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Heel raises versus prefabricated orthoses in the treatment of posterior heel pain associated with calcaneal apophysitis (Sever's Disease): study protocol for a randomised controlled trial  

PubMed Central

Background Posterior Heel pain can present in children of 8 to 14 years, associated with or clinically diagnosed as Sever's disease, or calcaneal apophysitis. Presently, there are no comparative randomised studies evaluating treatment options for posterior heel pain in children with the clinical diagnosis of calcaneal apophysitis or Sever's disease. This study seeks to compare the clinical efficacy of some currently employed treatment options for the relief of disability and pain associated with posterior heel pain in children. Method Design: Factorial 2 × 2 randomised controlled trial with monthly follow-up for 3 months. Participants: Children with clinically diagnosed posterior heel pain possibly associated with calcaneal apophysitis/Sever's disease (n = 124). Interventions: Treatment factor 1 will be two types of shoe orthoses: a heel raise or prefabricated orthoses. Both of these interventions are widely available, mutually exclusive treatment approaches that are relatively low in cost. Treatment factor 2 will be a footwear prescription/replacement intervention involving a shoe with a firm heel counter, dual density EVA midsole and rear foot control. The alternate condition in this factor is no footwear prescription/replacement, with the participant wearing their current footwear. Outcomes: Oxford Foot and Ankle Questionnaire and the Faces pain scale. Discussion This will be a randomised trial to compare the efficacy of various treatment options for posterior heel pain in children that may be associated with calcaneal apophysitis also known as Sever's disease. Trial Registration Trial Number: ACTRN12609000696291 Ethics Approval Southern Health: HREC Ref: 09271B



Diagnosis of heel pain.  


Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated. PMID:22010770

Tu, Priscilla; Bytomski, Jeffrey R



Heel Pain  


... pronation may also contribute to injury to the hip, knee, and lower back. Achilles tendinitis: Pain at the back of the heel is associated ... of steps can be taken to avoid heel pain and accompanying afflictions: Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, ...


Heel Pain in Recreational Runners.  

ERIC Educational Resources Information Center

Provides physicians with the signs, symptoms, and management of heel/sole pain in recreational runners (usually due to plantar fasciitis, Achilles tendinitis, and calcaneal stress fractures). Remedies involve palliative treatment of symptoms, correction of underlying biomechanical problems, and flexibility exercises. (SM)

Bazzoli, Allan S.; Pollina, Frank S.



Heel Pain  


... you may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). People ... 8" or 1/2" heel insert. Stretch your Achilles tendon by leaning forward against a wall with your ...


Pediatric heel pain.  


Heel pain is a common complaint among young children and adolescents. It has many causes, including trauma, overuse injuries, and tumors, and therefore a thorough clinical examination is warranted. This article outlines some common causes of pediatric heel pain. PMID:24075133

Joseph, Alison M; Labib, Irene K



Black heel, talon noir or calcaneal petechiae?  


We describe a series of six patients with superficial cutaneous haemorrhages of the feet, including a classical case of black heel (talon noir) and other similar cases with diverse clinical presentations that do not match the typical description of that process. The main differences lay in production mechanism, morphology and location. The causes of these 'atypical' lesions were: burns with hot sand, friction against the rough edge of a swimming pool, wearing new shoes, jogging, or pricking a blister with a needle. Clinically, they consisted of isolated or multiple, small, large or linear, brown or black lesions located in areas that did not include the convex part of the heel, in which talon noir usually appears; on the contrary, the lesions affected the back third of the soles, the toes, periungual fold and plantar arch. As the presence of blood in the horny layer was a common final factor in all these cases, a better name for this process would be 'post-traumatic cutaneous intracorneal blood' to describe black heel and its diverse clinical presentations. PMID:18638222

Urbina, Francisco; León, Lorena; Sudy, Emilio



Chronic bilateral heel pain in a child with Sever disease: case report and review of literature  

PubMed Central

We are presenting a case report of a 10-year-old male with a 1 year history of bilateral heel pain. Sever disease is self limiting condition of calcaneal apophysis. It is the most common cause of heel pain in the growing child. There is no documented case of this condition in this region. This case highlights the clinical features of this self limiting disorder as seen in this patient and reviews the current literature.



Plantar heel pain and fasciitis  

PubMed Central

Introduction Plantar heel pain causes soreness or tenderness of the sole of the foot under the heel, which sometimes extends into the medial arch. The prevalence and prognosis are unclear, but the symptoms seem to resolve over time in most people. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for plantar heel pain? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: casted orthoses (custom-made insoles), corticosteroid injection (alone, or plus non-steroidal anti-inflammatory drugs), extracorporeal shock wave therapy, heel cups, heel pads (alone or with corticosteroid injection), lasers, local anaesthetic injection (alone or with corticosteroid injection), night splints plus non-steroidal anti-inflammatory drugs, stretching exercises, surgery, taping, and ultrasound.



Heel pain due to retrocalcaneal bursitis-radiographic diagnosis (with an historical footnote on Sever's disease)  

Microsoft Academic Search

Retrocalcaneal bursitis is a distinct condition causing posterior heel pain in active, healthy children. It appears to result\\u000a from post-traumatic inflammation of the soft tissues of the posterior heel, and is unrelated to avascular necrosis of the\\u000a calcaneal apophysis. The diagnosis may be confirmed radiographically by the loss of the lucent retrocalcaneal recess, with\\u000a a normal Achilles tendon and superficial

M. A. Heneghan; T. Wallace



Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study  

Microsoft Academic Search

The aim of this prospective single-blind pilot study was to explore the pain-alleviating effect of low-energy extracorporeal shock wave therapy (ESWT) in painful heel associated with inferior calcaneal spurs. Thirty patients who suffered from persistent symptoms for more than 12 months qualified for low-energy ESWT and were assigned at random to two groups, real or simulated ESWT. Before beginning the

J. D. Rompe; C. Hopf; B. Nafe; R. Bürger



Differentiation of Heel Pain from Other Hoof Pain in Horses  

Microsoft Academic Search

Sardari, K, Kazemi, H. and Seifi, H. 2005. Differentiation of heel pain from other hoof pain in horses. J. Appl. Amm. Sci., 28: 133–135.Thirty-four horses with forelimb lameness referable to the hoof based on their response to the palmar digital nerves analgesia were divided into 2 groups based on their response to distal interphalangeal joint analgesic injection and hoof tester

K. Sardari; H. Kazemi; H. Seifi



Partial calcaneal ostectomy for retrocalcaneal bursitis  

Microsoft Academic Search

Heel pain in runners is very common. Retrocalcaneal bursitis may be disabling to the competitive runner. When conservative treatment fails, surgery (partial cal caneal ostectomy) may be indicated. Ten patients un derwent partial calcaneal ostectomies at our clinic and returned to their desired level of activity within 6 months. When the surgeon adheres to the surgical principles outlined in this

Donald C. Jones; Stanley L. James



Management of subcalcaneal pain and Achilles tendonitis with heel inserts  

PubMed Central

Soft tissue symptoms in the leg due to sporting activity are commonly associated with the force of heel strike. Conventional training shoes compromise between comfort and performance; few models are suitably designed for both considerations. Using a visco-elastic polymer insert the symptoms of heel pain and Achilles tendonitis have been largely or completely abolished in a preliminary study. Imagesp117-ap117-bp117-cp118-a

Maclellan, G. E.; Vyvyan, Barbara



The effect of gait velocity on calcaneal balance at heel strike; Implications for orthotic prescription in injury prevention  

Microsoft Academic Search

Exercise related lower limb injuries (ERLLI), are common in the recreational and competitive sporting population. Although ERLLI are thought to be multi-factorial in aetiology, one of the critical predisposing factors is known to gait abnormality. There is little published evidence comparing walking and running gait in the same subjects, and no evidence on the effect of gait velocity on calcaneal

Shivanthan Shanthikumar; Zi Low; Eanna Falvey; Paul McCrory; Andy Franklyn-Miller



Heel pain due to psoriatic arthritis in a 50 year old recreational male athlete: case report  

PubMed Central

Heel pain is a common presentation in a sports injury practice, with a list of common differentials including achilles tendinopathy and retrocalcaneal bursitis. However, seronegative arthritis can also cause enthesopathies that produce heel pain and should be considered in a differential diagnosis list. In this case, a 50 year old recreationally active male presented with non-traumatic insidious heel pain and without history of any skin conditions or any other symptoms of seronegative spondyloarthritis. Clinical suspicion led to laboratory testing and radiographs/bone scan which yielded the diagnosis of psoriatic arthritis.

Yedon, Dominique Forand; Howitt, Scott



Extracorporal shock wave therapy in patients with tennis elbow and painful heel  

Microsoft Academic Search

The aim of this study was to evaluate the effect of extracorporal shock wave therapy (ESWT) in tennis elbow and painful heel.\\u000a Nineteen patients with tennis elbow and 44 patients with painful heel in which conservative treatment had failed underwent\\u000a ESWT. Both groups received 3000 shock waves of 0.12 mJ\\/mm2 three times at weekly intervals. After a follow-up of 5

Dietrich S. Hammer; Stefan Rupp; Stefan Ensslin; Dieter Kohn; Romain Seil



The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review  

Microsoft Academic Search

Background  Plantar heel pain is a commonly occurring foot complaint. Stretching is frequently utilised as a treatment, yet a systematic\\u000a review focusing only on its effectiveness has not been published. This review aimed to assess the effectiveness of stretching\\u000a on pain and function in people with plantar heel pain.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Medline, EMBASE, CINAHL, AMED, and The Cochrane Library were searched from inception

David Sweeting; Ben Parish; Lee Hooper; Rachel Chester



Malunited calcaneal fracture fragments causing tarsal tunnel syndrome: a rare cause.  


This is a report of tarsal tunnel syndrome (TTS) due to a specific malunited calcaneal fracture fragment in a 46-year-old man. He was treated non-operatively for extra-articular calcaneal fracture. Four months later he presented with pain, tingling and hypoaesthesia over the medial aspect of the heel. He had a positive Tinel's sign and a positive dorsiflexion-eversion test. Radiography revealed malunited calcaneal fracture along medial wall producing bony prominence. The tarsal tunnel was surgically decompressed by excising the malunited fragments. The branches of the posterior tibial nerve were stretched over these fragments intra-operatively. There was symptomatic improvement with surgical excision of the fragment, however, the hypoesthesia did not resolve completely. Appropriate initial treatment will help to prevent this complication. PMID:19840754

Manasseh, Nithyananth; Cherian, Vinoo Mathew; Abel, Livingston



Don't Ignore Your Kid's Heel Pain  


... pull quickly on tendons. Several things should tip parents off that their child needs attention, including limping, complaining, walking on toes, and pain the morning after a game. Parents should never push their children to play ...


Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review  

Microsoft Academic Search

BACKGROUND: Plantar heel pain (plantar fasciitis) is one of the most common musculoskeletal pathologies of the foot. Plantar heel pain can be managed with dry needling and\\/or injection of myofascial trigger points (MTrPs) however the evidence for its effectiveness is uncertain. Therefore, we aimed to systematically review the current evidence for the effectiveness of dry needling and\\/or injections of MTrPs

Matthew P Cotchett; Karl B Landorf; Shannon E Munteanu



Kangaroo mother care diminishes pain from heel lance in very preterm neonates: A crossover trial  

Microsoft Academic Search

BACKGROUND: Skin-to-skin contact, or kangaroo mother care (KMC) has been shown to be efficacious in diminishing pain response to heel lance in full term and moderately preterm neonates. The purpose of this study was to determine if KMC would also be efficacious in very preterm neonates. METHODS: Preterm neonates (n = 61) between 28 0\\/7 and 31 6\\/7 weeks gestational

C Celeste Johnston; Francoise Filion; Marsha Campbell-Yeo; Celine Goulet; Linda Bell; Kathryn McNaughton; Jasmine Byron; Marilyn Aita; G Allen Finley; Claire-Dominique Walker



Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial  

PubMed Central

Background Plantar heel pain (plantar fasciitis) is a common and disabling condition, which has a detrimental impact on health-related quality of life. Despite the high prevalence of plantar heel pain, the optimal treatment for this disorder remains unclear. Consequently, an alternative therapy such as dry needling is increasingly being used as an adjunctive treatment by health practitioners. Only two trials have investigated the effectiveness of dry needling for plantar heel pain, however both trials were of a low methodological quality. This manuscript describes the design of a randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. Methods Eighty community-dwelling men and woman aged over 18 years with plantar heel pain (who satisfy the inclusion and exclusion criteria) will be recruited. Eligible participants with plantar heel pain will be randomised to receive either one of two interventions, (i) real dry needling or (ii) sham dry needling. The protocol (including needling details and treatment regimen) was formulated by general consensus (using the Delphi research method) using 30 experts worldwide that commonly use dry needling for plantar heel pain. Primary outcome measures will be the pain subscale of the Foot Health Status Questionnaire and "first step" pain as measured on a visual analogue scale. The secondary outcome measures will be health related quality of life (assessed using the Short Form-36 questionnaire - Version Two) and depression, anxiety and stress (assessed using the Depression, Anxiety and Stress Scale - short version). Primary outcome measures will be performed at baseline, 2, 4, 6 and 12 weeks and secondary outcome measures will be performed at baseline, 6 and 12 weeks. Data will be analysed using the intention to treat principle. Conclusion This study is the first randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. The trial will be reported in accordance with the Consolidated Standards of Reporting Trials and the Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines. The findings from this trial will provide evidence for the effectiveness of trigger point dry needling for plantar heel pain. Trial registration Australian New Zealand 'Clinical Trials Registry'. ACTRN12610000611022.



The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review  

PubMed Central

Background Plantar heel pain is a commonly occurring foot complaint. Stretching is frequently utilised as a treatment, yet a systematic review focusing only on its effectiveness has not been published. This review aimed to assess the effectiveness of stretching on pain and function in people with plantar heel pain. Methods Medline, EMBASE, CINAHL, AMED, and The Cochrane Library were searched from inception to July 2010. Studies fulfilling the inclusion criteria were independently assessed, and their quality evaluated using the modified PEDro scale. Results Six studies including 365 symptomatic participants were included. Two compared stretching with a control, one study compared stretching to an alternative intervention, one study compared stretching to both alternative and control interventions, and two compared different stretching techniques and durations. Quality rating on the modified Pedro scale varied from two to eight out of a maximum of ten points. The methodologies and interventions varied significantly between studies, making meta-analysis inappropriate. Most participants improved over the course of the studies, but when stretching was compared to alternative or control interventions, the changes only reached statistical significance in one study that used a combination of calf muscle stretches and plantar fascia stretches in their stretching programme. Another study comparing different stretching techniques, showed a statistically significant reduction in some aspects of pain in favour of plantar fascia stretching over calf stretches in the short term. Conclusions There were too few studies to assess whether stretching is effective compared to control or other interventions, for either pain or function. However, there is some evidence that plantar fascia stretching may be more effective than Achilles tendon stretching alone in the short-term. Appropriately powered randomised controlled trials, utilizing validated outcome measures, blinded assessors and long-term follow up are needed to assess the efficacy of stretching.



Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines  

Microsoft Academic Search

ObjectiveTo describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations.MethodsInformation on use of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a

Valentina Losacco; Marina Cuttini; Gorm Greisen; Dominique Haumont; Carmen R Pallás-Alonso; Veronique Pierrat; Inga Warren; Bert J Smit; Björn Westrup



Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study  

Microsoft Academic Search

BACKGROUND: Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors. METHODS: Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched

Damien B Irving; Jill L Cook; Mark A Young; Hylton B Menz



Familial hypophosphatemia: an unusual presentation with low back ache, heel pain, and a limp in a young man, and literature review.  


A case of young man with low back ache and heel pains who was examined in a rheumatology outpatient and diagnosed as familial hypophosphatemia (FH), probably X-linked (XL), is presented. FH is most commonly transmitted as XL. The role of PHEX gene and fibroblast growth factor 23 is also described. PMID:21042824

Arthur, Sharon; Chopra, Arvind



Biomechanical and histiological considerations for development of plantar fasciitis and evaluation of arch taping as a treatment option to control associated plantar heel pain: a single-subject design  

Microsoft Academic Search

Study design: Alternating single-subject A-B and A-B-A designs. Objective: To discuss biomechanical and histiological issues related to the development of plantar fasciitis and to evaluate the effectiveness of arch taping in controlling heel pain during ambulation. Background: Plantar heel pain as a consequence of plantar fascial strain, a condition frequently diagnosed as plantar fasciitis, can significantly interfere with functional ambulation.

Gary C Hunt; Tom Sneed; Herb Hamann; Sheldon Chisam



Endoscopic Achilles tenolysis for management of heel cord pain after repair of acute rupture of Achilles tendon.  


Tendon pain after repair of an acute Achilles tendon rupture can result from suture granuloma formation, modification of the threshold of the pain receptors inside the tendon by scar tissue, expansion of the paratenon by tendon enlargement with secondary stimulation of mechanoreceptors, or underlying tendon degeneration. In the present technique report, an endoscopic technique of Achilles tenolysis for denervation and debulking is described that might be applicable in cases in which conservative treatment fails to alleviate the pain. PMID:23085384

Lui, Tun Hing



Surgical management of a diabetic calcaneal ulceration and osteomyelitis with a partial calcanectomy and a sural neurofasciocutaneous flap  

PubMed Central

The treatment of calcaneal osteomyelitis in diabetic patients poses a great challenge to the treating physician and surgeon. The use of a distally based sural neurofasciocutaneous flap after an aggressive debridement of non-viable and poorly vascularized tissue and bone that is combined with a thorough antibiotic regimen provides a great technique for adequate soft tissue coverage of the heel. In this case report, the authors describe the aforementioned flap as a versatile alternative to the use of local or distant muscle flaps for diabetic patients with calcaneal osteomyelitis and concomitant large wounds.

Ignatiadis, Ioannis A.; Tsiampa, Vassiliki A.; Arapoglou, Dimitrios K.; Georgakopoulos, Georgios D.; Gerostathopoulos, Nicolaos E.; Polyzois, Vasilios D.



Dual energy x-ray laser measurement of calcaneal bone mineral density  

NASA Astrophysics Data System (ADS)

In dual energy x-ray absorptiometry (DXA) the photon attenuation is assumed to be similar in soft tissue overlying, adjacent to and inside the measured bone. In the calcaneal dual energy x-ray laser (DXL) technique, this assumption is not needed as attenuation by soft tissues at the local bone site is determined by combining DXA and heel thickness measurements. In the present study, 38 subjects were measured with DXL Calscan, Lunar PIXI and Lunar DPX-IQ DXA instruments and Hologic Sahara ultrasound instrument, and the performance and agreement of the instruments were analysed. Furthermore, numerical simulations on the effect of non-uniform fat-to-lean tissue ratio within soft tissue in heel were conducted. In vivo short-term precision (CV%, sCV%) of DXL Calscan (1.24%, 1.48%) was similar to that of Lunar PIXI (1.28%, 1.60%). Calcaneal areal bone mineral densities (BMD, g cm-2) measured using DXL Calscan and Lunar PIXI predicted equally well variations in BMD of femoral neck (r2 = 0.63 and 0.52, respectively) or lumbar spine (r2 = 0.61 and 0.64, respectively), determined with Lunar DPX-IQ. BMD values measured with DXL Calscan were, on average, 19% lower (p < 0.01) than those determined with Lunar PIXI. Interestingly, the difference in BMD values between instruments increased as a function of body mass index (BMI) (r2 = 0.17, p < 0.02) or heel thickness (r2 = 0.37, p < 0.01). Numerical simulations suggested that the spatial variation of soft tissue composition in heel can induce incontrollable inaccuracy in BMD when measured with the DXA technique. Theoretically, in contrast to DXA instruments, elimination of the effect of non-uniform soft tissue is possible with DXL Calscan.

Hakulinen, M. A.; Saarakkala, S.; Töyräs, J.; Kröger, H.; Jurvelin, J. S.



Strength of internal fixation for calcaneal fractures  

Microsoft Academic Search

Objective. To compare the strength of two types of fixation method for calcaneal fractures.Design. A biomechanical testing examined the stability of 12 fractured calcaneal specimens fixed with two different methods.Background. Though anatomic reduction and internal fixation for the treatment of intra-articular fractures of the calcaneus has become popular, biomechanical data on the fixation strength is lacking.Methods. Twenty fresh frozen specimens

Chung-Li Wang; Guan-Liang Chang; Wen-Chang Tseng; Chin-Yin Yu; Ruey-Mo Lin



Skin-to-skin contact (Kangaroo Care) analgesia for preterm infant heel stick.  


The purpose of the study was to compare a heel stick conducted during Kangaroo Care (skin-to-skin contact) with the mother to a heel stick in a warmer in reducing premature infant physiologic and behavioral pain responses. Twenty-four premature infants in a university-based neonatal intensive care unit were recruited and randomized to 2 sequences: sequence A group received 3 hours of Kangaroo Care (with a heel stick in Kangaroo Care) followed by 3 hours in a warmer (with a heel stick in the warmer). Sequence B group had warmer care and a heel stick (in the warmer) before Kangaroo Care and a heel stick (in Kangaroo Care). Heart rate, respiratory rate, oxygen saturation, crying time, and behavioral state were measured before, during, and after heel stick. Repeated measures ANOVA and Mann Whitney U statistics were performed. Heart rate and length of crying in response to pain were significantly reduced during Kangaroo Care and the Kangaroo Care heel stick as compared to when infants were in the warmer and had a heel stick in the warmer. Three infants did not cry at all during the Kangaroo Care heel stick; infants slept more during Kangaroo Care than in the warmer. Kangaroo Care positioning before and during heel stick is a simple and inexpensive analgesic intervention to ameliorate pain in stable premature infants. PMID:16082239

Ludington-Hoe, Susan M; Hosseini, Robert; Torowicz, Deborah L


A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries  

PubMed Central

Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome.

Faroug, Radwane; Stirling, Paul; Ali, Farhan



Comparison of sucrose, expressed breast milk, and breast-feeding on the neonatal response to heel prick  

Microsoft Academic Search

Newborns endure many heel pricks and other uncomfortable procedures during their first hospital stay. The aim of this study was to investigate the effectiveness of breast-feeding in reducing pain in newborns undergoing heel prick tests. One hundred thirty healthy term infants requiring a heel prick blood sampling for the Guthrie test were studied. Infants were randomly allocated to 1 of

Hülya Bilgen; Eren Özek; Dil?at Cebeci; Rahmi Örs



Achilles Pain.  

ERIC Educational Resources Information Center

|Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

Connors, G. Patrick


Mountaineer’s heel  

Microsoft Academic Search

Mountaineers are at risk of skin lesions caused by constant boot friction. This is the case of a 35 year old mountaineer who presented with large and deeply ulcerated lesions over the medial aspects of both heels after a two and a half day climb using crampons. A number of factors such as the length of the climb in cold

R M Strauss



The influence of heel height on patellofemoral joint kinetics during walking.  


Although wearing high-heeled shoes has long been considered a risk factor for the development for patellofemoral pain (PFP) in women, patellofemoral joint kinetics during high-heeled gait has not been examined. The purpose of this study was to determine if heel height increases patellofemoral joint loading during walking. Eleven healthy women (mean age 25.0±3.1 yrs) participated. Lower extremity kinematics and kinetics were obtained under 3 different shoe conditions: low heel (1.27 cm), medium heel (6.35 cm), and high heel (9.53 cm). Patellofemoral joint stress was estimated using a previously described biomechanical model. Model outputs included patellofemoral joint reaction force, patellofemoral joint stress and utilized contact area as a function of the gait cycle. One-way ANOVAs with repeated measures were used to compare the model outputs and knee joint angles among the 3 shoe conditions. Peak patellofemoral joint stress was found to increase significantly (p=0.002) with increasing heel height (low heel: 1.9±0.7 MPa, medium heel: 2.6±1.2 MPa, and high heel: 3.6±1.5 MPa). The increased patellofemoral joint stress was mainly driven by an increase in joint reaction force owing to higher knee extensor moments and knee flexion angles. Our findings support the premise that wearing high-heeled shoes may be a contributing factor with respect to the development of PFP. PMID:22520457

Ho, Kai-Yu; Blanchette, Mark G; Powers, Christopher M



Heel lance in newborn during breastfeeding: an evaluation of analgesic effect of this procedure  

Microsoft Academic Search

OBJECTIVES: The reduction of pain due to routine invasive procedures (capillary heel stick blood sampling for neonatal metabolic screening) in the newborn is an important objective for the so-called \\

Elena Uga; Manuela Candriella; Antonella Perino; Viviana Alloni; Giuseppina Angilella; Michela Trada; Anna Maria Ziliotto; Maura Barbara Rossi; Danila Tozzini; Clelia Tripaldi; Michela Vaglio; Luigina Grossi; Michaela Allen; Sandro Provera



Rearward movement of the heel at heel strike.  


This paper describes the observation of rearward movement (RM) of the heel following heel strike occurring during normal gait. Thirty-one participants recruited as part of a larger study on slip kinematics walked the length of an 8-m runway at a speed of 1.5 m/s. Several floor surfaces, presented dry and with contaminant, were used for the purpose of eliciting a wide range of small slip distances. The normal force applied to a forceplate mounted in the runway was used to identify heel strike, as well as to calculate the utilized coefficient of friction during early stance phase. A motion analysis system tracked the displacement of two heel-mounted markers, and the data were used to derive kinematic variables related to the heel strike event. Results showed that RMs occurred in 18.1% of 494 trials, with a mean rearward displacement of 5.02 (+/-3.68) mm. When present, RMs occurred in close temporal proximity to heel strike, typically completing RM within 40 ms of the heel strike event. When divided into groups by age, older participants (>40 years) were more than twice as likely to have RMs as younger participants. When grouped by height or weight, differences in the proportion of trials with RMs were small. In trials where RMs were observed, forward slip distances were significantly less than for trials with no RMs, 2.17 (+/-3.87) mm vs. 12.58 (+/-10.71) mm, respectively. The time until the heel stopped moving during the post-heel strike period was not significantly different between RM and non-RM trials. Further investigation of this gait feature may improve understanding of normal gait patterns and may have implications for future slipmeter development. PMID:18280459

McGorry, Raymond W; Chang, Chien-Chi; DiDomenico, Angela



The effect of different depths of medial heel skive on plantar pressures  

PubMed Central

Background Foot orthoses are often used to treat lower limb injuries associated with excessive pronation. There are many orthotic modifications available for this purpose, with one being the medial heel skive. However, empirical evidence for the mechanical effects of the medial heel skive modification is limited. This study aimed to evaluate the effect that different depths of medial heel skive have on plantar pressures. Methods Thirty healthy adults (mean age 24 years, range 18–46) with a flat-arched or pronated foot posture and no current foot pain or deformity participated in this study. Using the in-shoe pedar-X® system, plantar pressure data were collected for the rearfoot, midfoot and forefoot while participants walked along an 8 metre walkway wearing a standardised shoe. Experimental conditions included a customised foot orthosis with the following 4 orthotic modifications: (i) no medial heel skive, (ii) a 2 mm medial heel skive, (iii) a 4 mm medial heel skive and (iv) a 6 mm medial heel skive. Results Compared to the foot orthosis with no medial heel skive, statistically significant increases in peak pressure were observed at the medial rearfoot – there was a 15% increase (p?=?0.001) with the 4 mm skive and a 29% increase (p?heel skive. With respect to the midfoot and forefoot, there were no significant differences between the orthoses. Conclusions This study found that a medial heel skive of 4 mm or 6 mm increases peak pressure under the medial rearfoot in asymptomatic adults with a flat-arched or pronated foot posture. Plantar pressures at the midfoot and forefoot were not altered by a medial heel skive of 2, 4 or 6 mm. These findings provide some evidence for the effects of the medial heel skive orthotic modification.



Computed tomography of calcaneal fractures  

SciTech Connect

Computed tomography (CT) of 25 fractured calcanei was performed to investigate the potential of CT in evaluating the pattern and biomechanics of these fractures. The characteristic findings of typical fractures are presented, including the number and type of principal fragments, size and dislocation of the sustentacular fragment, and involvement of the anterior and posterior facets of the subtalar joint. In 17 cases, the calcaneus consisted of four or more fragments. Furthermore, in 17 cases the sustentacular fragment included all or part of the posterior facet joint. In 18 of the 25 cases, the sustentacular fragment was displaced. It is concluded that well performed CT is an invaluable adjunct in understanding the fracture mechanism and in detecting pain-provoking impingement between the fibular malleolus and the tuberosity fragment.

Heger, L.; Wulff, K.; Seddiqi, M.S.A.



Spontaneous talar and calcaneal fracture in rheumatoid arthritis: a case report  

PubMed Central

Rheumatoid arthritis (RA) leads to a progressive weakening of the skeleton which may result in bone fractures. However, spontaneous fractures (exclusive of stress fractures, vertebral collapse, and superficial articular fragmentation) in patients with rheumatoid arthritis have been only occasionally reported in the medical literature. A case of spontaneous talar and calcaneal fracture in rheumatoid arthritis is described. Bone lesions were identified on radiographs, MR images and scintigraphy in a patient with right ankle pain. The absence of episodes of acute trauma, and the presence of acute clinical manifestations should guide the clinical suspicion.

Spina, Antonio; Clemente, Alberto; Vancini, Chiara; Fejzo, Majlinda; Campioni, Paolo



Heel Spurs: Do They Always Cause Pain?  


... of Physical Medicine and Rehabilitation, including subspecialty certification in sports medicine, and is a fellow of the American ... staff of Mayo Clinic since 1990 and specializes in sports medicine, fitness, strength training and stability training. He ...


