http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12775 Noncardiac chest pain (NCCP) is very prevalent in the community. Although mortality remains low, morbidity and the financial implications are high. Women, especially those of middle age, should be thoroughly investigated as per current guidelines for coronary artery disease before labeling their chest pain as NCCP. Gastroesophageal reflux disease is the most common cause of NCCP; however other esophageal pathology including esophageal hypersensitivity, neuromuscular disease and eosinophilic esophagitis may also cause NCCP. Proton pump inhibitors are commonly used initially to manage NCCP, although patients who do not respond to this therapy require further investigation and differing treatment regimes. This article will focus on current knowledge regarding GI tract-related NCCP management strategies. 2013-04-16T05:17:12.810Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12744 Questions concerning the power of central nervous factors to significantly regulate coronary conductance receive new impetus each time a patient presents with unexplained chest pain. A familiar story is that of Mrs. V. C., who has bouts of crushing central chest pain at inappropriate times, as well as reproducible progressive and diagnostic ST segment depression on her electrocardiogram without pain during exercise to exhaustion, while having a normal coronary arteriogram and thallium scan. Such clinical observations suggest that some inherent mismatch during exercise can exist between neurohumoral vasconstrictor and local vasodilator factors. Furthermore, although the effects on coronary conductance of conventional experimental stimuli (i.e., those affecting arterial baro- and chemoreceptors) and of cardiac and pulmonary receptors have been investigated, the effects of direct central nervous influences (e.g., emotion) remain largely unknown. Moreover, how the gain of peripheral reflex changes in coronary conductance may be altered by central influences is also unknown. The studies summarized in this chapter were undertaken to investigate the possibility that central nervous μ-opioid agonists such as fentanyl, and monoamines such as 5-hydroxytryptamine (serotonin), can alter vagal vasodilator and sympathetic vasoconstrictor mechanisms in the coronary circulation at rest and during reflex disturbances. Further justification for such studies comes from data showing that humans and other mammals have a distribution of opiate receptors and serotonin-synthesizing neurons concentrated in and around structures known to be part of cardiorespiratory reflex pathways. Questions concerning the power of central nervous factors to significantly regulate coronary conductance receive new impetus each time a patient presents with unexplained chest pain. A familiar story is that of Mrs. V. C., who has bouts of crushing central chest pain at inappropriate times, as well as reproducible progressive and diagnostic ST segment depression on her electrocardiogram without pain during exercise to exhaustion, while having a normal coronary arteriogram and thallium scan. Such clinical observations suggest that some inherent mismatch during exercise can exist between neurohumoral vasconstrictor and local vasodilator factors. Furthermore, although the effects on coronary conductance of conventional experimental stimuli (i.e., those affecting arterial baro- and chemoreceptors) and of cardiac and pulmonary receptors have been investigated, the effects of direct central nervous influences (e.g., emotion) remain largely unknown. Moreover, how the gain of peripheral reflex changes in coronary conductance may be altered by central influences is also unknown. The studies summarized in this chapter were undertaken to investigate the possibility that central nervous μ-opioid agonists such as fentanyl, and monoamines such as 5-hydroxytryptamine (serotonin), can alter vagal vasodilator and sympathetic vasoconstrictor mechanisms in the coronary circulation at rest and during reflex disturbances. Further justification for such studies comes from data showing that humans and other mammals have a distribution of opiate receptors and serotonin-synthesizing neurons concentrated in and around structures known to be part of cardiorespiratory reflex pathways. 2013-04-08T04:53:03.464Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7687 The aim of this paper is to describe the challenges associated with conducting a pilot study designed to evaluate the effectiveness of targeting pain in older people. 2013-03-27T05:21:17.994Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12383 Introduction: Diagnostic criteria for irritable bowel syndrome (IBS) have not been validated by prospective symptom diary. We investigated the bowel patterns in community subjects with and without non-organic abdominal pain, and compared the symptoms with subjects fulfilling the Rome II criteria (IBS). Methods: From the Swedish population register, a random sample completed an abdominal symptom questionnaire. Responders were subsequently invited for a clinical evaluation and offered a colonoscopy regardless of whether they had abdominal symptoms or not. A total of 268 subjects underwent colonoscopy, clinical evaluation by gastroenterologist, laboratory investigations, and completed the Rome questionnaire and prospective gastrointestinal (GI) symptom diaries for 1 week. Twenty-three subjects of 268 were excluded due to organic GI disease. Results: Subjects recorded 2,194 bowel movements and 370 abdominal pain episodes on 1,504 days. Subjects with pain in the diary (n = 81) had higher stool frequency (P = 0.01), more urgency (P = 0.0002), feelings of incomplete evacuation (P = 0.0002), nausea (P = 0.0009), and abdominal bloating (P = 0.0005) than subjects without pain (n = 151). Twenty-eight subjects (12%) fulfilled the Rome II criteria for IBS. Together, they had 96 pain episodes but only 4% were improved by defecation; 29% of the pain episodes started or worsened after a meal. Subjects with IBS and other subjects with non-organic abdominal pain (n = 64) exhibited no differences in terms of the proportions of pain episodes improved by defecation, bloating, stool frequency, consistency, or defecatory symptoms. Conclusions: Current criteria for IBS that rely on recall of the relationship between abdominal pain and bowel disturbance may overcall this association when measured prospectively. 2013-01-10T01:50:04.109Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12375 Background: Prevalence of, and risk factors for, noncardiac chest pain in the community have not been well studied. Aims: To conduct a systematic review and meta-analysis to examine these issues. Methods: MEDLINE, EMBASE and EMBASE Classic were searched (up to March 2011) to identify population-based studies reporting prevalence of noncardiac chest pain in adults (≥15 years) according to self-report, questionnaire or specific symptom-based criteria. Prevalence of noncardiac chest pain was extracted for all studies, and according to study location and certain other characteristics including presence or absence of gastro-oesophageal reflux disease (GERD) symptoms, where reported. Pooled prevalence overall, as well as odds ratios (OR), with 95% confidence intervals (CIs) were calculated. Results: Of 18 articles evaluated, 16 reported prevalence of noncardiac chest pain in 14 separate populations, containing 24 849 subjects. Pooled prevalence of noncardiac chest pain in all studies was 13% (95% CI 9–16). The prevalence of noncardiac chest pain was higher in Australian studies and in studies using a questionnaire to define its presence, compared with those using Rome I or II criteria. Prevalence was no different in women vs. men (OR 0.99; 95% CI 0.82–1.20). The prevalence was markedly higher in subjects who also reported GERD (OR 4.71; 95% CI 3.32–6.70) and increased according to frequency of GERD symptoms. Conclusions: Pooled prevalence of noncardiac chest pain in the community was 13%, but there were few studies. Rates did not appear to differ according to gender or age. Presence of GERD was strongly associated with noncardiac chest pain. 2013-01-09T04:20:06.488Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12374 Objectives: Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained chest pain, and to identify whether any potential relationship is being driven by an association with psychological distress. Methods: Subjects were identified from 2 previous random population surveys that included people with irritable bowel syndrome (IBS) and/or functional dyspepsia (FD) and healthy controls. People in the unexplained chest pain group (n = 27) had chest pain in the past 12 months that was not heartburn or heart disease. People in the comparison group (n = 60) did not have chest pain for more than 12 months. Self-reported abuse and psychological variables were assessed using validated measures. Results: Emotional/verbal abuse (20.8% versus 4.4%, P = 0.032) and physical abuse (16.7% versus 2.2%, P = 0.028) were significantly more common in people with unexplained chest pain versus the comparison group. Only a history of emotional/verbal abuse was a significant independent predictor of meeting criteria for unexplained chest pain (OR = 5.66; 95%CI 1.01–31.80, P = 0.049) even after controlling for IBS and/or FD (OR = 5.45; 95%CI 0.96–30.83, P = .05), but not when depression was controlled for (OR = 4.70; 95%CI 0.90–27.61), P = 0.08. Conclusions: A history of childhood emotional/verbal abuse is a risk factor for having unexplained chest pain but the association may be moderated by psychological distress, specifically depression. 2013-01-09T04:10:04.231Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12216 Background: Eosinophilic oesophagitis clinically presents with recurrent episodes of dysphagia and food impaction. Recently, we observed patients with noncardiac chest pain and eosinophilic oesophagitis. Aims: To estimate the prevalence of abnormal eosinophilic infiltration in noncardiac chest pain patients and examine diagnostic utility of demographic, clinical and endoscopic variables to predict eosinophilic oesophagitis. Methods: Retrospective study of 171 consecutive patients referred for EGD evaluation of noncardiac chest pain. Endoscopic signs consistent with eosinophilic oesophagitis were recorded. The histological findings were grouped as normal: 0–5 eosinophils/high power field (e/hpf), indeterminate: 6–20 e/hpf, and eosinophilic oesophagitis: ≥21 e/hpf. Abnormal eosinophilic infiltration was defined as ≥6 e/hpf. Results: Abnormal eosinophilic infiltrate was noted in 24 patients (14%). Thirteen (8%) had indeterminate counts, while 11 (6%) had eosinophilic oesophagitis. Compared with normal, those with abnormal oesophageal eosinophilic infiltration were more likely to be male (71% vs. 34%, P = 0.001), have allergies (29% vs. 12%, P = 0.050), have current GER symptoms (42% vs. 18%, P = 0.013), rings (54% vs. 22%, P = 0.002), furrows (21% vs. 1%, P < 0.001) and abnormal eosinophilic oesophagitis findings on endoscopy (67% vs. 32%, P = 0.001). Of the 24 abnormal patients, 23 (96%) were either male or had rings, furrows, or white specs. Conversely, 68 of 69 patients (99%) who were female did not have rings, furrows, or white specs, and endoscopy was normal. Eight patients (33%) with abnormal eosinophilic infiltration had a normal endoscopy. Conclusions: Eosinophilic oesophagitis should be considered in the evaluation of noncardiac chest pain. Our findings suggest that oesophageal biopsies should be obtained particularly in males with recurrent unexplained chest pain, whether endoscopy is normal or abnormal. 2012-12-14T00:30:04.435Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:12171 This paper reports on the facilitators and barriers to the development and implementation of a pilot study undertaken in collaboration by clinicians from an Australian Area Health Service and academics from The University of Newcastle. It includes a description of a computerised clinical chart audit tool that may be developed to automate audits in the future. The pilot study investigated the efficacy of an educational promotion, termed the “Targeting Pain” campaign, to facilitate the detection and management of pain in older patients in an acute care ward of a large tertiary hospital. 