demographic and injury characteristics of patients who had pain relief, partial pain relief, and no pain relief after surgery. Two-way analysis of variance and logistic regression analysis were used to evaluate the association between neuropathic pain and the explanatory variables. Twenty-eight patients met the inclusion criteria. Three cohorts of patients were identified and analyzed. The no-recurrence cohort included 7 patients who had neuropathic pain before surgery that was resolved with surgery. The complete-recurrence (CR) cohort included 10 patients who had neuropathic pain before surgery and complete recurrence of pain intensity after surgery. The incomplete-recurrence (ICR) cohort included 11 patients who had neuropathic pain before surgery and partial recurrence of pain intensity after surgery. There was no statistical difference in preoperative pain intensity levels among the 3 cohorts (P= .16), but there were statistical differences at 3months (P= .007), 6months (P < .0001), and 12months (P < .0001). There were no statistical differences between the CR and ICR cohorts at 3months (P= .502), 6months (P= .1), and 12months (P= .2). There was no effect by age, gender, injury type, Sunderland classification, injury etiology, duration from injury to repair, health comorbidity, or repair type on the outcome. The recurrence of neuropathic pain after trigeminal nerve repair for neuropathic pain is likely multifactorial and might not depend on factors that normally affect sensory recovery in patients who have no neuropathic pain (ie, age, duration of injury, type of injury, or repair type) and undergo trigeminal nerve surgery. These differences indicate that the understanding of trigeminal neuropathic pain is incomplete. Predictive outcomes of treatment will probably improve when the etiology is better defined to allow target- and site-specific treatment. In the meantime, trigeminal nerve surgery is a treatment option that offers a chance of decreasing or resolving pain intensity.

Psychophysical investigations into Ramachandran&amp;#x2019;s mirror visual feedback for phantom limb pain: video-based variants for unilateral and bilateral amputees, and temporal dynamics of paresthesias

It is widely reported by Ramachandran, Altschuler and others that simple mirror visual feedback can cause phantom sensations in normal observers, and reduce phantom limb pain in amputees. First, a recent experiment designed to replicate classic findings (59 amputees) is reviewed, along with a mirror-based variant developed for bilateral amputees. Then, two variants are described which were intended to intensify effects without eliciting fatigue, and to sometimes reduce phantom pain when the simple mirror is ineffective. The first (simple video feedback) uses a laptop video movie of another (intact) person&#x2019;s limb movement (with metronome-paced periodic movement). The second (&#x201C;phantom pulse&#x201D;) uses a real-time video image of the observer that flickers between a normal image and a mirror-reversed image at rates varying form 0.5 to 2 cycles/sec (with an 0.2-sec delay). For both conditions, preliminary data from amputees support the finding that movement of one limb causes phantom sensations in the opposite limb, followed by seemingly permanent pain reduction in some amputees. Moreover when normal observers view their movements in these ways, they often report paresthesias, with optimal stimulation occurring in most individuals at 1-2 Hz. Thus psychophysical results may indicate that neural mechanisms underlying mirror visual feedback are temporarily tuned.

Treatment of Rockwood type III acromioclavicular joint dislocation using autogenous semitendinosus tendon graft and endobutton technique.

BackgroundThe aim of this study was to evaluate the therapeutic effect of autogenous semitendinosus graft and endobutton technique, and compare with hook plate in treatment of Rockwood type III acromioclavicular (AC) joint dislocation.MethodsFrom April 2012 to April 2013, we treated 46 patients with Rockwood type III AC joint dislocation. Patients were randomly divided into two groups: Group A was treated using a hook plate and Group B with autogenous semitendinosus graft and endobutton technique. All participants were followed up for 12 months. Radiographic examinations were performed every 2 months postoperatively, and clinical evaluation was performed using the Constant–Murley score at the last follow-up.ResultsResults indicated that patients in Group B showed higher mean scores (90.3±5.4) than Group A (80.4±11.5) in terms of Constant–Murley score (P=0.001). Group B patients scored higher in terms of pain (P=0.002), activities (P=0.02), range of motion (P<0.001), and strength (P=0.004). In Group A, moderate pain was reported by 2 (8.7%) and mild pain by 8 (34.8%) patients. Mild pain was reported by 1 (4.3%) patient in Group B. All patients in Group B maintained complete reduction, while 2 (8.7%) patients in Group A experienced partial reduction loss. Two patients (8.7%) encountered acromial osteolysis on latest radiographs, with moderate shoulder pain and limited range of motion.ConclusionAutogenous semitendinosus graft and endobutton technique showed better results compared with the hook plate method and exhibited advantages of fewer complications such as permanent pain and acromial osteolysis.

Primary Non-Hodgkins Lymphoma Mimicking Lateral Epicondylitis

Primary bone lymphoma constitutes 3-7% of all malign bone tumors and extra-nodal lymphomas. Joint infiltration is very rare clinical entity and mono arthritis may be a secondary synovial reaction to adjacent bone disease or direct synovial involvement. Radiological features of primary lymphoma of bone may present with different findings. Lateral epicondylitis is one of the most causes of elbow pain. It is usually observed between 30 and 50 years of age. The main symptom is the pain at the lateral epicondyle of the elbow. We report a case of primary Non-Hodgkin's Lymphoma mimicking lateral epicondylitis a 61 years female patient. It emphasizes the need for a high clinical suspicion in susceptible cases, particularly in permanent bone and joint pain.

Clinical parameter of odontoma with special emphasis on treatment of impacted teeth-a retrospective multicentre study and literature review.

Odontoma-separated into complex (CxOD) and compound (CpOD) subtypes-represents the most frequent odontogenic malformation. Retention of permanent teeth is a common symptom. Therefore, in a series of odontomas, an analysis of the management of retained teeth was conducted. In a retrospective multicenter study of two University Medical Centers and one private praxis in Germany, demographic and clinical data regarding odontomas from 01/2000-03/2015 were obtained. In particular, the influence of operative therapy on the dentition and on the treatment of impacted teeth was analyzed. Forty-five patients with 15 CxOD and 30 CpOD were included. Initial symptoms were delayed eruption of permanent teeth (n=11), pain (n=4), and swellings (n=2); 28 cases were discovered by incidence, all of them via panoramic radiographs. The mandible/maxilla ratio was about 1:0.55 (29/16). Thirty-five out of 45 odontomas were in close proximity of at least one tooth (n=16 at molars). A total of 14 teeth were extracted (CxOD: n=5; CpOD: n=9). Extractions had to be conducted more often in older patients (mean age 39.8 vs. 25.6years). Of the non-extracted teeth, 8 teeth were displaced and retained. Of those, 4 teeth were aligned in the dental arch via orthodontic help and 2 teeth erupted spontaneously after operation during the follow-up period. In all cases, no relapse was seen. Odontomas can cause displacement as well as malformation and resorption of the adjacent teeth. Mostly, removal of odontomas is conducted. Extirpation of odontoma can allow for normal tooth eruption, often rendering extractions avoidable. Orthodontic alignment, though sometimes challenging, is a reasonable therapeutic option. These findings underline the value of the panoramic radiograph in preventive dentistry in younger patients.