Examining the degree of pain reduction using a multielement exercise model with a conventional training shoe versus an ultraflexible training shoe for treating plantar fasciitis.  


Plantar fasciitis is a common injury to the plantar aponeurosis, manifesting as pain surrounding its proximal insertion at the medial calcaneal tubercle. Pain is typically worse in the morning when getting out of bed, and may subside after the tissue is sufficiently warmed up. For running-based athletes and individuals who spend prolonged periods of time on their feet at work, plantar fasciitis may become recalcitrant to conservative treatments such as ice, rest, and anti-inflammatory medication. Exercise-based therapies have received only limited attention in the literature for this common problem, yet they are becoming increasingly validated for pain relief and positive tissue remodeling at other sites of similar soft-tissue overuse injury. This study reports on pain outcomes in individuals experiencing chronic plantar fasciitis while wearing a shoe with an ultraflexible midsole (Nike Free 5.0) (FREE) versus a conventional training (CON) shoe in a 12-week multielement exercise regimen, and after a 6-month follow-up. Adults with >or= 6-month history of painful heel pain were recruited and randomly assigned to wear 1 of the 2 shoes. All subjects completed the same exercise protocol. A visual analogue scale item tracked peak pain in the preceding 24 hours taken at baseline, 6- and 12-week points, and at the 6-month follow-up. Twenty-one subjects completed the program (9 FREE; 12 CON). Both groups reported significant improvements in pain by the 6-month follow-up, and the FREE group reported an overall reduced level of pain throughout the study as a result of lower mean pain scores at the midpoint and post-test compared with the CON group. The exercise regimen employed in this study appears to reduce pain associated with chronic plantar fasciitis, and in doing so, the Nike 5.0 shoe may result in reductions in pain earlier than conventional running shoes. PMID:20048543

Ryan, Michael; Fraser, Scott; McDonald, Kymberly; Taunton, Jack



Minimally invasive reposition of intraarticular calcaneal fractures: A case report.  


Background: Calcaneal fracture is a most common bony injury of the hindfoot. In constitutes 60% of foot fractures and 1-2% of all fractures. According to current literature 75% of these fractures involve articular surfaces, which makes them especially difficult to treat. Intraarticular fractures often result in permanent disability impairing foot function and ambulation, sometimes due to inadequate treatment method. According to literature, in developed countries open reduction and internal plate fixation is standard treatment of intraarticular calcaneal fractures. This treatment poses a risk of impaired wound healing and is appropriate for selected group of patients without additional risk factors. Other patients are treated with minimally invasive methods. Proponents of minimally invasive techniques apply distraction, which makes most intraarticular calcaneal fractures amenable to this method. Case Report: This paper presents a minimally invasive treatment technique for intraarticular (depression type according to Essex-Lopresti, IIA accordind to Sanders) calcaneal fracture in 63-years old man. External fixator (Monotube) is used for intraoperative distraction. Posterior facet is reduced with additional maneuvers. Results: With this technique we were able to reduce posterior faced, correct varus alignment and restore Böhler's angle. With restoration of shape of calcaneal bone optimal functional result can be expected. At six moths follow-up very good result was observed.   PMID:24022217

Malawski, Piotr; Pomianowski, Stanis?aw



Internal strain estimation for quantification of human heel pad elastic modulus: A phantom study.  


Shock absorption is the most important function of the human heel pad. However, changes in heel pad elasticity, as seen in e.g. long-distance runners, diabetes patients, and victims of Falanga torture are affecting this function, often in a painful manner. Assessment of heel pad elasticity is usually based on one or a few strain measurements obtained by an external load-deformation system. The aim of this study was to develop a technique for quantitative measurements of heel pad elastic modulus based on several internal strain measures from within the heel pad by use of ultrasound images. Nine heel phantoms were manufactured featuring a combination of three heel pad stiffnesses and three heel pad thicknesses to model the normal human variation. Each phantom was tested in an indentation system comprising a 7MHz linear array ultrasound transducer, working as the indentor, and a connected load cell. Load-compression data and ultrasound B-mode images were simultaneously acquired in 19 compression steps of 0.1mm each. The internal tissue displacement was for each step calculated by a phase-based cross-correlation technique and internal strain maps were derived from these displacement maps. Elastic moduli were found from the resulting stress-strain curves. The elastic moduli made it possible to distinguish eight of nine phantoms from each other according to the manufactured stiffness and showed very little dependence of the thickness. Mean elastic moduli for the three soft, the three medium, and the three hard phantoms were 89kPa, 153kPa, and 168kPa, respectively. The combination of ultrasound images and force measurements provided an effective way of assessing the elastic properties of the heel pad due to the internal strain estimation. PMID:23079052

Holst, Karen; Liebgott, Hervé; Wilhjelm, Jens E; Nikolov, Svetoslav; Torp-Pedersen, Søren T; Delachartre, Philippe; Jensen, Jørgen A



[Surgical treatment of intra-articular calcaneal fractures].  


PURPOSE OF THE STUDY The calcaneus is one of the most complex bones in the human body. If fractured, restoration of its anatomy is demanding and displaced fractures may have permanent consequences affecting both daily living and work activities of the patient. In this prospective study, the authors present the results of surgical treatment of 48 dislocated intra-articular fractures of the heel bone. MATERIAL In the period from September 2006 to September 2009, 48 dislocated intra-articular fractures in 41 patients were surgically treated at the Department of Trauma Surgery in Bratislava-Kramare. Seven (17 %) patients, six men and one woman, had bilateral calcaneal fractures. In the group of 41 patients, 32 (78 %) were men and nine (22 %) were women. The average age of the group was 41 years (range, 16 - 64 years). METHODS Based on computed tomography scans, the fractures (n=48) were classified according to the Sanders system into Sanders II to IV subgroups. This included 26 Sanders II fractures (54 %), 15 Sanders III fractures (31 %) and seven Sanders IV fractures (15 %). Minimally invasive reduction and osteosynthesis (MIOS) was used to treat 16 Sanders II fractures (33.33 %) and two Sanders IV fractures (4.16 %). Open reduction and internal fixation (ORIF) was employed in 10 Sanders II fractures (20.83 %), all 15 Sanders III fractures (31 %) and one Sanders IV fracture (2.08 %). Four comminuted fractures (8.33 %) classified as Sanders IV fractures were stabilised with an external fixator. The surgical technique was selected in accordance with the bone morphology, soft tissue condition and patient's overall state. RESULTS The patients were followed up for 6 to 36 months and clinical assessment was based on the Creighton Nebraska Health Foundation scoring system (C-N score) and the AOFAS Ankle-Hindfoot Scale (A-H score). The functional outcomes were excellent in 25 fractures (52 %), good in nine (18.75 %), less satisfactory in eight (16.6 %) and poor in six fractures (12.5 %). Complications of wound healing were recorded in three fractures (6.25 %) treated by ORIF, and only involved superficial marginal wound necrosis. There was no deep wound infection. Algodystrophic syndrome developed in two cases (4.16 %). X-ray measurements were used to assess the final Böhler's angle, whose value after treatment ranged from 8° to 38°, with an average of 27°. DISCUSSION At present the selection of an operative technique is being discussed. The advocates of MIOS emphasise a lower com- plication rate associated with wound healing and the possibility of using this technique when the treated tissues are in a critical condition. The advantage of ORIF lies in exact open reduction and stable osteosynthesis. CONCLUSIONS The method of percutaneous reduction and osteosynthesis is the optimal treatment for Sanders II dislocated fractures. Severely dislocated fractures (Sanders II and III) require open reduction and plate osteosynthesis. Comminuted fractures should be treated first by external fixation and by arthrodesis at the second stage if problems arise. PMID:21575552

Popelka, V; Simko, P



Comparison of lateral opening wedge calcaneal osteotomy and medial calcaneal sliding-opening wedge cuboid-closing wedge cuneiform osteotomy for correction of planovalgus foot deformity in children.  


The purpose of the present study was to compare the clinical and radiographic results between 2 procedures, lateral opening wedge calcaneal osteotomy (LCL) and medial calcaneal sliding-opening wedge cuboid-closing wedge cuneiform osteotomy (3C) in patients with planovalgus foot deformity. A total of 38 patients who underwent either LCL (18 patients, 28 feet) or 3C (20 patients, 32 feet) were included in the present study. The etiology of the planovalgus foot deformity was idiopathic in 16 feet and cerebral palsy in 44 feet. The 2 procedures used in the present study were indicated in symptomatic (pain or callus) children in whom conservative treatment, such as shoe modifications or orthotics, had been applied for more than 1 year but had failed. The patients were evaluated preoperatively, postoperatively, and at the last follow-up visit, both clinically and radiologically, and the interval to union and postoperative courses were compared between the 2 groups. In the LCL group, 19 of the 28 feet (68%) showed a satisfactory outcome and 9 (32%) an unsatisfactory outcome. In the 3C group, 28 of the 32 feet (88%) showed a satisfactory outcome and 4 (12%) an unsatisfactory outcome. The clinical results were not significantly different between the 2 groups, with mild to moderate pes planovalgus deformity. However, the clinical results were better in the 3C group with severe pes planovalgus deformity than in the LCL group with severe pes planovalgus deformity. All 4 radiographic parameters were improved at the last follow-up visit in both groups. In particular, the talar-first metatarsal angle and the calcaneal pitch angle on the weightbearing lateral radiographs were significantly improved in the 3C group with mild to moderate planovalgus foot deformity. All 4 parameters were significantly improved in the 3C group with severe planovalgus foot deformity. No significant differences were observed between the 2 groups in terms of the interval to union and postoperative care. No case of postoperative deep infection or nonunion was encountered in either group. 3C is a more effective procedure than LCL for the correction of pes planovalgus deformity in children, especially severe pes planovalgus deformities. PMID:23333282

Kim, Jung Ryul; Shin, Sung Jin; Wang, Sung-Il; Kang, Sang Min



Practice Recommendations for Preventing Heel Pressure Ulcers  

Microsoft Academic Search

Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers are a particular concern for surgical patients. A review of the literature, including poster presentations, shows that controlled clinical studies to assess the effectiveness and cost-effectiveness of available interventions are not available. Case series (with or

Evonne Fowler; Suzy Scott-Williams; James B. McGuire


Calcaneal stress fractures in amateur football players  

Microsoft Academic Search

Stress fractures resulting from physical exercise have been recognized since 1855, when Breithaupt reported foot pain and\\u000a swelling in a group of Prussian soldiers feet (1,8). They typically occur in normal bones which are subjected to repeated\\u000a cyclic force but the strength of the force applied on the bone should not be strong enough to result in an acute fracture.

Z. Orhan; A. Parmaksizoglu; E. Kayiran




Microsoft Academic Search

Background. Most researches prove that surgery is the only way to a successful treatment result of calcaneal fractures despite poor quality of existing data. However, com- plications are still frequent. Rehabilitation is rather lengthy and even if the surgery is successful, there is no guarantee for successful final treatment results. Patients and methods. 48 patients with 52 calcaneal fractu- res

Drago Brilej; Radko Komadina


Calcaneal osteomyelitis due to Achromobacter xylosoxidans: a case report.  


Achromobacter xylosoxidans (A. xylosoxidans) has been described as an opportunistic pathogen causing infection. The case we describe is that of an elderly man who had osteomyelitis of calcaneal bone caused by A. xylosoxidans. As far as we are aware there are only 5 cases of osteomyelitis with A. xylosoxidans in the literature. Impaired defensive mechanism of the foot in direct contact with this waterborne bacterium can cause this disease. Because of the high level of antibiotic resistance of this bacterium, clinically more attention should be paid to patients who have impaired defensive mechanisms in their extremities, for example free flaps. PMID:22286410

Ozer, Kadri; Kankaya, Yuksel; Baris, Ruser; Bektas, Cem Inan; Kocer, Ugur



Recovery of Plutonium from Electrorefining Anode Heels at Savannah River.  

National Technical Information Service (NTIS)

In a joint effort, the Savannah River Laboratory (SRL), Savannah River Plant (SRP), and the Rocky Flats Plant (RFP) have developed two processes to recover plutonium from electrorefining anode heel residues. Aqueous dissolution of anode heel metal was dem...

J. H. Gray L. W. Gray D. G. Karraker



The impact of low-saturated fat, low cholesterol diet on bone properties measured using calcaneal ultrasound in prepubertal children.  


To analyze the effects of low-saturated fat, low-cholesterol diet on bone in healthy children, calcaneal ultrasound measurements were obtained in 139 subjects (71 girls, 68 boys; mean age 8 years, SD 0.5), who were recruited from the STRIP (Special Turku Coronary Risk Factor Intervention Project) trial. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and quantitative ultrasound index (QUI) values were determined at the dominant heel using a Hologic Sahara scanner. Values were compared with anthropometry and mean, energy-adjusted dietary intakes (absolute intake/1000 kcal) of fat, carbohydrates, protein, cholesterol, calcium, fiber, and the polyunsaturated to saturated fatty acid ratio derived from 4-day food diaries kept once a year between the ages of 2-7 years. The intakes were also analyzed separately at each time point. The BUA, SOS, and QUI values of the intervention children (n = 90) and the control children (n = 49) were similar. No gender differences were found. BUA correlated with age (r = 0.26, P<0.01), height (r = 0.19, P<0.05), and weight (r = 0.22, P<0.05). QUI correlated with mean intake of fat (r = 0.19, P<0.05) and carbohydrate (r = -0.22, P<0.05), SOS with mean intake of cholesterol (r = 0.18, P<0.05), and BUA with mean intake of carbohydrate (r = -0.22, P<0.05). The intakes of fat and cholesterol were lower (P<0.001) and intakes of protein and carbohydrates higher (P<0.01) in the intervention children, but the intakes of calcium were similar. The differences in the dietary intakes persisted throughout the study period. We conclude that dietary counseling aimed at reducing risk of atherosclerosis in later life does not decrease dietary intake of calcium or diminish the calcaneal ultrasound values in the intervention of children in this study. However, since this study is cross-sectional and only one measurement of bone is used, further studies are needed to draw further conclusions about the influence of dietary counseling on bone health. PMID:12170372

Paakkunainen, U; Raittinen, P; Viikari, J; Seppänen, R; Simell, O



Novel posterior splinting technique to avoid heel ulcers.  


Heel ulcers are a costly and preventable complication of lower-extremity immobilization, but they still occur with some regularity. A technique using a short leg posterior splint that suspends the heel away from the splint is described. This modification completely removes pressure the heel to prevent decubitus ulcer formation. This technique is simple, inexpensive, and effective. PMID:23276331

Hsu, Raymond Y; Lareau, Craig R; Born, Christopher T



Analysis of heel pad tissues mechanics at the heel strike in bare and shod conditions.  