2012-12-06T03:44:50.259Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11820 Professional Doctorate - Doctor of Clinical and Health Psychology 2012-10-26T05:23:38.580Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11242 Masters Research - Master of Philosophy (MPhil) 2012-08-14T00:31:16.068Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:11146 Background: Transforaminal injection of steroids is used to treat lumbar radicular pain. Not known is whether the route of injection or the agent injected is significant. Study Design: A prospective, randomized study compared the outcomes of transforaminal injection of steroid and local anesthetic, local anesthetic alone, or normal saline, and intramuscular injection of steroid or normal saline. Patients and outcome evaluators were blinded as to agent administered. Methods: The primary outcome measure was the proportion of patients who achieved complete relief of pain, or at least 50% relief, at 1 month after treatment. Secondary outcome measures were function, disability, patient-specified functional outcomes,use of other health care, and duration of relief beyond 1 month. Results: A significantly greater proportion of patients treated with transforaminal injection of steroid (54%) achieved relief of pain than didpatients treated with transforaminal injection of local anesthetic (7%) or transforaminal injection of saline (19%), intramuscular steroids (21%), or intramuscular saline (13%). Relief of pain was corroborated by significant improvements in function and disability, and reductions in use of other health care. Outcomes were equivalent for patients with acute or chronic radicular pain. Over time, the number of patients who maintained relief diminished. Only some maintained relief beyond 12 months. The proportions of patients doing so were not significantly different statistically between groups. Discussion: Transforaminal injection of steroids is effective only in a proportion of patients. Its superiority over other injections is obscured when group data are compared but emerges when categorical outcomes are calculated. Over time, the proportion of patients with maintained responses diminishes. 2012-07-30T23:41:50.858Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:3817 Question: Is there an association between Caesarean section and back pain over the longer term? Design: Secondary analysis of data from the Australian Longitudinal Study on Women’s Health. Participants: The mid-aged cohort of women within the Australian Longitudinal Study on Women’s Health aged 54 to 59 years (n = 9146). Outcome measures: Data were included from women who answered the question regarding back pain. Data were extracted on whether they had given birth and, if so, whether it was by Caesarean section. Then, data on confounding variables (such as arthritis, asthma, osteoporosis, hysterectomy, ovaries removed, and repair of prolapsed vagina, bladder or bowel, menopause, smoking) were also extracted. Results: After adjusting for confounding factors, women who delivered by Caesarean section had the same odds (OR 1.03, 95% CI 0.81 to 1.31) of having back pain as women who had not had a birth. Conclusion: Previous delivery by Caesarean section is not associated with increased back pain in mid-aged Australian women. 2012-05-29T02:04:17.705Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10572 The aim of this study was to evaluate the influence of posture and body type on the experience of exercise-related transient abdominal pain (ETAP). Postural and somatotype assessments were performed on 104 active males and 55 active females aged 18.6 ± 0.4 years (mean ± SD) and were correlated against their self-reported experience of ETAP. Individuals demonstrating kyphosis were more likely to be susceptible to ETAP (p < 0.01). Among the individuals susceptible to ETAP, the extent of kyphosis and lordosis influenced the pain severity (p < 0.05). There was no relationship between any measure of body type and ETAP. The findings indicate that postural abnormality, particularly in the thoracic region, influences the experience of ETAP. 2012-03-30T01:03:11.180Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10511 The present article describes a pattern of abnormal responses to pain (APR) among children in care, suggestive of pain insensitivity or failure to communicate felt pain. Exploratory analyses of caregiver-reported APR were conducted within a larger epidemiological study of 347 preadolescent children in foster and kinship care. APR items were generated from clinical assessment reports and a clinician survey, during development of a psychiatric rating scale for children in care. An APR construct was identified in factor analysis. Nine per cent of the sample had scores suggesting clinically meaningful APR, with a high level of corresponding psychological disturbance. Various analyses suggest the phenomenon may be a discrete, but integral component of complex, multifaceted psychopathology. Concurrent and retrospective measures of a large number of potential risk variables did not discriminate between APR scores and other estimates of psychopathology. However, moderate correlations between APR and ad hoc measures of impulsivity, dissociative behaviours, and inhibited-avoidant attachment difficulties suggest a number of hypothesized developmental mechanisms that might be explored in further studies. 2012-03-25T22:10:09.553Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10443 Aims: This article looks at the effect that fear of movement can have on the lives of people with chronic low back pain. It describes the experiences of people who were attending a six week work hardening programme as part of their vocational rehabilitation in Sydney, Australia. Method: A thematic content analysis of data collected during an ethnographic study of eleven unemployed participants with chronic low back pain who attended the work hardening programme took place. The analysis focused on the effects of fear of movement on the participants' lives. Findings: The fear of movement impacted on all aspects of the participants' daily occupations and restricted their occupational roles. These changes involved loss of occupational roles, relationship changes, loss of participation in leisure and encountering barriers to returning to paid employment. Conclusions: The findings suggest that fear of movement has a significant effect on all areas of the lives of people with chronic low back pain. Recognizing fear of movement as a barrier will enable health professionals involved in vocational rehabilitation to develop a greater understanding of the context in which people with chronic low back pain live. 2012-03-19T21:40:05.023Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10393 Professional Doctorate - Doctorate of Clinical and Health Psychology 2012-03-13T01:10:11.596Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9989 We investigated the epidemiology of musculoskeletal symptoms (MSS) among a complete cross-section of 330 nurses from a large Korean hospital, by means of a questionnaire survey (response rate: 97.9%). The prevalence of MSS at any body site was 93.6%, with symptoms most commonly reported at the shoulder (74.5%), lower back (72.4%), neck (62.7%), lower legs (52.1%) and hand/wrist (46.7%). Logistic regression indicated that nurses who undertook manual handling of patients were 7.2 times as likely to report MSS (OR 7.2, 95%CI 1.2–42.3, P = .0275), while nurses suffering from periodic depression experienced a 3.3-fold MSS risk (OR 3.3, 95%CI 1.3–8.3, P = .0104). Overall, our study suggests that Korean nurses incur a very high MSS burden when compared internationally. A greater commitment is needed to improve physical conditions, occupational tasks and psychosocial work issues among nurses in this country. 2012-02-09T04:30:03.663Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9914 Peripheral mechanisms of endogenous pain control are significant. In peripheral inflamed tissue, an interaction between immune-cell-derived opioids and opioid receptors localized on sensory nerve terminals results in potent, clinically measurable analgesia. Opioid peptides and the mRNA encoding their precursor proteins are present in immune cells. These cells ‘home’ preferentially to injured tissue, where they secrete opioids to reduce pain. Investigation of the mechanisms underlying the migration of opioid-containing immune cells to inflamed tissue is an active area of research, with recent data demonstrating the importance of cell adhesion molecules in leukocyte adhesion to both the endothelium in vascular transmigration and to neurons within peripheral inflamed tissue. This review summarizes the physiological mechanisms and clinical significance of this unique endogenous peripheral analgesic pathway and discusses therapeutic implications for the development of novel targeted peripheral analgesics. 2012-02-07T23:50:04.095Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9880 Evidence suggests that exposure to bacterial endotoxin in early life can alter the production of pro-inflammatory cytokines in later life. This phenomenon may have significant consequences for pain and pain related behaviours as pro-inflammatory cytokines heighten pain sensitivity. This association has yet to be examined. As such, the aim of the present study was to characterize pain behaviours in adult rat offspring following prenatal endotoxin (PE) exposure. Pregnant F344 rats received endotoxin (200 µg/kg, s.c.) or saline on gestational days 16, 18 and 20. Pain thresholds were assessed in the adult PE offspring (n = 23) and control offspring (n = 24) prior to and 4 h following administration of lipopolysaccharide (LPS; 100 µg/kg, s.c.). Three assays of pain were employed — the hot plate, tail immersion and von Frey tests. Results demonstrated sex-specific effects of prenatal endotoxin on the offspring, with PE males displaying unaltered pain thresholds on the von Frey test post-LPS administration (p < 0.01), while male control offspring (n = 24) displayed the expected hyperalgesia. Male PE offspring also displayed increased pain thresholds on the tail immersion test (p < 0.01), while no change in pain sensitivity was observed in control males following LPS exposure. No difference in response was observed between the female PE and control offspring on the von Frey test, however PE female offspring displayed increased thresholds on the tail immersion test compared to baseline — an effect not observed in the control female offspring. Pain sensitivity on the hot plate test was unaffected by prenatal exposure to endotoxin. These data suggest that prenatal exposure to products associated with bacterial infection have the capacity to alter pain responses, which are evident in the adult offspring. 2012-02-01T00:40:04.919Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7973 Pain assessments are rarely documented by health care workers outside pain services, which are a contributing factor to poor pain management. The acuity of most wards in major teaching hospitals is such that pain management often competes with overwhelming demands on clinicians’ time and thought processes. Strategies to overcome these barriers to effective pain management include the use of promotional materials as part of a multimodal approach which included face-to-face staff education. The use of visual aides or reminders to clinicians may have a greater impact on changing practice than traditional interventions such as education alone. Many studies in the area use multifaceted programs with a number of interventions combined to produce the desired outcome of changing clinicians’ behaviour and improving care for patients. It has been demonstrated that posters placed at crucial points can assist to ensure that a targeted message can get through to clinical staff. 2012-01-30T05:09:57.068Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7599 Approximately one-quarter of the population are affected by foot pain at any given time. It is often disabling and can impair mood, behaviour, self-care ability and overall quality of life. Currently, the nature and mechanism underlying many types of foot pain is not clearly understood. Here we comprehensively review the literature on foot pain, with specific reference to its definition, prevalence, aetiology and predictors, classification, measurement and impact. We also discuss the complexities of foot pain as a sensory, emotional and psychosocial experience in the context of clinical practice, therapeutic trials and the placebo effect. A deeper understanding of foot pain is needed to identify causal pathways, classify diagnoses, quantify severity, evaluate long term implications and better target clinical intervention. 2012-01-30T05:09:27.378Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4980 Objective: The aim of this paper is to identify midwifery and medical strategies that reduce pain and morbidity resulting from perineal trauma. The question put forward was What midwifery and medical strategies reduce pain and morbidity associated with perineal trauma resulting from birth? Method: A review of the literature was undertaken. Both qualitative and quantitative research-based literature related to perineal pain was examined. Findings: Cold therapy and analgesia reduce pain and oedema in the immediate postnatal period, while pelvic floor exercises reduce incontinence in the longer term. Conclusion: Prevention of perineal trauma is most favourable outcome for birthing women. Where perineal trauma exists, women should be offered analgesia and/or cold therapy to relieve immediate and short-term pain and morbidity. Longer-term morbidity and the incidence of postnatal incontinence is reduced with adherence to exercise programs. Midwives must become more proactive in preventative measures that reduce perineal trauma and provide pain relief strategies when perineal trauma exists. 