A combined experimental and numerical approach is used to investigate the interaction phenomena occurring between foot and footwear during the heel strike phase of the gait. Two force platforms are utilised to evaluate the ground reaction forces of a subject in bare and shod walking. The reaction forces obtained from the experimental tests are assumed as loading conditions for the numerical analyses using three dimensional models of the heel region and of the running shoe. The heel pad region, as fat and skin tissues, is described by visco-hyperelastic and fibre-reinforced hyperelastic formulations respectively and bone region by a linear orthotropic formulation. Different elastomeric foams are considered with regard to the outsole, the midsole and the insole layers. The mechanical properties are described by a hyperfoam formulation. The evaluation of the mechanical behaviour of the heel pad tissues at the heel strike in bare and shod conditions is performed considering different combinations of materials for midsole and insole layers. Results allow for the definition of the influence of different material characteristics on the mechanical response of the heel pad region, in particular showing the compressive stress differentiation in the bare and shod conditions. PMID:22789809

Fontanella, C G; Forestiero, A; Carniel, E L; Natali, A N



The movement of the heel within a running shoe.  


Most running shoe investigations have used the same standard procedure for the evaluation of the shoes: the runners are filmed from behind and a film analysis is carried out digitizing markers at the heel counter of the shoe and on the lower leg. The angular displacement of these markers relative to the horizontal or the vertical is assumed to be an indicator for various sports injuries. The goal of this investigation was to measure the movement of the heel counter as well as the movement of the heel inside the shoe. First, the influence of the size of different heel counter windows was controlled and found negligible for the test conditions of this study. Second, 15 subjects performed the following procedure: running (a) barefoot, (b) with shoes with windows, and (c) without windows. Overall, the heel was found to move similarly but not identically to the heel counter. The maximum change of pronation was (a) 13.7 +/- 3.7 degrees, barefoot; (b) 14.1 +/- 3.8 degrees for the shoe with windows and 12.1 +/- 3.7 degrees for the heel inside these shoes; and 14.9 +/- 4.2 degrees for the shoes with no windows. To achieve a general impression of a shoe in the sense of a qualitative description, the previous method without heel counter windows still seems adequate. However, for a detailed analysis of quantitative nature, it is important to use the method with heel counter windows. PMID:1602942

Stacoff, A; Reinschmidt, C; Stüssi, E



[A case of aseptic osteomyelitis with heel ulcer improved by steroid application].  


A 43-year-old male patient was admitted to our hospital because of left heel pain and fever. He had had swelling of the left ankle joint and pain 4 years prior to this, and 4 years later, he was admitted to another hospital when left heel ulcer and fever developed. The ulcer was diagnosed and treated as a diabetic ulcer because of hyperglycemia. In spite of good control of blood sugar, the ulcer became enlarged and the pain deteriorated, so he was transferred to orthopedics. Antibiotics produced no response, and culture from a specimen of the ulcer was negative. However, severe inflammatory response was seen in blood examination. MRI and scintigram of his left foot showed disseminated low intensity areas and accumulation in the tarsal bone area, so osteomyelitis was suspected. A biopsy of the ulcer showed infiltration of inflammatory cells into the dermis. We considered amputation of the left lower leg at first. However the biopsy result suggested an autoimmune mechanism, so prednisolone was administered. As a result, the ulcer and pain both diminished. This case was similar to pyoderma gangenosum, however this diagnosis cannot explain osteomyelitis or all its symptoms. We expect that there must be other case report with the same symptoms. PMID:10917019

Idogawa, M; Takahashi, H; Soma, T; Mihara, M; Mizukoshi, T; Murakami, R; Sugaya, T; Makiguchi, Y; Imai, K



Substantially reduced calcaneal bone ultrasound parameters in severe untreated asthma.  


We report the case of a 9-year-old male patient with severe bronchial asthma, who had not received inhaled corticosteroids (ICS) despite persistent asthma symptoms and 2 life-threatening asthma attacks. ICS application had been avoided for fear of systemic side effects like bone density loss. Quantitative ultrasound (QUS) is a noninvasive and ionizing radiation-free method to assess bone characteristics. In our clinic, regional age-, sex-, weight- and height-related references for calcaneal QUS were generated from 3,299 children and adolescents. Ultrasonic bone parameters from our patient were substantially reduced at the initial measurement when the patient was 6 years of age by up to -3.75 standard deviation scores. At the same time, chronic pulmonary hyperinflation led to severe thoracic deformation. Only when a second life-threatening asthma attack almost required mechanical ventilation, the family was convinced to have ICS therapy initiated. This treatment led to clinical stabilization including normalization of the thoracic shape. In parallel, QUS values improved continuously up to the normal range. Our case report emphasizes the risks of omitting ICS in severe asthma for fear for systemic side effects. On the contrary, ICS in low to medium dosages may allow regular growth, bone development and normalization of previously severe effects of the disease itself. PMID:19246875

Mainz, Jochen G; Kaiser, Werner A; Beck, James F; Mentzel, Hans-Joachim



Association between CT imaging at follow-up and clinical outcomes in heel fractures  

Microsoft Academic Search

The reliability of CT data for calcaneal fractures was evaluated, quantifying five CT parameters and investigating their association\\u000a with clinical outcomes. Fifty-four intra-articular calcaneal fractures surgically treated were considered. Vertical and longitudinal\\u000a alignment, calcaneal body height, position of sustentaculum tali and subtalar joint congruity were evaluated at 49 months\\u000a (27–94) follow-up. Each parameter was then quantified and its association with the

Bruno Magnan; Elena Samaila; Dario Regis; Michele Merlini; Pietro Bartolozzi



The effect of amenorrhea on calcaneal bone density and total bone turnover in runners.  


To examine in athletes the effect of long-term amenorrhea on the skeleton, measurements of calcaneal density and whole body retention of 99mTc-imidodiphosphate were made in 42 women who could be allocated to one of 3 groups defined by their level of physical activity and by menstrual status. There was no difference in bone density between eumenorrheic normoactive females and either eumenorrheic or amenorrheic athletes. However, calcaneal density was significantly greater for each group than for previously measured sedentary controls. Total body bone turnover was greater in both eumenorrheic and amenorrheic athletes than in eumenorrheic normoactive women. Sustained, intense physical activity does not significantly increase calcaneal bone density over and above the increase associated with normal levels of activity. This is despite a significant increase in the rate of total body bone mineral turnover. PMID:1752722

Harber, V J; Webber, C E; Sutton, J R; MacDougall, J D



An alternative method of fixation of calcaneal tuberosity fractures using the tightrope(®) technique.  


Calcaneal tuberosity fractures account for 1% to 3% of all calcaneal fractures. These fractures are frequently seen in the osteoporotic or diabetic elderly population. The patient's comorbidities, coupled with the usually osteoporotic bone, make fixing this fracture pattern a challenge. Numerous surgical techniques have been advocated for this fracture, including the standard lag screw fixation, tension band wiring, suture anchors, and direct suture repair. Whichever method is used, the construct must resist the massive pull of the gastrocnemius-soleus complex. We have described a method of fixing the avulsed calcaneal tuberosity using the TightRope(®) ankle syndesmosis fixation device (Arthrex(®), Naples, FL), which offers the advantages of allowing a robust and reliable fixation of a small or comminuted fragment. It is particularly advantageous in osteoporotic bone because of concern regarding the use of standard lag screw fixation, and it also may eliminate complications associated with retained hardware. PMID:24160723

Harb, Ziad; Dachepalli, Sunil; Mani, Ganapathyraman


Dystrophic calcification following neonatal heel-prick testing.  


A 7-year-old boy presented with a 5-year history of dystrophic calcification manifesting as solitary nodules on the plantar aspect of both heels. Microscopic examination showed hyperkeratosis and psoriasiform hyperplasia overlying an area of dystrophic calcification. Multiple heel-prick tests carried out during the neonatal period to monitor blood glucose levels are the likely causative mechanism. PMID:20695862

Kurzydlo, Ann-Maree; Hannaford, Rodney



A Biomechanical Evaluation of Standing in High Heeled Shoes  

Microsoft Academic Search

The purpose of this study was to determine the action of the ground reaction force upon the heels of women standing in high-heeled shoes. The study involved a non-invasive determination of the location of the subtalar joint axis, the joint about which the foot bends in and out. It was determined where the ground reaction force acts relative to the

Paula D. Henderson; Penn State; Stephen J. Piazza


Reliability and Validity of the Standing Heel-Rise Test  

ERIC Educational Resources Information Center

|A standardized protocol for a pediatric heel-rise test was developed and reliability and validity are reported. Fifty-seven children developing typically (CDT) and 34 children with plantar flexion weakness performed three tests: unilateral heel rise, vertical jump, and force measurement using handheld dynamometry. Intraclass correlation…

Yocum, Allison; McCoy, Sarah Westcott; Bjornson, Kristie F.; Mullens, Pamela; Burton, Gay Naganuma



Recovery of plutonium from electrorefining anode heels at Savannah River  

SciTech Connect

In a joint effort, the Savannah River Laboratory (SRL), Savannah River Plant (SRP), and the Rocky Flats Plant (RFP) have developed two processes to recover plutonium from electrorefining anode heel residues. Aqueous dissolution of anode heel metal was demonstrated at SRL on a laboratory scale and on a larger pilot scale using either sulfamic acid or nitric acid-hydrazine-fluoride solutions. This direct anode heel metal dissolution requires the use of a geometrically favorable dissolver. The second process developed involves first diluting the plutonium in the anode heel residues by alloying with aluminum. The alloyed anode heel plutonium can then be dissolved using a nitric acid-fluoride-mercury(II) solution in large non-geometrically favorable equipment where nuclear safety is ensured by concentration control.

Gray, J.H.; Gray, L.W.; Karraker, D.G.



Deltoid ligament forces after tibialis posterior tendon rupture: effects of triple arthrodesis and calcaneal displacement osteotomies.  


Deltoid ligament forces were studied after observing deltoid ligament insufficiency in several post-triple arthrodesis patients. Six fresh-frozen, below-knee amputation specimens were axially loaded. The results demonstrate that a properly positioned triple arthrodesis produced deltoid ligament forces that were similar to those seen with an intact tibialis posterior tendon. A triple arthrodesis in combination with a lateral displacement calcaneal osteotomy produced deltoid ligament forces that were 76% greater than those seen with the intact tibialis posterior tendon (P < .05). A triple arthrodesis in combination with a medial displacement calcaneal osteotomy produced deltoid ligament forces that were 56% less than those seen with the lateral displacement calcaneal osteotomy (P < .01). Patients with longstanding ruptures of the tibialis posterior tendon and associated peritalar subluxation/dislocation may have less than optimal clinical results after triple arthrodesis, unless the hindfoot can be properly reduced, due to persistent elevated forces in the deltoid ligament and resulting ligament laxity. This study suggests that a medial displacement calcaneal osteotomy in combination with a triple arthrodesis may be a viable treatment when the hindfoot cannot be positioned properly. PMID:7697148

Resnick, R B; Jahss, M H; Choueka, J; Kummer, F; Hersch, J C; Okereke, E



Heel-line hyperpigmentation: a variant of sock-line hyperpigmentation after the use of heel-length socks.  


Two infants developed hyperpigmented curvilinear patches on the posterior heel after wearing heel-length socks. Both of the patient's lesions improved after discontinuing the use of the heel-length socks. Hyperpigmented patches called sock-line or mitten-line hyperpigmentation have been reported at sites of tight elastic bands from socks or mittens in infants on the calves and wrists. Recognizing this clinical entity is important to differentiate it from other causes of linear lesions such as child abuse or amniotic band syndrome. PMID:23432211

Ciliberto, Heather; Berk, David; Salphale, Pankaj; Bayliss, Susan



Want to Spend Less? Shop in High Heels, Study Says  


... in high heels," study author Jeffrey Larson, a marketing professor at Brigham Young University, said in a ... in the current issue of the Journal of Marketing Research , found people focused on balancing were more ...


Effectiveness of a locking plate in preserving midcalcaneal length and positional outcome after evans calcaneal osteotomy: a retrospective pilot study.  


When using the Evans calcaneal osteotomy for repair of a calcaneovalgus deformity, lengthening of the lateral column of the foot is the method by which the procedure acts to correct the deformity. Therefore, maintaining the length is a priority. In our experience, substantial length is lost soon after surgery using the traditional nonfixated procedure. To test this hypothesis, a retrospective study was undertaken in which we compared the calcaneal length before and after the Evans procedures in 22 patients treated without fixation and 13 patients in whom the graft was fixated with a small locking plate to bridge the osteotomy and reduce the compressive forces on the graft. Within the first 10 days after surgery, the increase in calcaneal length from the preoperative length was 6.3 mm in the nonfixated group and 6.8 mm in the fixated group (p = .54 for the 0.5-mm difference). At 12 weeks after surgery, the mean amount of shortening from the value observed at 1 week was 2.45 (range 0 to 6) mm in the nonfixated group and 1.0 (range 0 to 3) mm in the internal fixation group (p = .48). Also, at 12 weeks, distal calcaneal migration or dorsal anterior calcaneal displacement of more than 3 mm occurred in 5 patients (23%) in the nonfixated group and 1 patient (8%) in the fixated group (p = .04). Our results suggest that locking plates do preserve the correction obtained with the Evans calcaneal osteotomy. PMID:23800574

Dayton, Paul; Prins, Dustin B; Smith, David E; Feilmeier, Mindi J



Calcaneal insufficiency fracture in a child with osteosarcoma after chemotherapy and limb-sparing surgery  

Microsoft Academic Search

We report a rare case of a calcaneal insufficiency fracture in an 11-year-old boy with an osteosarcoma of the right proximal\\u000a tibia. After one course of neoadjuvant chemotherapy for 4 months, we performed limb-sparing surgery. The knee joint was replaced\\u000a with a custom-made endoprosthesis and the knee extensor mechanism was reconstructed with a medial gastrocnemius muscle flap.\\u000a Seven months postoperatively, he

Toshihisa Osanai; Takashi Tsuchiya; Masato Sugawara



Early Weight-bearing Using Percutaneous External Fixator for Calcaneal Fracture  

PubMed Central

Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patients. We have used a biplanar percutaneous external fixator for treating calcaneal fractures without operative and per operative visualization of the fractures. We have treated 17 calcaneal fractures in 16 patients, 12 intra articular and five extra articular, with our percutaneous external fixator system without preoperative X-ray control or reduction. Functional outcome was measured using the American Orthopaedic Foot and ankle society Hind foot score. All fractures united with a mean of 55 days. Partial weight bearing was possible in a mean of 1.8 days and full bearing was possible in a mean of 11.6 days. All the patients were returned to their original work within six weeks. Minor infectious complications occurred in 17.6 percent of cases. The average AOFAS score at six months follow up was 83.8. We conclude that our percutaneous external fixator technique for fracture calcaneum is an effective alternative to the currently available – surgical and conservative treatment modalities especially in lower socio economic labor population who need to return to their job as early as possible. Level of Evidence – IV Case series.

Sengodan, Vetrivel Chezian; Sengodan, Mugundhan Moongilpatti



Is heel prick as safe as we think?  