2012-01-30T04:08:31.542Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5087 The purpose of the overall study was to explore the lived experiences of older people with chronic unrelieved pain, who live in residential aged care facilities. This paper presents one of the main themes from the study which was conducted using a phenomenological study. This study was undertaken at three aged care facilities within the Hunter New England Area Health Service (HNEAHS). Thirteen people aged 75 years and over, were interviewed for this study. The main outcome measures led to an understanding of what it is like for older people to live with chronic unrelieved pain in a residential aged care facility. A key theme that emerged from this study was “Attending to life” comprising four sub-themes including “preserving oneself”, “feeling useful/useless”, “tending the body”, and “attending to spirituality”. “Attending to life” shows how elderly people with chronic pain responded to the world of the residential aged care facility, in particular, how they immersed themselves in their “living present” whilst suffering with chronic unrelieved pain. An important feature of “attending to life” is that in order to stay actively engaged in the world, the participants busied themselves with acts of self-preservation and self-care. The findings of this paper highlight the importance of self-identity in the nursing home setting and show how unrelieved pain mitigates this. 2012-01-30T04:05:27.426Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9658 Back problems and back pain are amongst the most prevalent conditions afflicting Australians and carry high direct and indirect costs for the health care systems of all developed countries. A major gap in the research literature on this topic is the longitudinal analysis of health seeking behaviour for people with back pain. All studies to date have been cross-sectional and it is important that the use of different providers (both conventional and complementary and alternative medicine, CAM) is examined over time. This study analysed data from a longitudinal study conducted over a 3-year period on 8,910 young Australian women. Information on health service use, self-prescribed treatments, and health status was obtained from two questionnaires mailed to study participants in 2003 and 2006. We found that there is little difference in the consultation practises or use of self-prescribed CAM between women who recently sought help for back pain and women who had longer-term back pain; the only difference being that women with longer-term back pain consulted more with chiropractors. We conclude that women who seek help for their back pain are frequent visitors to a range of conventional and CAM practitioners and are also high users of self-prescribed CAM treatments. The frequent use of a range of conventional providers and practitioner-based and self-prescribed CAM amongst women with back pain warrants further investigation. 2011-12-08T00:50:03.991Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9599 Many conditions associated with chronic pain have no detectable morphological correlate. Consequently, the source of pain cannot be established by clinical examination or medical imaging. However, for some such conditions, the source of pain can be established using diagnostic blocks. The aim of this paper is to review the available evidence concerning the validity and utility of diagnostic blocks, and to identify areas where research is needed. Diagnostic blocks for cervical and lumbar zygapophysial joint pain have been extensively studied. Single blocks are associated with about 30% false-positive responses. Patients can report relief of pain for reasons other than the effect of a local anaesthetic injected during a diagnostic block, e.g. as the result of placebo effect. Therefore, in order to be valid, diagnostic blocks must be controlled in each patient. Many practitioners find limitations in the clinical applicability of placebo-controlled blocks. Comparative blocks (comparison lidocaine–bupivacaine for each block within each patient) have been investigated as alternatives to placebo-controlled blocks. A positive response requires short-lasting relief when lidocaine is used, and long-lasting relief when bupivacaine is used. The validity of comparative blocks is high when the disease under investigation is common. This is the case for zygapophysial joint pain after whiplash injury. However, the validity of comparative blocks strongly decreases with decreasing prevalence of the condition. This is the case for lumbar zygapophysial joint pain in young subjects: in these patients, the expected false-positive rate with comparative blocks is unacceptably high. Diagnostic blocks for cervical and lumbar zygapophysial joint have therapeutic utility. When positive, radiofrequency denervation is expected to produce substantial pain relief in 60–80% of patients. For all other types of blocks, very little research has been conducted. The few studies that have been published did not use controlled blocks. This may have produced a high rate of false-positive responses. Some data on spinal nerve root blocks suggest that these procedures may be valid for the diagnosis of radicular pain and are perhaps predictive for the success of surgery. The validity of diagnostic sympathetic blocks and their prognostic value in relation to outcomes of sympathectomy are unclear. There is lack of data on the validity of diagnostic intra-articular blocks. Discogenic pain is typically diagnosed by provocative discography, but this procedure remains controversial. Intradiscal and sinuvertebral nerve blocks with local anaesthetics are possible alternatives to provocation discography. At present, the sparse data available on these procedures do not allow an estimation of their validity. In conclusion, nerve blocks have an important potential role in the management of chronic pain. These procedures are not suitable to identify the pathology that is the cause of the pain (e.g. inflammatory, neuropathic, etc.). However, they can reveal the anatomical source of pain, thereby allowing the development of targeted treatments. Unfortunately, there is currently very little research on the validity and prognostic value of blocks. The potential usefulness of this practice remains therefore largely unexplored. 2011-12-06T00:50:03.713Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9482 This paper reports the findings of an exploratory pilot study which used mixed methods to determine (a) the feasibility of the study design for a larger multi site project and (b) whether a pain education promotion approach, termed ‘Targeting Pain’, using a multidisciplinary educational campaign and promotional media such as staff badges and ward signage, improves the detection and management of pain in older people in an acute care setting. Pre and post evaluation surveys and interviews were used to evaluate the approach. Findings showed an increase in pain assessment and documentation of pain by nursing staff, as well as an increase in the prescription of oral analgesics. However, the study indicated that the uptake regarding pain management from the education campaign was different between professional groups. Although there was a positive response by patients and staff to the use of staff badges, the ward signage failed to attract attention. The mixed methods approach used highlighted several areas that need to be improved for the next phase of the study. 2011-11-28T02:40:04.170Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9419 Background: Chronic anal pain is relatively common as a presentation to specialist physicians and surgeons. Currently, it is regarded as a functional disorder upon the exclusion of occult intersphincteric sepsis. Our study assessed an unselected cohort of patients presenting with chronic previously undiagnosed anal pain using routine ultrasonography. Methods: All patients referred to a tertiary gastroenterology service between January 2005 and January 2008 with a diagnosis of chronic anal pain (>3 months duration with no clinical anorectal signs) underwent endoanal and static and dynamic transperineal ultrasound to assess for the frequency and pattern of occult intersphincteric sepsis. Results : Of 1,580 patients referred, there were 146 presenting with chronic anal pain as a main symptom. Of these, 37 (25.3%) had intersphincteric sepsis (ISS) diagnosed with ultrasound examination with 17 undergoing evaluable surgery. There was a male preponderance (70.3%) with the diagnosis being made in 46% of cases after 6 months of symptoms and with 80.8% having posteriorly located sepsis. This occurred on a background of 62% having previous acute proctological conditions. There was complete ultrasonographic and operative concordance with 15 becoming asymptomatic after surgery at a mean follow-up of 6 months. Conclusion : Occult intersphincteric sepsis is not uncommon and is diagnosed using routine ultrasonography at the time of clinical presentation. Endoanal and transperineal ultrasound is recommended as part of the investigative armamentarium to exclude categorization as functional anorectal pain. This is currently not part of the Rome III coding for such a diagnosis suggesting a revision of these diagnostic criteria for the ultimate diagnosis of functional proctalgia. 2011-11-17T04:10:03.726Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9398 Nick Cave has asserted that all his songs are love songs. Rather than follow his own guidelines for interpreting his work in terms of biblical influences from the Song of Solomon and the Psalms, I suggest a fourfold schema. It operates in terms of the presence and absence of both God and pain. There are very few of the secular soppy songs (no pain, no God) that are standard fare for much pop music and the ones Cave does offer are not very good. A few more appear in the painlessly divine songs (no pain, with God), which are the songs that opened Cave’s work out to wider audiences. However, the vast majority are either painfully secular songs (with pain, no God) or the brutally divine ones (both pain and God are present). I explore these in more detail, since here we find complex overlaps between God, pain and women. 2011-11-16T02:10:07.341Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9300 Objective: To determine the effect of cardiac troponin I testing with a point-of-care (POC) device versus central laboratory on length of stay (LOS) in emergency department (ED) patients presenting with possible acute coronary syndromes (ACS). Methods: A 12-week randomised controlled trial at two metropolitan ED in eastern Australia with a combined annual census of 80 000. Participants were all patients presenting with possible ACS. Exclusions were a diagnosis of ACS before arrival, ST elevation and failure to wait for complete assessment. Randomisation was by week when POC was made available. Primary outcome was LOS from patient arrival to physical departure from the ED. The proportion of patients meeting a government target of less than 8 h stay was compared. Analysis was by intention to treat. Results: Despite underutilisation of POC, LOS was shorter during weeks when it was available. The time savings translates into approximately 48 minutes (95% CI 12 to 84) per average LOS of almost 7 h, which did not reach statistical significance (p=0.063), or an absolute increase of 10% (95% CI 4.3 to 16.6) in the number of people discharged from the ED within the target LOS of less than 8 h, which did reach significance (p=0.007). These savings were more pronounced in the setting without 24 h central laboratory availability. Conclusions: POC testing for troponin in the ED tended to reduce the LOS for possible ACS patients. The degree of this benefit is likely to be markedly dependent on its acceptance and uptake by attending personnel, and on the ED setting in which it is used. 2011-11-09T22:50:04.926Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8471 Die Wirbelbogengelenke sind kleine Diarthrosen, die entlang der Rückseite der Wirbelsäule angeordnet sind. Sie kommen paarweise auf beiden Seiten vor und verbinden die aufeinanderfolgenden Wirbel vom zweiten Halswirbel (C2) bis zum ersten Brustwirbel (Th1) miteinander. Schmerzen in den Wirbelbogengelenken sind die häufigste Ursache chronischer Nackenschmerzen nach einem Schleudertrauma. Biomechanische Studien haben gezeigt, wie diese verletzt werden können. Postmortale Studien haben die Verletzung dargelegt, die sie schädigen kann. Klinische Studien haben gezeigt, wie haufig diese Gelenke eine Schmerzquelle sind, wie dieser Schmerz diagnostiziert und wie er behandelt werden kann. 2011-07-29T06:50:55.166Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8350 Objective: Although musculoskeletal disorders (MSD) represent one of the most important occupational health issues in contemporary society, few studies have specifically investigated this problem among veterinarians. Design: An anonymous questionnaire survey mailed to all veterinarians registered with the Veterinary Surgeons Board of Queensland during 2006. Results: Almost two-thirds of respondents (63%) had experienced MSD of the lower back, 57% had experienced neck-related MSD, 52% had experienced shoulder-related MSD and 34% had experienced MSD of the upper back during the previous 12 months. MSD was statistically correlated with a range of psychosocial factors, including stress associated with career structure, time pressures, client's attitude, lack of recognition by the public, lack of recognition by colleagues, lack of understanding from family or partners and work stress because of insufficient holidays each year. Conclusion: Overall, this study has demonstrated significant correlations between MSD and psychosocial risk factors among a large cohort of veterinarians, apparently for the first time in the published literature. The results also suggest that personal and workplace issues may contribute more to the development of MSD among veterinarians than many of the previously recognised ergonomic risk factors. 