Purulent lymphadenitis is rare in newborn and is associated with prematurity and invasive procedure. Neonatal staphylococcal infections due to skin interruption during intramuscular vitamin K administration and national metabolic screening programme (heel prick or Guthrie card test) have been already previously described. This is a report of a premature infant who developed an inguinal adenitis as a result of late complications from heel pricks. The diagnosis was made on clinical grounds and confirmed by ultrasound scans. Staphylococcus aureus was isolated. Bacteremia did not occur and the lymphadenitis had a complete resolution with antimicrobial therapy. The heel prick is a well-established procedure in neonatal practice, nevertheless it is not risk-free. The attention to signs of infections is important to avoid complications such as purulent lymphadenitis, abscess formation and septicemia. Best practice prevention and control in minimising the risk of infections are the most important intervention to prevent this complication. PMID:22675035

Onesimo, Roberta; Fioretti, Maria; Pili, Stefania; Monaco, Serena; Romagnoli, Costantino; Fundarò, Carlo



Contribution of calcaneal and leg segment rotations to ankle joint dorsiflexion in a weight-bearing task.  


Joint angle is the relative rotation between two segments where one is a reference and assumed to be non-moving. However, rotation of the reference segment will influence the system's spatial orientation and joint angle. The purpose of this investigation was to determine the contribution of leg and calcaneal rotations to ankle rotation in a weight-bearing task. Forty-eight individuals performed partial squats recorded using a 3D motion capture system. Markers on the calcaneus and leg were used to model leg and calcaneal segment, and ankle joint rotations. Multiple linear regression was used to determine the contribution of leg and calcaneal segment rotations to ankle joint dorsiflexion. Regression models for left (R(2)=0.97) and right (R(2)=0.97) ankle dorsiflexion were significant. Sagittal plane leg rotation had a positive influence (left: ?=1.411; right: ?=1.418) while sagittal plane calcaneal rotation had a negative influence (left: ?=-0.573; right: ?=-0.650) on ankle dorsiflexion. Sagittal plane rotations of the leg and calcaneus were positively correlated (left: r=0.84, P<0.001; right: r=0.80, P<0.001). During a partial squat, the calcaneus rotates forward. Simultaneous forward calcaneal rotation with ankle dorsiflexion reduces total ankle dorsiflexion angle. Rear foot posture is reoriented during a partial squat, allowing greater leg rotation in the sagittal plane. Segment rotations may provide greater insight into movement mechanics that cannot be explained via joint rotations alone. PMID:22336147

Chizewski, Michael G; Chiu, Loren Z F



Farriery for the hoof with low or underrun heels.  


Underrun heels are common and involve hoof capsule distortion in which the horn tubules of the heels undergo bending and lengthening, resulting in decreased strength and functionality. The syndrome varies in clinical presentation, depending on duration, severity of distortion, presence of secondary problems, and presence of lameness. Primary treatment goals are to maintain soundness and functional integrity of the foot and to establish a normal hoof capsule. Resolution of the problem is generally not achieved in horses in a heavy work schedule, and realistic goals in this situation are to maintain function, alleviate lameness, and arrest progression of the distortion. PMID:22981194

Hunt, Robert J



Farriery for the hoof with a sheared heel.  


Sheared heels develop as an adaptation-distortion of the hoof capsule as a result of an abnormal strike and loading pattern of the foot, which is generally a consequence of limb conformation. The growth rate around the circumference of the hoof should be approximately uniform, but regional disturbances in growth rate can occur to either increase or decrease growth. The primary conformational trait that is observed in horses that develop sheared heels is a rotational deformity of the distal limb and a narrow chest. Farriery is directed toward improving the hoof capsule distortion and decreasing the forces on the displaced side of the foot. PMID:22981196

O'Grady, Stephen E



Occurrence, Characterization and Synthesis of Hanford and SRS Tank Heel Materials  

Microsoft Academic Search

The long-range objective of this study was to develop chemically assisted technologies for removing heels from tanks. In FY 01, the first two steps toward this objective were taken: (1) catalogue the occurrence and nature of tank heels and assess which materials are available for study and (2) develop methods for synthesizing non-radioactive surrogate heel materials for use in testing




Physiological Achilles' heels of Enteropathogenic bacteria in livestock  

Microsoft Academic Search

An elaborate feeding regimen of animals, which takes advantage of the Achilles' heels of enteropathogenic bacteria, can possibly enable prophylaxis in the intestinal tract, attenuate actual disease symptoms, accelerate recovery from a bacterial gastroenteritis or ensure food safety. There is a wide spectrum of conceivable weak spots in bacteria. Some pathogenic bacteria cannot use certain compounds, or use them less

P. M. Becker



Serum testosterone, sex hormone-binding globulin and total calcium levels predict the calcaneal speed of sound in men  

PubMed Central

OBJECTIVES: Variations in sex hormones and the calcium balance can influence bone health in men. The present study aimed to examine the relationship between the calcaneal speed of sound and biochemical determinants of bone mass, such as sex hormones, parathyroid hormones and serum calcium. METHODS: Data from 549 subjects from the Malaysian Aging Male Study, which included Malay and Chinese men aged 20 years and older residing in the Klang Valley, were used for analysis. The subjects' calcaneal speed of sound was measured, and their blood was collected for biochemical analysis. Two sets of multiple regression models were generated for the total/bioavailable testosterone and estradiol to avoid multicollinearity. RESULTS: The multiple regression results revealed that bioavailable testosterone and serum total calcium were significant predictors of the calcaneal speed of sound in the adjusted model. After adjustment for ethnicity and body mass index, only bioavailable testosterone remained significant; the total serum calcium was marginally insignificant. In a separate model, the total testosterone and sex hormone-binding globulin were significant predictors, whereas the total serum calcium was marginally insignificant. After adjustment for ethnicity and body mass index (BMI), the significance persisted for total testosterone and SHBG. After further adjustment for age, none of the serum biochemical determinants was a significant predictor of the calcaneal speed of sound. CONCLUSION: There is a significant age-dependent relationship between the calcaneal speed of sound and total testosterone, bioavailable testosterone and sex hormone-binding globulin in Chinese and Malay men in Malaysia. The relationship between total serum calcium and calcaneal speed of sound is ethnicity-dependent.

Chin, Kok-Yong; Soelaiman, Ima-Nirwana; Mohamed, Isa Naina; Ngah, Wan Zurinah Wan



The mechanical and histological estimation of calcaneal tendon callus in rats after PRP injection.  


Background: The study investigated the potential impact of platelet-rich plasma on tendon healing. Material/Methods: The study was conducted in 88 young, sexually mature rats, Wistar strain. The animals were randomly divided into two groups. The animals from the examined group (n=44) with an operated calcaneal tendon were given subcutaneously allogeneic PRP. The animals from the control group (n=44) were given 0.9% NaCl solution within the area of calcaneal tendon damage. After 7, 14, 21, and 42 days, the tendons were tested mechanically using the universal testing machines (UTM, Lloyd LRX), and were subjected to histological evaluation. Results: The study evaluated the maximum breaking force (Fmax), the force at the end of the proportional range (Fs) and stiffness of the tendons (H). After 7 days of the experiment, there were significant differences in H (P=0.021), between the examined and control groups. There were no significant differences in Fmax (P=0.53) and Fs (P=0.48) after 7 days. Mean values of Fmax, Fs and H after 14, 21, and 42 days in the study group were significantly higher compared to the control group (P<0.05). In the histological evaluation, the tendons of the examined groups were characterized by higher cellular and vascular density and a more orderly arrangement of collagen fibers compared to the control groups. Conclusions: Growth factors in allogeneic PRP increased the mechanical strength of regenerating calcaneal tendons after 14, 21, and 42 days from injury. PRP resulted in the increased histological maturity of the tendon callus in examined groups, at each stage of the experiment. PMID:23306279

Wnuk, Tomasz; Blacha, Jan; Mazurkiewicz, Tomasz; Olchowik, Gra?yna; Chy?y?ska, Monika



Physical activity is the strongest predictor of calcaneal peak bone mass in young Swedish men  

Microsoft Academic Search

Summary  In a highly representative sample of young adult Swedish men (n?=?2,384), we demonstrate that physical activity during childhood and adolescence was the strongest predictor of calcaneal\\u000a bone mineral density (BMD), and that peak bone mass was reached at this site at the age of 18 years.\\u000a \\u000a \\u000a \\u000a Introduction  The purpose of the present study was to determine if physical activity during growth is

U. Pettersson; M. Nilsson; V. Sundh; D. Mellström; M. Lorentzon



Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study  

Microsoft Academic Search

BACKGROUND: Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to

Emmanuel P Laabes; Dorothy J VanderJagt; Michael O Obadofin; Ayuba J Sendeht; Robert H Glew



Heel height affects lower extremity frontal plane joint moments during walking.  


Wearing high heels alters walking kinematics and kinetics and can create potentially adverse effects on the body. Our purpose was to determine how heel height affects frontal plane joint moments at the hip, knee, and ankle, with a specific focus on the knee moment due to its importance in joint loading and knee osteoarthritis. 15 women completed overground walking using three different heel heights (1, 5, and 9 cm) for fixed speed (1.3 ms(-1)) and preferred speed conditions while kinematic and force platform data were collected concurrently. For both fixed and preferred speeds, peak internal knee abduction moment increased systematically as heel height increased (fixed: 0.46, 0.48, 0.55 N m kg(-1); preferred: 0.47, 0.49, 0.53 N m kg(-1)). Heel height effects on net frontal plane moments of the hip and ankle were similar to those for the knee; peak joint moments increased as heel height increased. The higher peak internal knee abduction moment with increasing heel height suggests greater medial loading at the knee. Kinetic changes at the ankle with increasing heel height may also contribute to larger medial loads at the knee. Overall, wearing high heels, particularly those with higher heel heights, may put individuals at greater risk for joint degeneration and developing medial compartment knee osteoarthritis. PMID:22169388

Barkema, Danielle D; Derrick, Timothy R; Martin, Philip E



Sever's injury: treatment with insoles provides effective pain relief.  


Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. The traditional advice is to reduce and modify the level of physical activity. Recommended treatment in general is the same as for adults with Achilles tendon pain. The purpose of the study was to find out if insoles, of two different types, were effective in relieving heel pain in a group of boys (n=38) attending a Sports Medicine Clinic for heel pain diagnosed as Sever's injury. The type of insole was randomized, and self-assessed pain during physical activity in the treatment phase with insoles was compared with pain in the corresponding pre- and post-treatment phases without insoles. There were no other treatments added and the recommendations were to stay on the same activity level. All patients maintained their high level of physical activity throughout the study period. Significant pain reduction during physical activity when using insoles was found. Application of two different types of insoles without any immobilization, other treatment, or modification of sport activities results in significant pain relief in boys with Sever's injury. PMID:20492591

Perhamre, S; Janson, S; Norlin, R; Klässbo, M



Constitutive formulation and analysis of heel pad tissues mechanics.  


This paper presents a visco-hyperelastic constitutive model developed to describe the biomechanical response of heel pad tissues. The model takes into account the typical features of the mechanical response such as large displacement, strain phenomena, and non-linear elasticity together with time-dependent effects. The constitutive model was formulated, starting from the analysis of the complex structural and micro-structural configuration of the tissues, to evaluate the relationship between tissue histology and mechanical properties. To define the constitutive model, experimental data from mechanical tests were analyzed. To obtain information about the mechanical response of the tissue so that the constitutive parameters could be established, data from both in vitro and in vivo tests were investigated. Specifically, the first evaluation of the constitutive parameters was performed by a coupled deterministic and stochastic optimization method, accounting for data from in vitro tests. The comparison of constitutive model results and experimental data confirmed the model's capability to describe the compression behaviour of the heel pad tissues, regarding both constant strain rate and stress relaxation tests. Based on the data from additional experimental tests, some of the constitutive parameters were modified in order to interpret the in vivo mechanical response of the heel pad tissues. This approach made it possible to interpret the actual mechanical function of the tissues. PMID:20304698

Natali, A N; Fontanella, C G; Carniel, E L



Kangaroo Care (skin contact) reduces crying response to pain in preterm neonates: pilot results.  


Crying commonly occurs in response to heel stick and adversely affects the infant's physiologic stability. Minimal crying in response to pain is desired. "Kangaroo Care," skin contact between mother and infant, reduces pain and may reduce crying in response to pain. The purpose of this pilot study was to test Kangaroo Care's effect on the preterm infant's audible and inaudible crying response to heel stick. Inaudible crying has not been previously studied. A prospective randomized cross-over study with 10 preterm infants 2-9 days old (30-32 weeks' postmenstrual age) was conducted. Infants were randomly assigned to two sequences (sequence A: day 1 heel stick in Kangaroo Care [after 30 min of prone skin contact upright between maternal breasts] and day 2 heel stick in incubator [inclined, nested and prone]; or sequence B: opposite of sequence A) was conducted. Videotapes of baseline, heel warming, heel stick, and recovery phases were scored for audible and inaudible crying times. Audible and inaudible crying times for each subject in each phase were summed and analyzed by repeated-measures analysis of variance. Subject characteristics did not differ between those in the two sequences. Crying time differed between the study phases on both days (p heel stick (p = .001) and recovery (p = .01) phases, regardless of sequence. Because Kangaroo Care reduced crying in response to heel stick in medically stable preterm infants, a definitive study is merited before making recommendations. PMID:18513662

Kostandy, Raouth R; Ludington-Hoe, Susan M; Cong, Xiaomei; Abouelfettoh, Amel; Bronson, Carly; Stankus, Allison; Jarrell, Julia R



Calcaneal osteomyelitis following steroid injection for plantar fasciitis: a case report.  


This study reports a case of a 57-year-old woman diabetic patient who presented to the authors' institution with signs and symptoms typical of plantar fasciitis. Her condition did not resolve with nonsteroidal anti-inflammatory drug therapy, podiatry, and physiotherapy input and she was given a steroid injection for treatment of plantar fasciitis. She was admitted to the hospital 17 days following injection with signs of acute infection. Diagnostic workup revealed an acute calcaneal osteomyelitis. Infection did not respond to conservative treatment and the patient required a partial calcanectomy. This case highlights the significant risk of steroid injection in plantar fasciitis, especially in diabetic patient. The authors urge surgeons to consider this when obtaining consent for injection and they advise very close follow-up of such patients. PMID:22732240

Wronka, Konrad Sebastian; Sinha, Amit



Calcaneus, calcaneal tendon and retrocalcaneal bursa. Historical overview and plea for an accurate terminology.  


Diseases and injuries of several specific structures in the heel region have been an enduring focus of medicine: The anatomical terminology of many of these structures has not been established until recently. The aim of the study was a historical analysis of the advances of anatomical terminology of three selected morphological units in the heel region--the Achilles tendon, calcaneus and retrocalcaneal bursa. It starts with a critical evaluation of the mythological eposes, the Illiad and Odyssey, describing the exploits of heroes in the Trojan war, followed by a review of relevant terms used for the designation of selected heel structures in the Middle Ages as well as in the 18" and 19" centuries. Principal versions of Latin anatomical terms used for the denotation of the mentioned structures are discussed. Recently applicable Latin terms and their recommended English synonyms, according to the latest version of Terminologia Anatomica (1998) are summed up. It surveys examples of "not very appropriate" terms, which are frequently used in clinical literature. The authors consider the use of official anatomical terms (both Latin and English) as an important step for the improvement of the clinical expressions and formulations. PMID:20514849

Kachlik, D; Musil, V; Vasko, S; Klaue, K; Stingl, J; Baca, V


Novel Surgical Treatment for Refractory Heel Ulcers in Werner's Syndrome  

PubMed Central

Patients with Werner's syndrome frequently develop chronic leg ulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical heel ulcers. Treatment of the ulcer is challenging, as flap options are limited over the lower third of the leg and skin grafting is not easy as there is a lack of healthy granulations. We successfully treated the ulcer with osteomyelitis by drilling the bone and applying an ultrathin split thickness skin graft with the thigh skin as the donor site.

Oe, Keisuke; Miwa, Masahiko; Kurosaka, Masahiro



Hybrid toe and heel joints for biped\\/humanoid robots for natural gait  

Microsoft Academic Search

A biped\\/humanoid robot with toe and heel joints is capable of more natural locomotion due to the additional degrees of freedom available. Though passive spring loaded joints can help to some extent, they introduce constraints between the joint torque and the joint angular displacement. In this paper, we propose to use hybrid active\\/passive toe and heel joints in order to

R Prasanth KumarI; Nandha Handharu; Jungwon Yoon; Gap-soon Kim



Maternal and early life influences on calcaneal ultrasound parameters and metacarpal morphometry in 7- to 9-year-old children  

Microsoft Academic Search

We investigated the relationship between maternal and early life influences, calcaneal ultrasound parameters, and metacarpal\\u000a morphometry in 7- to 9-year-old children (n = 109) of mixed ancestral origin from a working class community. Their mothers had participated in a nutrition and pregnancy\\u000a study at the time of the birth. Demographic and maternal data were collected. Anthropometry was assessed. Broadband ultrasound

Lisa Micklesfield; Naomi Levitt; Muhammed Dhansay; Shane Norris; Lize van der Merwe; Estelle Lambert



Serum osteocalcin in relation to calcaneal bone mineral density in elderly men and women: a 5-year follow-up  

Microsoft Academic Search

.   A 5-year follow-up study investigated serum concentrations of total (tOC) and intact (iOC) osteocalcin in relation to calcaneal\\u000a bone mineral density (BMD). The study comprised two cohorts, 75- and 80-year-olds, both resident in the city of Jyv?skyl?,\\u000a Finland. Baseline OC and BMD were obtained for 161 men and 233 women, of whom 83 men and 189 women participated in

Sulin Cheng; Harri Suominen; Kalervo Väänänen; Sanna-Maria Käkönen; Kim Pettersson; Eino Heikkinen



Size and separability of the calcaneal and the medial and lateral plantar nerves in the distal tibial nerve.  


The tibial nerve (TN) has three main terminal branches: the medial and lateral plantar nerves and the calcaneal branch (CB), which innervates the foot sole. The design and implantation of nerve cuff electrodes with separate channels for each of these three terminal branches would provide significant sensory information, which can be used in functional electrical stimulation systems to assist standing or to correct foot drop. Detailed quantitative anatomical data about fascicular size and separability of the terminal branches of TN are needed for the design and implantation of such cuff electrodes. Therefore, the branching pattern, the fascicular separability and the fascicular size of the TN posterior to the medial malleolar-calcaneal axis were examined in this study, using ten human TN specimens. The TN branching patterns were highly dispersed. For the CBs, multiple branches were identified in five (50%) of the specimens. For the TN, the bifurcation point was located within the tarsal tunnel in eight (80%) of the cases. The distance proximal to the medial malleolar-calcaneal axis for which the TN could be split ranged form 0 to 41 mm. Quantitative and qualitative data were obtained for the fascicular size and separability of the TN. Only the CB of the TN proved separable for a sufficient length for nerve cuff electrode implantation. The results suggest the use of a two-channel cuff with one common channel for the lateral and medial plantar nerves, having multiple electrodes for selective recording, and one channel for the CB. PMID:19449089

Andreasen Struijk, Lotte N S; Birn, Henrik; Teglbjaerg, Peter S; Haase, Jens; Struijk, Johannes J



State of the science: procedural pain management in the neonate.  


Neonates in the neonatal intensive care unit experience painful procedures. Over the last 10 years, investigators have examined several pharmacologic and nonpharmacolgic treatment strategies to decrease or eliminate the pain associated with mechanical ventilation, endotrachial intubation, insertion of percutaneous or central venous lines, heel stick, and venipuncture. These procedures and others are addressed as well as the reported severity of pain associated with these procedures. Progress has been made in the past decade to establish evidence-based treatments that will help the clinician more effectively relieve neonatal stress and pain when performing many routine procedures. PMID:16508464

D'Apolito, Karen C


Influence of Different Designs of High-Heeled Shoes on Kinematics, Kinetics, and Muscle EMG of Female Gait  

Microsoft Academic Search

Many studies have investigated the differences in gait patterns with increasing heel height. The purpose of this investigation is to study the differences in gait patterns when wearing stiletto and wedge type high-heeled shoes with different heel designs versus barefoot walking. A Vicon 512 Motion Analysis system and four Kistler force plates were used to record changes in lower-extremity joint

Deger Ozkaramanli



Effect of high-heeled shoes on the parameters of body posture.  


Study Design: The study group consisted of 90 young, healthy women, aged 20 - 25 years. Three types of measurements were conducted for each woman: without shoes, with 4 cm heels, and with 10 cm heels.Objective: The aim of this study was to assess the impact of high-heeled shoes on chosen parameters characterizing body posture.Summary of Background Data: For a long time, high-heeled shoes have been an attribute of femininity. Currently, there is an increasing amount of research being published investigating the effect of high-heeled shoes on selected biomechanical parameters.Methods: The study employed a photogrammetric method, based on the chamber projection and Moiré phenomenon. The study was performed using pre-designated points of anthropometric measures. We used 19 photogrammetric parameters characterizing body posture.Results: Results of the measurements showed no significant differences using the significance level p < 0.05 between the measurements taken with no shoes, with 4 cm high-heeled shoes, and with 10 cm high-heeled shoes. Statistically significant results were obtained only for the ATB (angle of trunk bend) parameter. The value of the p coefficient in the Kruskal-Wallis ANOVA test for the ATB parameter was p = 0.0140. Analysis based on the multiple comparison test indicated differences between the group wearing no shoes, and those wearing 4 cm heels (p = 0.0226), and between the group wearing no shoes and the group wearing 10 cm heels (p = 0.0459).Conclusion: High-heeled shoes increased the forward inclination of the trunk. This paper shows that there are only certain trends for some parameters that require further scientific investigation. PMID:24042722

Drza?-Grabiec, Justyna; Snela, S?awomir



Trypanosome resistance to human innate immunity: targeting Achilles' heel.  


Trypanosome lytic factors (TLFs) are powerful, naturally occurring toxins in humans that provide sterile protection against infection by several African trypanosomes. These trypanocidal complexes predominantly enter the parasite by binding to the trypanosome haptoglobin/hemoglobin receptor (HpHbR), trafficking to the lysosome, causing membrane damage and, ultimately, cell lysis. Despite TLF-mediated immunity, the parasites that cause human African Trypanosomiasis (HAT), Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense, have developed independent mechanisms of resistance to TLF killing. In this review we describe the parasite defenses that allow trypanosome infections of humans and discuss how targeting these apparent strengths of the parasite may reveal their Achilles' heel, leading to new approaches in the treatment of HAT. PMID:23059119

Stephens, Natalie A; Kieft, Rudo; Macleod, Annette; Hajduk, Stephen L



Treatment of a heel blister caused by pressure and friction.  


The treatment of heel blisters caused by pressure, friction, and shear is a complex subject. Issues such as whether to aspirate the blister, how to protect it from further pressure, friction, and shear, and which dressing to choose, need to be considered. As nurses are increasingly aware of the emphasis that has been placed on the importance of ensuring that clinical practice is based on evidence, this article attempts to shed some light on these areas of debate. It is important to highlight that during the literature search very little research was found to exist on blister care and it became clear that further research into the nursing care of a blister caused by pressure would be useful to aid nursing care and patient comfort. PMID:12170479

Read, S


Ethnic dress, vitamin D intake, and calcaneal bone health in young women in the United Kingdom.  


Clothing styles that conceal skin from ultraviolet sun radiation contribute to vitamin D deficiency, especially in veiled female minorities in high latitudes. This is the first research into possible effects of ethnic dress on the os calcis and the first study outside North Africa and the Middle East to investigate whether discernible differences in bone quality exist between veiled and unveiled women. The limited previous research into clothing habits and bone health has been inconclusive. One hundred eight women aged 18--45yr living in the United Kingdom (around 51° north) were analyzed. Forty-three consistently covered arms, hair, and neck when outdoors, whereas 65 consistently had arms, hair, neck, and possibly legs exposed. The quantitative ultrasound scanning (QUS) measurements at the calcaneus were speed of sound (SOS) and broadband ultrasound attenuation (BUA), which were translated into a single clinical value, stiffness index (SI). Dietary intake of vitamin D and calcium was estimated using a validated food frequency questionnaire, and several other risk factors were assessed. There was no significant difference in SI between veiled and unveiled participants (101.30±1.71 vs 99.98±1.86; p=0.721); SOS and BUA were also not significantly different. However, smoking and long-term use of steroid medication were significant predictors of calcaneal bone quality, confirming existing research. Our analysis suggests that clothing style alone does not lead to appreciable differences in the quality of the os calcis in young women in the United Kingdom as assessed by QUS. PMID:22178237

Knoss, Robert; Halsey, Lewis G; Reeves, Sue



A three-dimensional inverse finite element analysis of the heel pad.  


Quantification of plantar tissue behavior of the heel pad is essential in developing computational models for predictive analysis of preventive treatment options such as footwear for patients with diabetes. Simulation based studies in the past have generally adopted heel pad properties from the literature, in return using heel-specific geometry with material properties of a different heel. In exceptional cases, patient-specific material characterization was performed with simplified two-dimensional models, without further evaluation of a heel-specific response under different loading conditions. The aim of this study was to conduct an inverse finite element analysis of the heel in order to calculate heel-specific material properties in situ. Multidimensional experimental data available from a previous cadaver study by Erdemir et al. ("An Elaborate Data Set Characterizing the Mechanical Response of the Foot," ASME J. Biomech. Eng., 131(9), pp. 094502) was used for model development, optimization, and evaluation of material properties. A specimen-specific three-dimensional finite element representation was developed. Heel pad material properties were determined using inverse finite element analysis by fitting the model behavior to the experimental data. Compression dominant loading, applied using a spherical indenter, was used for optimization of the material properties. The optimized material properties were evaluated through simulations representative of a combined loading scenario (compression and anterior-posterior shear) with a spherical indenter and also of a compression dominant loading applied using an elevated platform. Optimized heel pad material coefficients were 0.001084 MPa (?), 9.780 (?) (with an effective Poisson's ratio (?) of 0.475), for a first-order nearly incompressible Ogden material model. The model predicted structural response of the heel pad was in good agreement for both the optimization (<1.05% maximum tool force, 0.9% maximum tool displacement) and validation cases (6.5% maximum tool force, 15% maximum tool displacement). The inverse analysis successfully predicted the material properties for the given specimen-specific heel pad using the experimental data for the specimen. The modeling framework and results can be used for accurate predictions of the three-dimensional interaction of the heel pad with its surroundings. PMID:22482682

Chokhandre, Snehal; Halloran, Jason P; van den Bogert, Antonie J; Erdemir, Ahmet



Osteochondrosis: common causes of pain in growing bones.  


Osteochondrosis is a term used to describe a group of disorders that affect the growing skeleton. These disorders result from abnormal growth, injury, or overuse of the developing growth plate and surrounding ossification centers. The exact etiology of these disorders is unknown, but genetic causes, repetitive trauma, vascular abnormalities, mechanical factors, and hormonal imbalances may all play a role. Legg-Calvé-Perthes disease is a hip disorder that causes hip pain, an atraumatic limp, and knee pain. Osgood-Schlatter and Sinding-Larsen-Johannson diseases are common causes of anterior knee pain that is aggravated by jumping activities and kneeling. Sever disease causes heel pain that is exacerbated by activity and wearing cleats. It often mimics Achilles tendinitis and is treated with activity and shoe modifications, heel cups, and calf stretches. Freiberg disease and Köhler bone disease often cause foot pain and are disorders of the metatarsal head and navicular bone, respectively. Radiographs show sclerosis, flattening, and fragmentation of bone in both diseases. Elbow pain can be caused by medial epicondyle apophysitis or Panner disease. Medial epicondyle apophysitis is exacerbated by frequent throwing and is treated with throwing cessation and acetaminophen or nonsteroidal anti-inflammatory drugs. Panner disease is the most common cause of lateral-sided elbow pain in children younger than 10 years. It may or may not be associated with frequent throwing, and it resolves spontaneously. Scheuermann disease causes back pain and a humpback deformity from vertebral bone anterior wedging. PMID:21302869

Atanda, Alfred; Shah, Suken A; O'Brien, Kathleen



Knee Stretch Walking Method for Biped Robot: Using Toe and Heel Joints to Increase Walking Strides  

NASA Astrophysics Data System (ADS)

This paper proposes a knee stretch walking method for biped robots; the method involves the use of the toes and heel joints to increase walking strides. A knee can be stretched by switching control variables. By a knee stretch walking with heel contacts to the ground and toe takeoffs from the ground, biped robots can increase their walking stride and speed. The validity of the proposed method is confirmed by simulation and experimental results.

Sato, Takahiko; Shimmyo, Shuhei; Nakazato, Miki; Mikami, Kei; Sato, Tomoya; Sakaino, Sho; Ohnishi, Kouhei


Off-the-shelf in-shoe heel inserts: does cost matter?  

Microsoft Academic Search

Objective:A growing exercise culture has lead to an increase in the use of off-the-shelf heel inserts. While there are a variety of designs in a spectrum of cost ranges, probably the ease of availability and cost would mainly determine the choice of purchase. This study was designed to determine whether expensive designs provide better pressure attenuation under the heel than

A K Ramanathan; M C John; G P Arnold; L A Cochrane; R J Abboud



Foot-Ankle RollOver Characteristics in Different Heel Heights during Walking  

Microsoft Academic Search

In this study, a feasibility study was performed for biomechanical applications of foot-ankle roll-over characteristics in different heel height shoes during walking. Five nondisabled female volunteers were participated in gait experiments, wearing four pairs of shoes with different heel heights. Roll-over shapes of the foot-ankle systems were obtained using trajectories of ankle, knee and the center of pressure between initial

H. S. Choi; H. L. Park; Y. H. Kim



COX-2 in cancer: Gordian knot or Achilles heel?  