2011-07-20T02:00:08.733Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5071 Background: Custom foot orthoses are commonly recommended for the treatment of foot pain. Objectives: To evaluate the effectiveness of custom foot orthoses for different types of foot pain. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), CINAHL (from January 1982) and the Physiotherapy Evidence Database (PEDro) (to June 2007). We also contacted authors of included trials and known researchers in the field and checked the reference lists of included trials to identify trials. No language or publication restrictions were applied. Selection criteria: Randomised controlled trials and controlled clinical trials evaluating custom-made foot orthoses for any type of foot pain. Outcomes included quantifiable levels of foot pain, function, disability, health-related quality of life, participant satisfaction, adverse effects and compliance. Data collection and analysis: Two authors independently selected trials, rated methodological quality and cross checked data extraction. Data were analysed separately for different diagnoses of foot pain and follow-up time points. Main results: Eleven trials involving 1332 participants were included: five trials evaluated custom-made foot orthoses for plantar fasciitis (691 participants); three for foot pain in rheumatoid arthritis (231 participants); and one each for foot pain in pes cavus (154 participants), hallux valgus (209 participants) and juvenile idiopathic arthritis (JIA) (47 participants). Comparisons to custom-made foot orthoses included sham orthoses; no intervention; standardised interventions given to all participants; non-custom (prefabricated) foot orthoses; combined manipulation, mobilisation or stretching; night splints; and surgery. Follow up ranged from one week to three years. Custom-made foot orthoses were effective for painful pes cavus (NNTB: 5), rear foot pain in rheumatoid arthritis (NNTB: 4), foot pain in JIA NNTB: 3) and painful hallux valgus (NNTB: 6); however, surgery was even more effective for hallux valgus and non-custom foot orthoses appeared just as effective for JIA but the analysis may have lacked sufficient power to detect a difference in effect. It is unclear if custom-made foot orthoses were effective for plantar fasciitis or metatarsophalangeal joint pain in rheumatoid arthritis. Custom-made foot orthoses were a safe intervention in all studies. Authors' conclusions: There is limited evidence on which to base clinical decisions regarding the prescription of custom-made foot orthoses for the treatment of foot pain. Currently, there is gold level evidence for painful pes cavus and silver level evidence for foot pain in JIA, rheumatoid arthritis, plantar fasciitis and hallux valgus. 2011-05-31T22:40:15.566Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7776 On 25 September 1999 Nick Cave gave a lecture called ‘The Love Song’ at the Atelierhaus der Akademie der Bildenden Kunste in Vienna. In that lecture Cave argued that the love song is an inherently sad one, full of pain and loss, but that it also includes God in the picture, for the love song is nothing less than a prayer. I use this lecture as the starting point for my discussion of the love song in the music of Nick Cave, although I do so with a particular twist, namely, the question of redemption. These love songs may be overflowing with pain and God, so much so that I would call them ‘brutally divine’, but I wish to know whether they offer any redemption. Will love save us? Is it a case of no pain, no gain? Or may redemption be found in an entirely other place in the love songs? In what follows I seek to answer these questions in four stages. I begin with a brief discussion of Cave’s lecture, focussing on what he does say, what is barely said, and what is neglected; the next two sections deal with two ways in which pain appears in Cave’s songs, one where pain is suffered, and the other where pain is inflicted; finally, I look for redemption in a few unlikely places. 2011-05-23T05:50:12.122Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7657 In memoriam: Jay Govind was raised in Durban, South Africa. He graduated with a degree in Medicine from the University of Cape Town, and completed several years as a resident medical officer. Being of Indian descent, he found that career opportunities in specialist medicine were limited to him in South Africa. He emigrated to Australia to pursue his fortune. 2011-05-03T04:50:01.886Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7628 Objective: To determine the presence of lumbar multifidus atrophy and pain after successful lumbar medial branch radiofrequency neurotomy for zygapophysial joint mediated pain. Design: A prospective observational analysis of 5 patients who had undergone successful unilateral radiofrequency neurotomy (RFN) of the lumbar medial branch divisions of the lumbar dorsal rami. At 17 to 26 months after RFN, 3 blinded radiologists evaluated the relative composition and size of the multifidus muscle at different segmental levels on lumbar magnetic resonance imaging (MRI). They were asked to determine the lesioned levels by evidence of multifidus atrophy. The accuracy of predicting the correct side and level lesioned was evaluated. Setting: Private spine practice in Tyler, Texas. Patients: Five patients who had unilateral lumbar medial branch RFN for proven lumbar zygapophysial joint-mediated pain were selected. Interventions: MRI of the lumbar spine at a mean of 21 months (range, 17-26) after successful lumbar RFN. Outcome Measures: Multifidus atrophy on a lumbar MRI, pain assessment and use of cointerventions. Results: Diffuse lumbar multifidus atrophy was detectable with MRI. However, radiologists could not reliably predict the side and segments lesioned. Despite denervation of the multifidus, at 12 months after RFN all subjects had ongoing pain relief and did not require or request additional treatment. Conclusions: This preliminary study provides evidence that successful medial branch RFN for lumbar zygapophysial-mediated pain does cause initial denervation but no discernable segmental atrophy of the multifidus at long-term follow-up. Previous denervation and diffuse atrophy in these subjects was not associated with pain. 2011-05-02T06:10:03.520Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7559 Objective: To determine the proportion of adverse events in patients discharged after ED assessment for possible acute coronary syndrome. Methods: Prospective observational cohort study enrolling consecutive patients presenting with symptoms suggestive of coronary syndrome. Main outcome was the proportion of adverse coronary events (defined a priori) within 30 days. Results: Of 2627 patients, 1819 (69%) were discharged without a diagnosis of coronary syndrome and 808 (31%) were admitted for further investigation and treatment. Of these, 385 (14.7%) were given a final diagnosis of acute coronary syndrome. On 30 day follow up, 18 of the discharged patients were diagnosed with acute coronary syndrome (0.7%; 95% confidence intervals [CI] 0.4–1.1%), 10 with unstable angina (0.4%; 95% CI 0.2–0.7%) and 8 with non-ST elevation myocardial infarction (0.3%; 95% CI 0.2–0.6%). There were no cases of ST elevation infarction or death. The sensitivity for diagnosis of acute coronary syndromes was 95.5% (95% CI 92.9–97.3%). Average length of stay was 7 h for discharged patients. Forty-six per cent of patients with diabetes and 47% with a past history of coronary disease were discharged. Subsequent outpatient stress testing was performed in 13.6%. Conclusions: In a large Australian ED, less than 1% of patients presenting with symptoms suggestive of coronary syndrome were discharged and subsequently had a 30 day adverse event. Reducing this proportion by admitting patients with traditional risk factors would markedly increase hospital workload. Opportunities exist to improve both the safety and efficiency of chest pain assessment in the ED. 2011-04-12T03:40:11.148Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7544 The objective of this study was to demonstrate the efficacy, safety and patient acceptability of the use of intranasal sufentanil for cancer-associated breakthrough pain. This was a prospective, open label, observational study of patients in three inpatient palliative care units in Australia. Patients on opioids with cancer-associated breakthrough pain and clinical evidence of opioid responsiveness to their breakthrough pain were given intranasal (IN) Sufentanil via a GO Medical™ patient controlled IN analgesia device. The main outcome measures were pain scores, need to revert to previous breakthrough opioid after 30 min, number of patients who chose to continue using IN sufentanil, and adverse effects. There were 64 episodes of use of IN sufentanil for breakthrough pain in 30 patients. There was a significant reduction in pain scores at 15 (P < 0.0001) and 30 min (P < 0.0001). In only 4/64 (6%) episodes of breakthrough pain did the participants choose to revert to their prestudy breakthrough medication. Twenty-three patients (77%) rated IN sufentanil as better than their prestudy breakthrough medication. The incidence of adverse effects was low and most were mild. Our study showed that IN sufentanil can provide relatively rapid onset, intense but relatively short lasting analgesia and in the palliative care setting it is an effective, practical, and safe option for breakthrough pain. 2011-04-08T06:10:07.915Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7488 Human studies conducted more than half a century ago have suggested that superficial pain induces excitatory effects on the sympathetic nervous system, resulting in increases in blood pressure (BP) and heart rate (HR), whereas deep pain is believed to cause vasodepression. To date, no studies have addressed whether deep or superficial pain produces such differential effects on muscle sympathetic nerve activity (MSNA). Using microneurography we recorded spontaneous MSNA from the common peroneal nerve in 13 awake subjects. Continuous blood pressure was recorded by radial arterial tonometry. Deep pain was induced by intramuscular injection of 0.5 ml hypertonic saline (5%) into the tibialis anterior muscle, superficial pain by subcutaneous injection of 0.2 ml hypertonic saline into the overlying skin. Muscle pain, with a mean rating of 4.9 ± 0.8 (S.E.M.) on a 0–10 visual analog scale (VAS) and lasting on average 358 ± 32 s, caused significant increases in MSNA (43.9 ± 10.0%), BP (5.4 ± 1.1%) and HR (7.0 ± 2.0%) - not the expected decreases. Skin pain, rated at 4.9 ± 0.6 and lasting 464 ± 54 s, also caused significant increases in MSNA (38.2 ± 12.8%), BP (5.1 ± 2.1%) and HR (5.6 ± 2.0%). The high-frequency (HF) to low-frequency (LF) ratio of heart rate variability (HRV) increased from 1.54 ± 0.25 to 2.90 ± 0.45 for muscle pain and 2.80 ± 0.52 for skin pain. Despite the different qualities of deep (dull and diffuse) and superficial (burning and well-localized) pain, we conclude that pain originating in muscle and skin does not exert a differential effect on muscle sympathetic nerve activity, both causing an increase in MSNA and an increase in the LF : HF ratio of HRV. Whether this holds true for longer lasting experimental pain remains to be seen. 2011-04-06T06:10:12.458Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7493 Diagnostic blocks can be a powerful tool for the investigation of spinal pain. However, for their use to be rational, blocks must have diagnostic or therapeutic utility, proven validity, and their use should be efficient. Of the 6 diagnostic blocks available for spinal pain, only some have been fully validated. Others still require particular validation studies. 