PubMed Central

The networks of blood and lymphatic vessels and of the extracellular matrix and their cellular and structural components, that are collectively termed the tumor microenvironment, are frequently co-opted and shaped by cancer cells to survive, invade, and form distant metastasis. With an enviable capacity to adapt to continually changing environments, cancer represents the epitome of functional chaos, a stark contrast to the hierarchical and organized differentiation processes that dictate the development and life of biological organisms. The consequences of changing landscapes such as hypoxia and acidic extracellular pH in and around tumors create a cascade of changes in multiple pathways and networks that become apparent only several years later as recurrence and metastasis. These molecular and phenotypic changes, several of which are mediated by COX-2, approach the complexities of a “Gordian Knot.” We review evidence from our studies and from literature suggesting that cyclooxygenase-2 (COX-2) biology presents a nodal point in cancer biology and an “Achilles heel” of COX-2-dependent tumors.

Stasinopoulos, Ioannis; Shah, Tariq; Penet, Marie-France; Krishnamachary, Balaji; Bhujwalla, Zaver M.



Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon  

Microsoft Academic Search

The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence- based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy

Bradley Kobsar; Joel Alcantara



The influence of a yacht's heeling stability on optimum sail design  

NASA Astrophysics Data System (ADS)

This paper presents fundamental results concerning the optimum design of yacht sails and masts. The aerodynamics of a high aspect ratio sail in uniform flow is analysed using lifting line theory to maximise thrust for a given sail area. The novel feature of this work is that thrust is optimised subject to the constraint that the aerodynamic heeling moment generated by the sail is balanced by the righting moment due to hull buoyancy (and the weight of the keel). Initially, the heel angle is therefore unknown, and determined as part of the solution process. Under the assumption of small heel angle, the problem reduces to minimising a quadratic form in the Fourier coefficients for the circulation distribution along the mast, and a simple analytic solution can be derived. It is found that if the mast is too high, the upper section is unused, and as a consequence there is a theoretically ideal mast height for a yacht of given heeling stability. Under the constraints of given sail area and heeling equilibrium it is found that no advantage is to be gained by allowing reverse circulation near the top of the mast. Various implications for yacht performance are discussed.

Sneyd, A. D.; Sugimoto, T.



The effects of orthotic heel lifts on Achilles tendon force and strain during running.  


This study assessed the effects of orthotic heel lifts on Achilles tendon (AT) force and strain during running. Ten females ran barefoot over a force plate in three conditions: no heel lifts (NHL), with 12 mm heel lifts (12HL) and with 18 mm heel lifts (18HL). Kinematics for the right lower limb were collected (200 Hz). AT force was calculated from inverse dynamics. AT strain was determined from kinematics and ultrasound images of medial gastrocnemius (50 Hz). Peak AT strain was less for 18HL (5.5 ± 4.4%) than for NHL (7.4 ± 4.2%) (p = .029, effect size [ES] = 0.44) but not for 12HL (5.8 ± 4.8%) versus NHL (ES = 0.35). Peak AT force was significantly (p = .024, ES = 0.42) less for 18HL (2382 ± 717 N) than for NHL (2710 ± 830 N) but not for 12HL (2538 ± 823 N, ES = 0.21). The 18HL reduced ankle dorsiflexion but not flexion-extension ankle moments and increased the AT moment arm compared with NHL. Thus, 18HL reduced force and strain on the AT during running via a reduction in dorsiflexion, which lengthened the AT moment arm. Therefore, heel lifts could be used to reduce AT loading and strain during the rehabilitation of AT injuries. PMID:22695168

Farris, Dominic James; Buckeridge, Erica; Trewartha, Grant; McGuigan, Miranda Polly



Treatment of displaced intraarticular calcaneal fractures with or without bone grafts: A systematic review of the literature  

PubMed Central

Background: The necessity of bone grafts in the treatment of intraarticular calcaneal fractures continues to be one of the most debated topics in foot and ankle surgery. The purpose of this study was to determine whether there are sufficient objective cumulative data in the literature to compare the two methods and if the bone graft was needed in surgical treatment of intraarticular calcaneal fractures. Materials and Methods: A comprehensive search of all relevant articles from 1990 to 2010 was conducted. Two reviewers evaluated each study to determine its suitability for inclusion and collected the data of interest. Meta-analytic pooling of group results across studies was performed for the two treatment methods. Results: The systematic review identified 32 primary studies with 1281 fractures, which contained 4 comparative studies, 13 with bone grafts, and 15 without bone grafts in treatment methods. The infection rate in bone graft group was higher through statistically insignificant than in non-graft group (8.3% vs. 6.3%) No significant difference was found between good reduction rate, postoperative osteoarthritis rate, and subtalar fusion rate. The average full weight-bearing time in bone graft group was significantly lower (5.4 months) than in non-graft group (10.5 months). The mean postoperative Böhler's angle was significantly higher in bone graft group (lose due to collapse was significancy less). For the efficacy outcomes, the bone graft group had a lower American Orthopaedic Foot and Ankle Society Score (AOFAS) (71.4 points vs. 80.5 points) but a higher Creighton score (89.9 points vs. 81.0 points) compared with non-graft group. Pooled mean results showed 35% of the patients in bone graft group had an excellent result, 40% had a good result, 21% had a fair result, and 4% had a poor result. In the non-graft group, the corresponding values were 34, 42, 14, and 10%, respectively. Conclusions: The operative treatment of intraarticular calcaneal fractures with bone grafts could restore the Böhler's angle better and the patients could return to full weight bearing earlier. However, the functional and efficacy outcomes appear to be similar between the two treatment groups. There were more joint depression and comminuted fractures in the bone graft group, and the mean followup time was shorter. Large sample comparative studies are still needed.

Yang, Yunfeng; Zhao, Hongmou; Zhou, Jiaqian; Yu, Guangrong



Elbow Pain  


... find it difficult to describe what exactly brings on the pain. Causes Most elbow pain results from overuse injuries. Many sports, hobbies and jobs require repetitive hand, wrist or arm movements. Elbow pain may occasionally ...


Neuropathic Pain  


... in Cart : 0 Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs ...


Chronic Pain  


... cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain from nerve damage Chronic pain usually cannot be cured. But treatments can help. They include medicines, acupuncture, electrical stimulation and surgery. Other treatments include psychotherapy, ...


Depression, Pain, and Pain Behavior.  

ERIC Educational Resources Information Center

Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

Keefe, Francis J.; And Others



Depression, Pain, and Pain Behavior  

Microsoft Academic Search

This study examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory (BDI) was administered to 207 low back pain patients. Observations of pain behaviors during physical examination, ratings of pain, and measures of activity level and medication intake were taken on each patient. Regression analyses revealed that depression and physical findings were the most

Francis J. Keefe; Robert H. Wilkins; Wesley A. Cook; James E. Crisson; Lawrence H. Muhlbaier



The effect of heel height on gait and posture: a review of the literature.  


This article explores relevant full-text literature to reveal the effects of heel height on gait and posture and the kinetics and kinematics of the foot, ankle, knee, hip, and spine. Furthermore, special attention will be given to the implications of increased heel height for clinicians treating locomotor disorders and provide information to aid clinical decision making. Full-text articles accessed from databases including AMED, ASSIA, Blackwell Synergy, BNI, Voyager, CINAHL, ScienceDirect, and Taylor Francis inform the review. PMID:19917737

Cowley, Emma E; Chevalier, Thierry L; Chockalingam, Nachiappan


Modification of the syme amputation to prevent postoperative heel pad migration.  


The Syme amputation (ankle disarticulation level amputation) can be a valuable procedure for properly selected patients but might be underused owing to the problem of postoperative migration of the heel pad cushion. The present report presents a modification of the Syme amputation technique to prevent postoperative heel pad migration. The technique was performed in 12 patients, most of whom were male patients with diabetic foot infections. At an average follow-up of 7 years, the soft tissue cushion remained in a stable position, without ulceration. Also, patient satisfaction was high with the Syme level of amputation using the modified technique. PMID:24021266

Bibbo, Christopher



Life-Course Predictors of Ultrasonic Heel Measurement in a Cross-sectional Study of Immigrant Women from Southeast Asia  

Microsoft Academic Search

Few studies address chronic disease risk for Southeast Asians in the United States. In 1999, the authors conducted a cross-sectional study of bone mineral density (BMD) estimated from ultrasonic calcaneal measurements in women born in Southeast Asia who then lived in Chicago, Illinois. The study addressed three questions: Do Southeast-Asian women have relatively low BMD? What factors before and after

Diane S. Lauderdale; Talya Salant; Katherine L. Han; Phuong L. Tran


Incidental findings of massive heel spurs in a veteran with a variant of psoriatic arthritis.  


A middle-aged man presented for left foot diabetic ulcer care. Pedal radiographs were negative for signs of osteomyelitis. However, asymptomatic incidental osseous findings demonstrated significant plantar and posterior calcaneal spurring possibly consistent with diffuse idiopathic skeletal hyperostosis (DISH). A differential of DISH, psoriatic arthritis, Reiter's, and ankylosing spondylitis was developed. Subsequent spinal imaging and laboratory work-up did not satisfy the diagnostic criteria for DISH. This case illustrates radiographic changes characteristic of multiple seronegative arthropathies. On initial presentation a diagnosis of DISH was most likely, but with further imaging studies a diagnosis of a variant of psoriatic arthritis may be more correct. PMID:23001738

Lowell, Danae L; Osher, Lawrence S; Grady, Angela F


Kinematics and kinetics of the lower extremities of young and elder women during stairs ascent while wearing low and high-heeled shoes  

Microsoft Academic Search

The effect of the heel height on the temporal, kinematic and kinetic parameters was investigated in 16 young and 11 elderly females. Kinematic and kinetic data were collected when the subjects ascended stairs with their preferred speed in two conditions: wearing low-heeled shoes (LHS), and high-heeled shoes (HHS). The younger adults showed more adjustments in forces and moments at the

Bih-Jen Hsue; Fong-Chin Su




Microsoft Academic Search

The Savannah River Site (SRS) will remove sludge as part of waste tank closure operations. Typically the bulk sludge is removed by mixing it with supernate to produce a slurry, and transporting the slurry to a downstream tank for processing. Experience shows that a residual heel may remain in the tank that cannot be removed by this conventional technique. In

M Poirier; D David Herman; F Fernando Fondeur; J John Pareizs; M Michael Hay; B Bruce Wiersma; K Kim Crapse; T Thomas Peters; S Samuel Fink; D Donald Thaxton



46 CFR 174.055 - Calculation of wind heeling moment (Hm).  

Code of Federal Regulations, 2010 CFR

...whereâ (1) H=wind heeling moment for...foot-pounds (kilogram-meters); (2) k=0... ); (3) v=wind velocity ofâ (i) 70 knots (36 meters per second) for...distance in feet (meters) from the the center of wind pressure on...



46 CFR 174.055 - Calculation of wind heeling moment (Hm).  

Code of Federal Regulations, 2010 CFR

...whereâ (1) H=wind heeling moment for...foot-pounds (kilogram-meters); (2) k=0... ); (3) v=wind velocity ofâ (i) 70 knots (36 meters per second) for...distance in feet (meters) from the the center of wind pressure on...



The influence of whole body vibration on the plantarflexors during heel raise exercise.  


Whole body vibration (WBV) during exercise offers potential to augment the effects of basic exercises. However, to date there is limited information on the basic physiological and biomechanical effects of WBV on skeletal muscles. The aim of this study was to determine the effects of WBV (40Hz, 1.9mm synchronous vertical displacement) on the myoelectrical activity of selected plantarflexors during heel raise exercise. 3D motion capture of the ankle, synchronised with sEMG of the lateral gastrocnemius and soleus, was obtained during repetitive heel raises carried out at 0.5Hz on 10 healthy male subjects (age 27±5 years, height 1.78±0.04m, weight 75.75±11.9kg). During both vibration and non vibration the soleus activation peaked earlier than that of the lateral gastrocnemius. The results indicate that WBV has no effect on the timing of exercise completion or the amplitude of the lateral gastrocnemius activity, however significant increases in amplitudes of the soleus muscle activity (77.5-90.4% MVC P<0.05). WBV had no significant effect on median frequencies of either muscle. The results indicate that the greatest effect of WBV during heel raise activity is in the soleus muscles during the early phases of heel raise. PMID:23261083

Robbins, D; Goss-Sampson, M



Feasibility of Quantitative Ultrasound Measurement of the Heel Bone in People with Intellectual Disabilities  

ERIC Educational Resources Information Center

Low bone mineral density (BMD) and fractures are common in people with intellectual disabilities (ID). Reduced mobility in case of motor impairment and the use of anti-epileptic drugs contribute to the development of low BMD. Quantitative ultrasound (QUS) measurement of the heel bone is a non-invasive and radiation-free method for measuring bone…

Mergler, S.; Lobker, B.; Evenhuis, H. M.; Penning, C.



46 CFR 174.055 - Calculation of wind heeling moment (Hm).  

Code of Federal Regulations, 2012 CFR

...Hm) of a unit in a given normal operating condition or severe storm condition is the sum of the individual wind heeling moments... (ii) 100 knots (51.5 meters per second) for severe storm conditions. (iii) 50 knots (25.8 meters per...



46 CFR 174.055 - Calculation of wind heeling moment (Hm).  

Code of Federal Regulations, 2011 CFR

...Hm) of a unit in a given normal operating condition or severe storm condition is the sum of the individual wind heeling moments... (ii) 100 knots (51.5 meters per second) for severe storm conditions. (iii) 50 knots (25.8 meters per...



Feasibility of Quantitative Ultrasound Measurement of the Heel Bone in People with Intellectual Disabilities  

ERIC Educational Resources Information Center

|Low bone mineral density (BMD) and fractures are common in people with intellectual disabilities (ID). Reduced mobility in case of motor impairment and the use of anti-epileptic drugs contribute to the development of low BMD. Quantitative ultrasound (QUS) measurement of the heel bone is a non-invasive and radiation-free method for measuring bone…

Mergler, S.; Lobker, B.; Evenhuis, H. M.; Penning, C.



Changes in temporal gait characteristics and pressure distribution for bare feet versus various heel heights  

Microsoft Academic Search

The purpose of this study was to identify changes in temporal gait characteristics and pressure generation across the sole of the foot due to various heel heights in women's dress pumps. Thirty female subjects, aged 18-30 years, volunteered to participate. Subjects were required to have normal gait and to wear comfortably either size 7 or size 9 shoes. Subjects were

Joanne R. Eisenhardt; Deneen Cook; Ingrid Pregler; Henry C. Foehl



Effects of the heel-to-toe rocker sole on walking in able-bodied persons.  