2011-04-06T06:10:08.526Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7420 Background: Confusion persists concerning the nature and efficacy of procedures variously known as facet denervation, lumbar medial branch radiofrequency neurotomy, and radiofrequency neurotomy or denervation for the treatment of back pain. Systematic reviews have not recognized the importance of patient selection and correct surgical technique when appraising the literature. As a result, negative conclusions about procedures have been drawn because lack of efficacy of one procedure has been misattributed to other, cognate, but different procedures. Objectives: To demonstrate how the rationale and efficacy of lumbar medial branch neurotomy depends critically on correct selection of patients and use of surgically correct technique. Methods: A narrative review and description of the available evidence, drawn from the personal libraries of the authors and from the bibliographies of systematic reviews. Results: Three studies, commonly accepted as evidence of lack of effectiveness, were not valid tests of lumbar medial branch neurotomy because of errors in selection of patients or errors in surgical technique, or both. Two descriptive studies and three controlled studies that used valid or acceptable techniques consistently showed that lumbar medial branch neurotomy had positive effects on pain and disability. All valid, randomized controlled trials showed medial branch neurotomy to be more effective than sham treatment. Discussion: Negative results have been reported only in studies that selected inappropriate patients or used surgically inaccurate techniques. All valid studies showed positive outcomes that cannot be attributed to placebo. Inappropriate conclusions have been drawn by systematic reviews that misrepresent invalid studies as providing evidence against the efficacy of lumbar medial branch neurotomy. 2011-03-18T04:40:06.385Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7413 Article discusses the definitions and physiology of the different types of back pain such as nociceptive back pain, Somatic referred pain, Radicular pain, and Radiculopathy and highlights the problems amongst clinicians in confusing these definitions. 2011-03-16T05:20:03.327Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7397 Background: Trigger points are promoted as an important cause of musculoskeletal pain. There is no accepted reference standard for the diagnosis of trigger points, and data on the reliability of physical examination for trigger points are conflicting. Objectives: To systematically review the literature on the reliability of physical examination for the diagnosis of trigger points. Methods: MEDLINE, EMBASE, and other sources were searched for articles reporting the reliability of physical examination for trigger points. Included studies were evaluated for their quality and applicability, and reliability estimates were extracted and reported. Results: Nine studies were eligible for inclusion. None satisfied all quality and applicability criteria. No study specifically reported reliability for the identification of the location of active trigger points in the muscles of symptomatic participants. Reliability estimates varied widely for each diagnostic sign, for each muscle, and across each study. Reliability estimates were generally higher for subjective signs such as tenderness (κ range, 0.22-1.0) and pain reproduction (κ range, 0.57-1.00), and lower for objective signs such as the taut band (κ range, -0.08-0.75) and local twitch response (κ range, -0.05-0.57). Conclusions: No study to date has reported the reliability of trigger point diagnosis according to the currently proposed criteria. On the basis of the limited number of studies available, and significant problems with their design, reporting, statistical integrity, and clinical applicability, physical examination cannot currently be recommended as a reliable test for the diagnosis of trigger points. The reliability of trigger point diagnosis needs to be further investigated with studies of high quality that use current diagnostic criteria in clinically relevant patients. 2011-03-16T05:10:24.541Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7310 Objective: To determine the effect of intravenous sedation on postprocedural pain relief for patients undergoing a spinal injection procedure in which there is no expectation of immediate relief. Design: A prospective audit to compare Visual Analog Scale (VAS) responses before and after interlaminar epidural corticosteroid injections without epidural anesthetic in those who did and did not receive intravenous sedation. Setting: This audit was undertaken in 2 interventional spine practices. Patients: A total of 102 patients were allotted to receive or not receive intravenous sedation depending on preference. Interventions: Interlaminar epidural injections of corticosteroid without epidural anesthetic. Main Outcome Measurements: Outcomes were measured by mean (VAS) scores after the procedure and mean VAS differences before and after the procedure. Results: There were no significant differences between mean VAS scores or mean differences in VAS scores between those who did or did not receive intravenous sedation. A relatively high percentage of patients in both groups obtained greater than 50% immediate pain relief. Conclusion: Intravenous mild or moderate conscious sedation did not have an effect on postprocedural VAS pain scores in those receiving a therapeutic spinal injection procedure. Immediate pain relief was most likely the result of nonspecific effects. 2011-02-24T05:10:09.289Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7290 Although musculoskeletal disorders (MSD) have been identified as a significant occupational health issue for dental hygienists, few studies have explored this problem among the dental hygiene student population. The aim of this study was to investigate the prevalence and correlates of MSD among a selection of undergraduate dental hygiene students in Australia. A self-reporting questionnaire was distributed to dental hygiene students at an Australian university during 2008, from which a response rate of approximately 72% was achieved. Musculoskeletal disorders were most commonly reported by students at the neck (64.29%), lower back (57.94%) and shoulder (48.41%) regions. Logistic regression indicated various correlations with MSD. Students who did not undertake regular exercise every week experienced an increased risk of lower back pain [Odds Ratio (OR): 4.88, 95% Confidence Interval (CI): 1.75–14.9]. Students undertaking 16–20 h of desk-based study per week were much more likely to report neck pain (OR: 19.7, 95% CI: 1.34–378.94). Working 6–10 h on a computer each week was a risk factor for shoulder (OR: 7.03, 95% CI: 1.42–39.49) and upper back pain (OR: 5.29, 95% CI: 1.21–25.56). Overall, this study suggests that MSD are a reasonably common problem for dental hygiene students in Australia. As such, further studies are required to establish epidemiological patterns of MSD, and our profession will need to carefully consider preventive strategies to help minimize the impact of this important occupational health issue on the next generation of dental hygienists. 2011-02-23T02:40:28.060Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7131 The aetiology of low-back pain (LBP) is still largely unknown. The injury model and our biomechanical hypotheses do not seem to be appropriate in explaining degeneration or common painful conditions. The spine has an extensive network of small and large muscles capable of finely adjusting load transfer on the spinal structures while providing mobility. The sensory system responsible for proper motor control of these muscles is not known. The clinical picture we often see in patients with LBP suggests that muscles are involved. The body is under constant change owing to ageing and degeneration, and, obviously, so is the spine. This implies that the sensory motor control system must adapt to these changes, which may imply reorganisation of muscle activation. Such an adaptation may be the physiological response that we call LBP. Even if it is painful, it may be beneficial in the long run. Chronic pain may be the result of maladaptation. 2011-02-02T23:10:21.476Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6784 The fundamental reason why I pursue the diagnosis of discogenic pain is that patients have no other valid alternative. Patients with chronic back pain get caught in a circus. They are told that there is nothing wrong with them medically; or they are told something fallacious such as: they once did have nociception; but that has now ceased; and now they have only a "memory" of that pain. Under those conditions, medical treatment will not help; and the only prospect of treatment is behavioural and physical rehabilitation. But that treatment does not work. The patients still have pain. Yet again they are told that there is nothing wrong. They failed rehabilitation, and the only recourse is to repeat it. 2010-09-28T00:30:05.548Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6691 The foremost message that any pain physician should take from a chapter on neck pain is that neck pain and cervical radicular pain are not synonymous. The causes, mechanisms, investigations, and treatment of radicular pain differ from those of neck pain, and the two conditions have a different evidence base. Most emphatically, when a patient presents with just neck pain there is no justification for investigating and treating them as if they had radicular pain. Confusion in this regard has led to inappropriate investigations and therapeutic misadventure in the past and continues to do so. The topic of cervical radicular pain is covered elsewhere. The present chapter deals exclusively with neck pain. 2010-09-10T04:50:10.450Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6689 Investigations for chronic pain are limited by what particular tests can and cannot show, and by the nature of conditions that cause chronic pain. Responsible and efficient practice in pain medicine requires understanding of what investigations can and cannot show, and when they should and should not be used. This needs to be complemented by understanding the conditions that cause chronic pain, which investigations are inappropriate, and which are likely to be informative. 2010-09-10T04:20:03.070Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6671 A chronic illness qualitative research program that has been in progress since 1996 has focused on understanding the experience of long-term illness and how people can learn to incorporate the symptoms and consequences of illness into their lives. A primary healthcare philosophy has underpinned this research program which has been undertaken in a community health practice setting. The philosophy guiding this research program has been researching with people; hence the principles of primary healthcare (PHC) and participatory action research (PAR) have provided the theoretical framework. We have researched with both men and women who have diverse chronic conditions. Pain appears to be a constant companion in the lives of some people. We have come to understand that health workers may be the expert in clinical matters, but the person with the illness is the expert in his or her own life. Prescriptions for treatment may have little impact unless an understanding of the social and cultural context of a person's life is gained. Qualitative research is a mode of research that may lead us to a greater appreciation of the complexity of living with chronic pain. In this chapter we focus on ways people with chronic illness express and experience pain and how qualitative research can facilitate our understandings of their experiences. Our aim is to reveal the possibilities of qualitative research as an approach that may give voice to people who may be silent or have been silenced by objectivist research practices. Rather than focus on the cause or treatment of pain, we show the way we have used qualitative research to provide context to the lives lived with pain and the meanings ascribed to the experience of pain. The aims of this chapter are to trace the development and share the findings of our research with men and women who live with pain, and to explore the ways that qualitative research can inform our understandings of the experience of living with long term and persistent pain. To achieve this, we will begin by introducing the chronic illness experience research program of which these studies with people who live with pain have been a part, and then explicate the participatory action research methodology we have utilized extensively to harness qualitative research findings. We will share our current theorizing and work in progress and explore contributions from the wider qualitative research literature. 2010-09-10T03:40:05.105Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6651 Cervicogenic headache is among the best understood of the headaches in terms of its anatomy and physiology. Essentially it is pain referred to the head from the upper cervical spine. For this reason, it has been recognized more widely by pain specialists and manual therapists, accustomed to treating spinal pain, than by mainstream headache specialists. Amongst headache specialists, the entity has been disputed, largely because of controversies concerning the validity of its diagnosis. Unlike other headaches, cervicogenic headache defies diagnosis by clinical features and conventional imaging. Therefore, headache specialists have lacked means of making the diagnosis. However, the diagnosis can be made using fluoroscopically guided diagnostic blocks. 2010-09-10T02:00:04.298Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1335 Study Design: A case-control study involving parallel benchmarking audits was conducted. Objective: To compare the safety, efficacy, and cost effectiveness of evidence-based medical care and usual care for acute low back pain. Summary of Background Data: Although several sets of guidelines have been promoted for the management of acute low back pain, there is no evidence that following guidelines results in better outcomes. Methods: Special clinics were established, at which trained medical practitioners managed patients with acute low back pain according to evidence-based guidelines. Their outcomes were audited by independent research nurses. Meanwhile, and separately, the outcomes of patients managed by their own general practitioners were audited by research nurses using the same instruments of assessment. Results: In both settings, patients showed remarkable degrees and rates of recovery, with low rates of recurrence. However, evidence-based medical care resulted in a significantly lower cost of treatment; a significantly greater reduction in pain, sustained at both 6 and 12 months; significantly fewer patients requiring continuing care at 3, 6, and 12 months; a significantly greater proportion of patients fully recovered at 12 months; and significantly greater proportions of patients rating their treatment as extremely helpful and offering positive, unsolicited comments about their treatment. Conclusions: The immediate results from evidence-based care are marginally better than those from good usual care, but in the long term, evidence-based care achieves clinically and statistically significant gains, with fewer patients requiring continuing care and remaining in pain. Consumers approve of evidence-based care. 2010-04-27T06:54:24.978Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:2228 Until recently most attention was focussed on low back pain but now the key area of interest for new research is neck pain and related headache often associated with whiplash or poor posture in working environments such as using computers. This book presents the latest research findings and gives recommendations and guidelines on how to relate those findings to the prevention and management of neck pain. It also points the way for areas where more research is needed. 2010-04-27T06:53:30.450Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1398 A questionnaire was administered to 848 participants (76% runners, 24% walkers) at the conclusion of the 14 km City to Surf community run in order to investigate their experience of exercise-related transient abdominal pain (ETAP). Twenty-seven percent of respondents reported experiencing ETAP during the event, with the condition reported more frequently (p< 0.01) by runners (30%) than walkers (16%). ETAP was mostly described as well-localised (88%) and of an aching (25%), sharp (22%) or cramping (22%) sensation. The most commonly-reported sites of the pain were the right (46%) and left lumbar (23%) regions of the abdomen. Forty-two percent of the respondents who experienced ETAP reported that the pain was detrimental to their performance. Reports of ETAP decreased with age (r= −0.23, p< 0.01) but were unrelated to gender, body mass index or the time taken to complete the event. Among respondents who ran, those who consumed a large mass of food relative to body weight in the time interval 1–2 hr before the event were more likely to develop symptoms of ETAP (p < 0.05). The nutritional content of the pre-event meal did not influence the experience of ETAP. Sufferers of ETAP were more likely to experience nausea (r = 0.12, p< 0.01) and report shoulder tip pain (r= 0.14, p< 0.01). The results indicate that ETAP is a commonly experienced problem and provide insights into the cause of the complaint. 2010-04-27T06:53:02.280Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1466 Work related injury to the thumb has become a recognised problem for physiotherapists who perform manual techniques in the treatment of patients with orthopaedic musculoskeletal disorders. Pain in the thumb often causes physiotherapists to alter their methods of treatment, which may decrease the effectiveness of physiotherapy services and lead to increased financial costs for patients and their funding agencies. Substantial numbers of physiotherapists have changed their specialty area or left the profession because of work-related injury, which further burdens education and healthcare systems. The extent of the influence of individual risk factors and preventive strategies on the development of thumb pain in physiotherapists has not been conclusively determined. This paper discusses the potential causes and consequences of thumb pain in physiotherapists, and reviews the supporting evidence on the incidence, risk, prevention, and treatment of this common occupational injury in physiotherapists. 2010-04-27T06:52:30.772Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:940 Objective: To compare the analgesic efficacy of interferential therapy (IFT) and transcutaneous electrical nerve stimulation (TENS) using an experimental cold pain model. Design: Randomised controlled trial with repeated measures design. Setting: University research laboratory. Participants: Twenty healthy subjects. Interventions: IFT and TENS applied to each subject on different days. Main outcome measures: Cold pain threshold (time), intensity and unpleasantness (visual analogue scales). Results: The mean cold pain threshold with a TENS intervention was higher than that with IFT. A training effect was evident as subjects’ responses become more consistent with repeated exposure to stimulation and the testing procedure. Using data from the second testing sessions, the differences in pain threshold between IFT and TENS for the two during-intervention (T3 and T4) measures were statistically significant (T3 difference in the means 5.9 seconds, 99% confidence interval 3.1 to 8.7 seconds; T4 difference in the means 6.6 seconds, 99% confidence interval 3.8 to 9.4 seconds). No significant differences were identified in pain intensity and unpleasantness ratings. Conclusions: TENS is more effective than IFT at increasing cold pain thresholds in healthy subjects, and this effect increases with repeated exposures. Future trials should include a familiarisation session prior to testing to increase the consistency of subjects’ responses. The clinical implications of these effects need investigation. 2010-04-27T06:42:12.376Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1879 The laboratory mouse is now considered the preferred mammalian species for molecular and genetic analysis in neurobiology. In part, this is due to the existence, in the mouse, of several well characterised naturally occurring mutations in ligand gated ion channels and recent knockout, knockin, and transgenic techniques, which facilitate the manipulation of key molecules. These techniques have recently been applied to pain research with in vitro electrophysiological and behavioural techniques traditionally developed for the rat, now being adapted for the mouse particularly at the level of the spinal cord. Here, we describe an in vivo preparation of the mouse spinal cord for patch-clamp recording of nociceptive processing in the superficial dorsal horn (SDH) that permits analysis in the intact nervous system. We have recorded from SDH neurons and characterised their background synaptic activity, discharge properties, and evoked synaptic responses following controlled application of innocuous and noxious stimuli to the hind paw. Application of these techniques along with genetic, biomolecular, in vitro and behavioural approaches will allow future studies to comprehensively analyse the contributions of specific molecules involved in nociceptive processing in the spinal cord of a single species. 2010-04-27T06:35:57.584Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:2013 The aim of the study was to determine whether differences exist between physiotherapists with work-related thumb pain and physiotherapists without thumb pain. 24 physiotherapists with work related thumb pain (pain group) and 20 physiotherapists without thumb or wrist pain (non-pain group), who were working at least 20 hours per week in an outpatient musculo-skeletal setting, were compared on a number of attributes: generalised joint laxity, hand and thumb strength, height, weight, working environment and position and force applied during mobilisation, mobility at individual thumb joints, extent of osteo-arthritis at the thumb and radial sided wrist joints, and demographic data such as age gender and years of experience. All physiotherapists in the pain group reported that their thumb pain was related to and initially caused by the performance of manual techniques, and 88% had altered their manual techniques because of pain in the thum b. There was extreme variability in hand position and force applied during mobilisation, and a slightly high prevalence of osteoarthritis (22.7%)considering the mean age of the total sample (38.6 years). Statistically significant differences between groups included right metacarpal joint laxity, decreased right tip pinch strength, and lower body mass index for the pain group. Other factors were not significantly different between the groups These results indicate work related thumb pain affects physiotherapists ability to administer manual treatments, and suggest that decreased stability and strength in the thumb may be associated with work related thumb pain. 2010-04-27T06:29:59.195Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1519 Aim: To assess whether there is any association between membrane damaging toxin production by Staphylococcus spp. and self-reported TMD symptom expression in a group of patients selected to have CFS. Methods: Thirty-three defined Chronic Fatigue Syndrome (CFS) patients and 33 ageand sex-matched controls were assessed to evaluate the relationship between carriage of membrane damaging toxin producing staphylococcus, CFS and temporomandibular dysfunction (TMD) symptoms. Results: The CFS patients had an increased prevalence of face pain (Odds Ratio = 21.0, 95% CL 4.2-106, P < .001) and temporomandibular joint (TMJ) clicking/locking (OR = 5.7, 95% CL 1.423.5, P < .007), and the coagulase-negative staphylococcus maximum% B*-toxin haemolysis per patient. Both multivariate and univariate analyses revealed an association between the membrane damaging o*-toxin producing CoNS (MDT-CoNS) species per subject and face pain prevalence and intensity within both the CFS patients and the control subjects. No association was found between CoNS toxin production and TMJ clicking/locking. Importantly, áand B*-toxin production by CoNS was associated with patient reporting of arthritis. Conclusions: These data confirm the original observations of the association between MDTCoNS and facial muscle pain (Butt et al, 1998; McGregor et al, 2003). These data also suggest that MDT-CoNS associated facial muscle pain expression represents a distinct clinical entity, which has an increased prevalence in CFS patients. 2010-04-27T06:29:06.763Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1541 Background: On the basis of observational data, intradiscal electrothermal anuloplasty (IDETA) has been implemented as a treatment for back pain resulting from internal disc disruption. Purpose: To assess the efficacy of IDETA. Study design: Prospective cohort study with comparison group and 2-year follow-up. Patient sample: Of 53 patients who satisfied the diagnostic criteria for internal disc disruption, 36 were allocated to a treatment group and 17 to a comparison group, according to whether their insurer approved treatment with IDETA. Outcome measures: Outcomes were assessed in terms of relief of pain, return to work and use of opioids to treat persisting pain. Methods: The treatment group underwent IDETA. The comparison group underwent a conventional rehabilitation program. Outcomes were assessed at 3 months, 12 months and 2 years after treatment. Results: As a group, the comparison patients exhibited no significant improvement in their pain at any time. One was partially relieved, but no patient was completely relieved at either 12 or 24 months. The patients treated with IDETA exhibited significant improvements in their median pain scores, which were sustained at 12 and 24 months. At 24 months, 54% of these patients had achieved at least 50% relief of their pain, no longer used opioids and were at work. Seven patients (20%) were totally free of pain and at work at 24 months. Conclusions: The long-term results of IDETA are stable and enduring. It is not universally successful, but 54% of patients can reduce their pain by half, and one in five patients can expect to achieve complete relief of their pain. 2010-04-27T06:29:04.843Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1520 Full blood counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), haematinics and markers for oxidative stress were measured on thirty-three patients diagnosed with chronic fatigue syndrome (CFS) and twenty-seven age and sex matched controls. The CFS patients had increased prevalence of symptoms of temporomandibular dysfunction (TMD). Jaw muscle pain was associated with increases in methaemoglobin (P < .002), ferritin (P < .02) and malondialdehyde (P < .007) whilst temporomandibular joint (tmj) clicking and/or locking was associated with increases in methaemoglobin (P < .001), malondialdehyde (P < .05) and vitamin (P < .02) levels. Multiple regression analysis found methaemoglobin to be the principle component associated with TMD symptoms in the CFS patients. Increases in scalar severity responses to jaw muscle pain and TMJ clicking and/or locking were positively correlated with methaemoglobin by multiple regression. These data indicate that oxidative stress due to excess free radical formation was associated with jaw muscle pain in CFS patients and suggest that these symptoms were likely to be associated with a pathogen-associated aetiology. 2010-04-27T06:29:00.803Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1504 Objective: To measure the prevalence of pain among residents of rural and regional nursing homes in northern New South Wales and to describe the procedures used for pain management. Design: Cross-sectional survey using interviews and audit of medical records. Setting and participants: 917 nursing home residents in 15 nursing homes within a northern NSW area health service in 1998–1999. Main outcome measures: Number of residents experiencing pain at the time of interview; sites of pain and magnitude of pain problem; diagnoses relevant to pain; analgesic prescribing patterns; non-pharmacological treatments for pain; and the extent of pain documentation in nursing records. Results: The prevalence of pain present at interview was 27.8% (95% CI, 21.8%–33.8%). Women reported pain more often than men (31% v 21%; χ22 = 5.38; P = 0.02), but pain was not significantly associated with age, length of stay, or diagnoses of arthritis or dementia. Common sites for pain were the limbs, joints and back; 22% of residents reporting pain had no record of analgesic medication, and 16% had had no form of pain treatment ordered. Agreement between the nursing record and the residents' pain symptoms was borderline poor/fair (κ, 0.24). Conclusions: The prevalence of pain is high among nursing home residents in rural NSW who are able to communicate their pain. Descriptive data suggest that pain management activities could be substantially improved. 2010-04-27T06:27:17.333Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1674 Aims: To investigate the association between toxin-producing staphylococci, symptom expression, and changes in urinary excretion of metabolites in temporomandibular disorder (TMD) patients and age- and sex-matched control subjects. Methods: Twenty-nine patients defined by the research diagnostic criteria/TMD as having Type 1a muscle pain (TMD1A), and 34 age- and sex-matched control subjects were assessed for the carriage of staphylococcal species, staphylococcal toxin production, expression of symptoms, and changes in urinary excretion of amino and organic acids. Results: TMD1A patients had an increased incidence of carriage of toxin-producing coagulase-negative staphylococcus (MDT-CoNS, P .004), which produced increased levels of -like membrane-damaging toxins. The TMD1A patients also had a reduction in the incidence of carriage of Staphylococcus aureus (P .02). Increased incidence of MDTCoNS was positively associated with increased pain intensity as assessed by a visual analog scale (P .001). Odds ratio analysis revealed a 9.2-fold increase in MDT-CoNS recovery from the nose of TMD1A patients compared with the control subjects (odds ratio = 9.2, 95% confidence limits: 2.3 to 37.5, P .001). Increases in the carriage incidence of MDT-CoNS were also associated with increases in the urinary tyrosine:leucine ratio (P .004), which represents a change in the balance of proteolysis and protein synthesis. The toxin production by these CoNS species was also associated with an increased urinary excretion of glutamic acid (P .03). Conclusion: These data suggest that an increased colonization of MDT-CoNS on skin and mucosal membranes was associated with changed proteolysis, increased pain intensity, and an increase in excitatory amino acids consistent with events associated with the development of chronic orofacial muscle pain in TMD patients. 2010-04-27T06:26:08.437Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:1713 Objectives. To assess the efficacy of a prolotherapy injection and exercise protocol in the treatment of chronic nonspecific low back pain. Design. Randomized controlled trial with two-by-two factorial design, triple-blinded for injection status, and single-blinded for exercise status. Setting. General practice. Participants. One hundred ten participants with nonspecific low-back pain of average 14 years duration were randomized to have repeated prolotherapy (20% glucose/0.2% lignocaine) or normal saline injections into tender lumbo-pelvic ligaments and randomized to perform either flexion/extension exercises or normal activity over 6 months. Main outcome measures : Pain intensity (VAS) and disability scores (Roland-Morris) at 2.5, 4, 6, 12, and 24 months. Results. Follow-up was achieved in 96% at 12 months and 80% at 2 years. Ligament injections, with exercises and with normal activity, resulted in significant and sustained reductions in pain and disability throughout the trial, but no attributable effect was found for prolotherapy injections over saline injections or for exercises over normal activity. At 12 months, the proportions achieving more than 50% reduction in pain from baseline by injection group were glucose-lignocaine: 0.46 versus saline: 0.36. By activity group these proportions were exercise: 0.41 versus normal activity: 0.39. Corresponding proportions for >50% reduction in disability were glucose-lignocaine: 0.42 versus saline 0.36 and exercise: 0.36 versus normal activity: 0.38. There were no between group differences in any of the above measures. Conclusions. In chronic nonspecific low-back pain, significant and sustained reductions in pain and disability occur with ligament injections, irrespective of the solution injected or the concurrent use of exercises. 2010-04-27T06:11:46.112Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:272 Aims: To assess whether opioid and sedative medication use affects survival (from hospice admission to death) of patients in an Australian inpatient palliative care unit. Background: Retrospective audit. Newcastle Mercy Hospice - a tertiary referral palliative care unit. All patients who died in the hospice between 1 February and 31 December 2000. Methods: Length of survival from hospice admission to death, and the median and mean doses of opioids and sedatives used in the last 24 h of life. Comparison of these with published studies outside of Australia. Results: In this study, the use of opioids, benzodiazepines and haloperidol did not have an association with shortened survival and the only statistical significant finding was an increased survival in patients who were on 300 mg/day or more of oral morphine equivalent (OME). The proportion of patients requiring greater than or equal to 300 mg OME/day (at 28%) was higher than published studies, but the mean dose of 371 mg OME/day was within the range of other studies. The proportion of patients receiving sedatives (94%) was higher than other studies, but the median dose of parenteral midazolam equivalent of 12.5 mg per 24 h was lower than other studies from outside Australia. Conclusions: There was no association between the doses of opioids and sedatives on the last day of life and survival (from hospice admission to death) in this population of palliative care patients. 2010-04-27T05:58:52.368Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:404 1 Schizophrenia is considered to be a neurodevelopmental disorder with origins in the prenatal or neonatal period. Brains from subjects with schizophrenia have enlarged ventricles, reduced cortical thickness (CT) and increased neuronal density in the prefrontal cortex compared with those from normal subjects. Subjects with schizophrenia have reduced pain sensitivity and niacin skin flare responses, suggesting that capsaicin-sensitive primary afferent neurons might be abnormal in schizophrenia. 2 This study tested the hypothesis that intrinsic somatosensory deprivation, induced by neonatal capsaicin treatment, causes changes in the brains of rats similar to those found in schizophrenia. Wistar rats were treated with capsaicin, 50mg kg(-1) subcutaneously, or vehicle (control) at 24-36 h of life. At 5-7 weeks behavioural observations were made, and brains removed, fixed and sectioned. 3 The mean body weight of capsaicin-treated rats was not significantly different from control, but the mean brain weight of male, but not female, rats, was significantly lower than control. 4 Capsaicin-treated rats were hyperactive compared with controls. The hyperactivity was abolished by haloperidol. 5 Coronal brain sections of capsaicin-treated rats had smaller cross-sectional areas, reduced CT, larger ventricles and aqueduct, smaller hippocampal area and reduced corpus callosum thickness, than brain sections from control rats. Neuronal density was increased in several cortical areas and the caudate putamen, but not in the visual cortex. 6 It is concluded that neonatal capsaicin treatment of rats produces brain changes that are similar to those found in brains of subjects with schizophrenia. 2010-04-27T05:45:36.317Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:74 Objective. To summarize and to analyze the available literature on the efficacy of intra-articular injections of corticosteroids for low back pain. Design. Publications, in English, French, and German, were obtained that reported the proportions of patients who obtained complete relief of pain following intra-articular steroids, and that provided any form of follow-up. These publications were analyzed to determine the rationale, indications, and outcomes of the treatment. Results. The only rationale for intra-articular steroids appears to be the expectation that they should work. The most commonly used indication has been back pain, for which no specific diagnosis has been made. When the results of observational studies are pooled, they paint a picture of impressive immediate responses, but a rapid decay of outcomes by three and six months. Initial responses, however, are dissonant with the literature from controlled studies of the prevalence of lumbar zygapophysial joint pain. Moreover, controlled trials have shown that there is no attributable effect to the injection of steroids. Conclusion. The apparent efficacy of lumbar intra-articular steroids is no greater than that of a sham injection. There is no justification for the continued use of this intervention. Better outcomes can be achieved with deliberate placebo therapy. 2010-04-27T05:36:17.820Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4567 Background: Although low back pain (LBP) is an important issue for the health profession, few studies have examined LBP among occupational therapy students. Purpose: To investigate the prevalence and distribution of LBP, its adverse sequelae; and to identify potential risk factors. Methods: In 2005, a self-reported questionnaire was administered to occupational therapy students in Northern Queensland. Findings: The 12-month period-prevalence of LBP was 64.6%. Nearly half (46.9%) had experienced pain for over 2 days, 38.8% suffered LBP that affected their daily lives, and 24.5% had sought medical treatment. The prevalence of LBP ranged from 45.5 to 77.1% (p=0.004), while the prevalence of LBP symptoms persisting longer than two days was 34.1 to 62.5% (p=0.020). Logistic regression analysis indicated that year of study and weekly computer usage were statistically-significant LBP risk factors. Implications: The occupational therapy profession will need to further investigate the high prevalence of student LBP identified in this study. 2010-04-27T05:17:39.828Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4927 The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP. 2010-04-27T05:09:21.380Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4597 Objective: The prevalence of neck and shoulder pain in visual display terminal operators is estimated between 40% and 69%. One theory proposed for this is inadequate low load functioning of the postural muscles of the neck and shoulder girdle leading to microtrauma of cervical spine structures. A temporal sequence linking muscle performance to the subsequent development of neck pain has never been established. This pilot study sought to determine whether postural muscle performance factors are associated with neck pain in a population of visual display terminal users. Methods: Twenty-eight subjects underwent a baseline physical examination. Clinical measurements of low-load deep cervical flexor muscle performance, shoulder girdle muscle endurance, neck column length, head and neck posture and body mass index were made and demographic factors collected. Following the examination, a Neck Pain and Disability Scale questionnaire was administered. Variables were analysed in a regression analysis with the questionnaire scores. Questionnaires were readministered at six months follow up. Results: Descriptive variables "years of occupational screen based keyboard use" (p = 0.021) and "use of reading glasses" (p = 0.027) were statistically significantly correlated with Neck Pain and Disability Scale score at baseline, while "hours of home computer use" (p < 0.001) was associated with the change in questionnaire score at 6 months follow up. Muscle performance factors did not contribute to either model. Conclusions: Given the sample size in this pilot study, we cannot rule out an association between muscle parameters and the onset of neck pain and disability. However, the influence of any such association would be weaker than other identified associated variables. 2010-04-27T04:56:31.786Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5804 Neurons in the superficial dorsal horn (SDH) of the spinal cord play a critical role in processing potentially painful or noxious signals from skin, muscle, and viscera. Many acute pain therapies are based on the notion that altering the excitability of SDH neurons can block or gate these signals and reduce pain. This same notion also underlies treatments for certain chronic pain states. Basic scientists are now beginning to identify a number of potential molecular targets for spinal cord - based pain therapies with a focus on ion channels and receptors that can alter neuronal excitability. The current challenge in pain research is to identify which are the most promising targets and how their manipulation alters pain processing. In this review, we propose that our understanding of spinal pain processing mechanisms and translation of these discoveries into pain therapies could be improved by 1) better appreciating and understanding neuronal heterogeneity in the SDH; 2) establishing connectivity patterns among SDH neuron types; and 3) testing and extending findings made in vitro to intact (in vivo) animal models. As this information becomes available, it will be possible to determine the precise distribution of potential therapeutic targets on various SDH neuron types within specific circuits known to be functionally important in spinal pain processing. 2010-04-27T04:49:35.096Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4998 This paper outlines the principles of exercise prescription, with an emphasis on the injured person. Patients with pain, particularly chronic pain often exhibit low levels of activity and fitness. The literature reports that if these patients increase their activity and fitness levels they will experience a corresponding improvement in their own sense of personal wellbeing. Post-discectomy patients generally experience pain and related decreased physical function for extended periods of time. As a consequence, they also frequently experience an increased level of psychosocial stress and decreased physical strength. By increasing their physical fitness and strength, these negative outcomes can be minimised or even neutralised. The key aim of any postsurgical exercise program is to achieve these goals without increasing pain. There are several concepts of exercise prescription that are critical when designing an exercise program for the injured person. These concepts will be discussed in relation to both postsurgical and pain patients. 2010-04-27T04:45:44.047Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5147 Skeletal muscle cramp has been proposed as the aetiology of exercise-related transient abdominal pain (ETAP). The aim of this study was to determine whether or not localised electromyographic (EMG) activity indicative of skeletal muscle cramp is elevated during ETAP. Surface EMG activity was quantified at the site of ETAP in 14 symptomatic individuals (ETAP group) while the pain was present and after the pain subsided. Additionally, measurements were taken in another 14 subjects (Comparison group) who performed the same experimental procedure but did not experience ETAP. In the ETAP group, localised EMG activity did not increase when the pain was present or decrease when the pain subsided. The level of EMG activity detected while the pain was present was indistinguishable from noise (0.20 ± 0.18 μV). No difference was observed between the ETAP and Comparison groups in the level of localised EMG activity (p = 0.89) at any time. After the pain subsided in the ETAP group, EMG activity was recorded at the site of the pain while the subjects performed a diaphragm-dependent sniff manoeuvre (8.3 ± 0.7 μV) and a maximum voluntary contraction of the abdominal muscles (17.5 ± 0.7 μV). It was concluded that ETAP is not associated with elevated EMG activity, suggesting that the pain is not the result of muscle cramping. 2010-04-27T04:44:58.482Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5055 Background: Spinal intervention procedures are widely practiced. Complications are sometimes described in case reports, but the full spectrum of possible complications has not been comprehensively publicized. The fact that certain complications continue to occur suggests that practitioners may not be fully aware of the nature of possible complications and how to recognize warning signs. Objectives: To highlight the nature of potential complications of spine interventions and to assist practitioners in recognizing warning signs of impending complications so that they might be prevented. Methods: Complications described in the literature and encountered by the authors in medicolegal proceedings were identified. Illustrations of such complications were collated together with illustrations of phenomena that might have led to complications had they not been recognized and the procedure appropriately corrected or abandoned. Results: Infection is a risk common to all invasive procedures. Spinal cord injuries have occurred during cervical medial branch blocks, intra-articular injections, and radiofrequency neurotomy because operators did not obtain correct views of the target region and misdirected their needles or electrodes. Similar errors have occurred in the conduct of lumbar blocks and neurotomy. The complications of lumbar intradiscal procedures include infection, injury to a ventral ramus, and breakage of electrodes. Cervical discography, additionally, can be complicated by spinal cord injury. Cervical transforaminal injections have been complicated by injections into a reinforcing radicular artery or the vertebral artery. Lumbar transforaminal injections have been complicated by intra-arterial injections and subdural or intrathecal injections. Epidural injections can be complicated by subdural or intrathecal injections, or venous puncture resulting in a haematoma. Intra-articular injections of the lateral atlantoaxial joint and sacroiliac joint theoretically could be complicated by injury to adjacent vessels, nerves, or viscera. Discussion: Strict adherence to published guidelines provides safeguards against encountering complications. Complications are avoided by operators knowing all the relevant anatomy of the procedure and being able to recognize aberrations in the procedure as soon as they occur. 2010-04-27T04:35:28.265Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5302 Objective: To determine the prevalence of different causes of neck pain in a private practice clinic. Design: A retrospective audit of records. Setting: A private spine pain clinic in the state of Washington, USA. Patients: All consecutive patients, seen between January 2003 and January 2005, in whom a diagnosis of neck pain was made. Interventions: The records of all patients were examined to determine the prevalence of various diagnostic entities determined by history, examination, and invasive test such as controlled diagnostic blocks and provocation discography. Outcome Measures: Using different denominators, the prevalence of various conditions was determined in all patients who presented with neck pain, in patients in whom investigations were undertaken, and in patients who completed investigations. Results: A large proportion of patients (36%) did not pursue investigations, which diluted the crude prevalence of various conditions. A further 17% deferred completing investigations. Among the 46% of patients who completed investigations, the prevalence of zygapophysial joint pain was 55%, discogenic pain was 16%, and lateral atlanto-axial joint pain was 9%. A diagnosis remained elusive in only 32% of those patients who completed investigations. Conclusions: In a private practice setting, a patho-anatomic diagnosis for chronic neck pain can be established in over 80% of patients, provided that appropriate investigations are undertaken. The prevalence of cervical zygapophysial joint pain encountered in the present study corroborates the prevalence rates established in academic studies. Cervical discogenic pain does not appear to be common among patients with chronic neck pain. 2010-04-27T04:33:24.059Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5268 The objectives of this study were to compare published methods of measuring cervical posture and to determine whether these measures were associated with clinical endpoints such as pain and disability levels, and postural muscle performance in the upper quarter. A cross-sectional study design was used, and the study was conducted at two call centres in Newcastle, New South Wales. The participants comprised 34 call centre operators with no history of neck trauma, using visual display terminals for a minimum of 4 hours per day. The main outcome measurements were correlations between angular measurements of posture, and correlations of postural measures with Northwick Park neck pain questionnaire, deep cervical flexor muscle performance, global neck flexor muscle and shoulder girdle endurance, and demographic factors. Moderate correlations of craniovertebral angle with cervical inclination (r = 0.61) and lower cervical angle (r = 0.47) existed. Moderate correlation existed between upper thoracic inclination and lower cervical angle (r = 0.55). Neck pain questionnaire scores were significantly associated with craniovertebral angle (p = 0.01). No postural muscle performance measures were associated with postural measures. Stratification by sex revealed trends between posture and demographic and muscle performance measures, with systematic reversal of correlations between sexes. Three postural measures indicated forward head posture with some agreement. Contradictory findings between sexes are systematic and indicate that sexes should be analysed separately. 2010-04-27T04:32:54.139Z ]]>