Background and aim:The most commonly prescribed external shoe modification is the use of rocker soles. The aim of this study was to evaluate the effect of a heel-to-toe rocker sole profile on specific temporal-spatial parameters and the kinematics of walking when added to footwear.Method:Seventeen healthy adult volunteers participated in this study. For each subject, gait analysis was performed under two conditions that were tested in a random order: walking with either a baseline shoe with a flat sole or a modified shoe adapted with a heel-to-toe rocker sole.Results:Significant differences were observed between rocker sole conditions during initial double-limb support and second double-limb support during stance phase. In frontal plane movement, significant differences were observed between the rocker sole conditions but only during second double-limb support phase.Conclusions:This heel-to-toe rocker sole may be useful for patients with conditions such as ankle arthrodesis or for use with ankle-foot orthoses where limited ankle motion is required.Clinical relevanceThe heel-to-toe rocker sole may be useful for conditions including ankle arthrodesis and for use with solid ankle-foot orthoses but may not be suitable for patients with reduced balance or an unstable posture. PMID:23401295

Arazpour, Mokhtar; Hutchins, Stephen W; Ghomshe, Farhad T; Shaky, Fahimeh; Karami, Masome V; Aksenov, Andrey Y



Accelerations due to impact at heel strike using below-knee prosthesis  

Microsoft Academic Search

The acceleration in the sagittal plane of the prosthetic tube at heel strike in normal walking was measured in five healthy amputees with their definitive below-knee prosthesis, every subject using six different prosthetic feet, wearing sport shoes as well as leather shoes. The experiments were carried out in the rehabilitation centre \\




Implementation guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511  

SciTech Connect

This report is an Implementation Guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511 to provide a set of uniform instructions for managing the two contractors selected. The primary objective is to produce the necessary deliverables and services for the HTI project within schedule and budget.

McDaniel, L.B.



Biomechanical implications of the negative heel rocker sole shoe: Gait kinematics and kinetics  

Microsoft Academic Search

Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus to prescription rehabilitative footwear. The purpose of this work is to investigate the dynamics of lower extremity joints (hip, knee and ankle) with the application of a negative heel rocker sole shoe under controlled lab conditions.

K. A. Myers; J. T. Long; J. P. Klein; J. J. Wertsch; D. Janisse; G. F. Harris



Cancer Pain  

Microsoft Academic Search

Cancer pain remains undertreated. Pain occurs in over three-quarters of cancer patients and remains one of the most feared\\u000a aspects of this illness despite the excellent therapies that are available. Cancer pain commonly results from tumor compressing\\u000a or invading soft tissue, bone, or nerves or from diagnostic or therapeutic endeavors. Optimal pain management involves determining\\u000a pain intensity, evaluating the etiology

Suzanne A. Nesbit


Long-term use of high-heeled shoes alters the neuromechanics of human walking.  


Human movement requires an ongoing, finely tuned interaction between muscular and tendinous tissues, so changes in the properties of either tissue could have important functional consequences. One condition that alters the functional demands placed on lower limb muscle-tendon units is the use of high-heeled shoes (HH), which force the foot into a plantarflexed position. Long-term HH use has been found to shorten medial gastrocnemius muscle fascicles and increase Achilles tendon stiffness, but the consequences of these changes for locomotor muscle-tendon function are unknown. This study examined the effects of habitual HH use on the neuromechanical behavior of triceps surae muscles during walking. The study population consisted of 9 habitual high heel wearers who had worn shoes with a minimum heel height of 5 cm at least 40 h/wk for a minimum of 2 yr, and 10 control participants who habitually wore heels for less than 10 h/wk. Participants walked at a self-selected speed over level ground while ground reaction forces, ankle and knee joint kinematics, lower limb muscle activity, and gastrocnemius fascicle length data were acquired. In long-term HH wearers, walking in HH resulted in substantial increases in muscle fascicle strains and muscle activation during the stance phase compared with barefoot walking. The results suggest that long-term high heel use may compromise muscle efficiency in walking and are consistent with reports that HH wearers often experience discomfort and muscle fatigue. Long-term HH use may also increase the risk of strain injuries. PMID:22241055

Cronin, Neil J; Barrett, Rod S; Carty, Christopher P



Biomechanical implications of the negative heel rocker sole shoe: gait kinematics and kinetics.  


Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus to prescription rehabilitative footwear. The purpose of this work is to investigate the dynamics of lower extremity joints (hip, knee and ankle) with the application of a negative heel rocker sole shoe under controlled lab conditions. Forty normal adults volunteered for gait evaluations using controlled baseline and prescription negative heel rocker sole shoes. Three-dimensional motion analysis techniques were used to acquire kinematic and kinetic data using a six-camera Vicon 370 motion system and two AMTI force plates. No significant change in walking speed or stride length was seen with the negative heel rocker shoe, although cadence was increased. The most significant kinematic changes with the application of the negative heel shoe occurred at the ankle in the sagittal plane with increased plantarflexion at terminal stance. Significant hip and knee changes were also noted with increased mid-stance hip extension and knee flexion. The most significant kinetic effects were seen in the transverse plane followed by changes in the sagittal and coronal planes. Changes in power were mostly noted in the sagittal plane. Other statistically significant changes in gait kinematics and kinetics were observed, although the magnitudes and durations were limited and as a result were not considered clinically significant. The study results indicated the negative heel rocker shoe significantly altered proximal joint metrics (hip and knee). The most significant distal joint alterations were seen in sagittal plane ankle kinetics. These kinematic and kinetic changes, along with previously studied effects of pressure relief at the metatarsal heads, should aid medical professionals in prescribing prophylactic footwear. PMID:16300949

Myers, K A; Long, J T; Klein, J P; Wertsch, J J; Janisse, D; Harris, G F



Dissolution of Plutonium Scrub Alloy and Anode Heel Materials in H-Canyon  

SciTech Connect

H-Canyon has a ''gap'' in dissolver operations during the last three months of FY03. One group of material to be processed during the gap is pre-existing scrub alloy material. There are 14 cans of material containing approximately 3.8 kilograms of plutonium. Of the 14 cans, it was anticipated that four cans contain salts, two cans contain anode heel materials, and eight cans contain scrub alloy buttons. H-Canyon desires to process the materials using a flowsheet similar to the SS and C (sand, slag and crucible) dissolution flowsheet used in F-Canyon. The materials will be loaded into carbon steel cans and then placed into aluminum metal charging bundles. Samples were sent to Savannah River Technology Center (SRTC) for characterization and flowsheet testing -- four MSE salts, two anode heels, and seven scrub alloy buttons. SRTC dissolved and characterized each of the samples. Two of them, originally thought to be MSE salts, were found to be graphite mold materials and were unsuitable for processing in H-Canyon. Characterization studies confirmed that the identification of the remaining items as MSE salts, scrub alloy buttons, and anode heel materials was correct. The MSE salts and anode heels solids are comprised primarily of plutonium, potassium, sodium and chloride. Both the MSE salts and anode heels left behind small amounts of residual solids. The scrub alloy buttons are comprised primarily of plutonium and aluminum. The solids dissolve readily with light, effervescent gas generation at the material surface and only trace amounts of NOx generation. Of the seven button samples, four dissolved completely. Two button samples contained small amounts of tantalum that did not dissolve. The last of the seven scrub alloy samples left a trace amount of residual plutonium solids. It is anticipated that the presence of undissolved fissile material is a function of where the sample was located relative to the button surface.




Orofacial Pain  


... Neck, shoulder or back pain Dizziness ?xml:namespace> Sleep disorders ; If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism, or a sleep-related breathing ...


Back Pain  


... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...


Hip Pain  


... 0/1807/0.html. Accessed May 13, 2013. Anderson BC. Evaluation of the adult with hip pain. ... Accessed May 13, 2013. Anderson BC. Patient information: Hip pain (Beyond the basics). ...


Neck Pain  


... over-the counter medicine, such as acetaminophen or ibuprofen, to relieve pain, and apply heat to the ... an injury. Use anti-inflammatory medicines, such as ibuprofen and aspirin, to relieve pain and discomfort, and ...


Cancer Pain  

Microsoft Academic Search

Pain is a significant problem in cancer and there are many barriers to adequate pain control. Cancer-related pain is common\\u000a and has a destructive impact on a patient’s quality of life. Physicians need to understand better the appropriate use of opioid\\u000a and nonopioid analgesics and to consider other therapeutic options when appropriate. This chapter discusses the mechanisms\\u000a of pain underlying

Sebastiano Mercadante


Engineering and Economic Feasibility Study of Roll Stabilization and Heel Inducing Systems for New Coast Guard Polar Icebreakers. Volume I.  

National Technical Information Service (NTIS)

This report summarizes studies of various roll stabilization and heeling systems for a new polar icebreaker design. Though the functions to these two systems are distinct they may be studied as one larger system because there exist many technical similari...

J. F. Dalzell H. Nowacki



Impact of heel effect and ROI size on the determination of contrast-to-noise ratio for digital mammography systems  

NASA Astrophysics Data System (ADS)

The European Guidelines for quality control in digital mammography specify a procedure for measuring contrast-to-noise ratio (CNR) using a 0.2mm thickness of aluminium with different thicknesses of Plexiglas. The relationship between ROI size and heel effect and how this affects CNR measurement is investigated in this work for DR and CR systems. The measured relative noise for the CR images was found to be strongly dependant on the ROI size due to the heel effect. After applying heel effect correction there was very little dependence on ROI size. The relative noise in the images from the DR system showed very little dependence on ROI size. The heel effect also distorted the CNR measurement on CR images when larger ROI is used. However the use of multiple small ROIs led to a result that was essentially the same as if a heel effect correction had been applied. The appropriate ROI size which should be used for CNR measurement was found to be 0.25 × 0.25 cm. Using this size the heel effect had an insignificant impact on the measurement of relative noise and CNR. This approach has the advantage that only a single image is required for each measurement. The application of heel effect correction with CR systems requires two images and complex image processing. The current suggestion in the European guidelines to use a 2 × 2cm ROI is inappropriate for CR systems and leads to an error of 8% to 18% in CNR determination due to the heel effect.

Alsager, Abdulaziz; Young, Kenneth C.; Oduko, Jennifer M.



Ability to perform a single heel-rise is significantly related to patient-reported outcome after Achilles tendon rupture.  


This study evaluated the short-term recovery of function after an acute Achilles tendon rupture, measured by a single-legged heel-rise test, with main emphasis on the relation to the patient-reported outcomes and fear of physical activity and movement (kinesiophobia). Eighty-one patients treated surgically or non-surgically with early active rehabilitation after Achilles tendon rupture were included in the study. Patient's ability to perform a single-legged heel-rise, physical activity level, patient-reported symptoms, general health, and kinesiophobia was evaluated 12 weeks after the injury. The heel-rise test showed that 40 out of 81 (49%) patients were unable to perform a single heel-rise 12 weeks after the injury. We found that patients who were able to perform a heel-rise were significantly younger, more often of male gender, reported a lesser degree of symptoms, and also had a higher degree of physical activity at 12 weeks. There was also a significant negative correlation between kinesiophobia and all the patient-reported outcomes and the physical activity level. The heel-rise ability appears to be an important early achievement and reflects the general level of healing, which influences patient-reported outcome and physical activity. Future treatment protocols focusing on regaining strength early after the injury therefore seem to be of great importance. Kinesiophobia needs to be addressed early during the rehabilitation process. PMID:22716232

Olsson, N; Karlsson, J; Eriksson, B I; Brorsson, A; Lundberg, M; Silbernagel, K G



Antiviral activity of Engystol® and Gripp-Heel®: an in-vitro assessment  

PubMed Central

Background Infections with respiratory viruses can activate the innate immune response - an important host defence mechanism in the early stage of viral infection. Interferon (IFN) release, triggered by virus infection, is an important factor in establishing an antiviral state, where IFN activation occurs prior to the onset of the adaptive immune response. The two ultra-low-dose combination medications, Engystol® and Gripp-Heel®, have documented efficacy for the treatment of the respiratory infections. However, the underlying antiviral mechanisms remain elusive. Methods It was the goal to investigate whether Engystol® and Gripp-Heel® display antiviral activity in a prophylactic treatment protocol (2, 24 and 48 h pre-incubation) using a plaque reduction assay and whether the medications affect the release of type 1 IFN in virus-susceptible cell lines and human peripheral blood mononuclear cells (PBMCs). Results Both medications demonstrate prophylactic effect against viral respiratory virus replication. However, when the incubation was continued for up to 5 days, both medications exhibited a pronounced antiviral effect which was dependent on the pre-incubation time. Moreover, in co-stimulated HeLa cells as well as in activated PBMCs Gripp-Heel® and Engystol® demonstrated an increased type 1 IFN production. Conclusions Engystol® and Gripp-Heel® inhibited the replication of a variety of respiratory viruses. Additionally, we showed that pre-incubation affects the magnitude of the inhibitory effect differently for the various tested viruses. Both medications stimulate type 1 IFN release in different cell systems which suggests that their antiviral activity may be mediated possibly via modulation of the antiviral type 1 IFN host response.



The Effects of 10 Weeks Military Training on Heel Ultrasound and Bone Turnover  

Microsoft Academic Search

.   To measure the physiological changes in bone in response to strenuous exercise we performed a prospective study of male army\\u000a recruits over 10 weeks of basic training. Measurements performed at the start and completion of training consisted of ultrasound\\u000a (US) measurements of the heel: velocity of sound (VOS in m\\/seconds) and broadband ultrasound attenuation (BUA in dB\\/MHz) and\\u000a bone

J. Etherington; J. Keeling; R. Bramley; R. Swaminathan; I. McCurdie; T. D. Spector



Pain Genes  

PubMed Central

Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

Foulkes, Tom; Wood, John N.



Neuropathic Pain  

PubMed Central

Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk.

Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.



Myofascial Pain  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Myofascial pain should be considered in patients with localized pain complaints without arthritic or neuropathic features.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Myofascial pain syndrome should not be diagnosed in patients with no physical findings. Myofascial pain requires the presence\\u000a of a taut band and muscular trigger points.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Active trigger points refer pain in predictable patterns.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Treatment of myofascial pain focuses on

Dawn A. Marcus


Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon  

PubMed Central

The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence-based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon. The care provided involves an array of modalities from exercise and rehabilitation to spinal manipulative therapy.

Kobsar, Bradley; Alcantara, Joel



Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon.  


The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence-based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon. The care provided involves an array of modalities from exercise and rehabilitation to spinal manipulative therapy. PMID:19421349

Kobsar, Bradley; Alcantara, Joel



Elbow pain  


... common causes of elbow tendinitis are gardening, playing baseball, using a screwdriver, or overusing your wrist and ... involve: Antibiotics Corticosteroid shots Pain medicine Physical therapy Surgery (last resort)


Relationship between hamstring activation rate and heel contact velocity: Factors influencing age-related slip-induced falls  

PubMed Central

The purpose of this research was to determine whether a decreased hamstring activation rate among the elderly is responsible for a higher horizontal heel contact velocity and increased likelihood of slip-induced falls compared to their younger counterparts. Twenty-eight subjects from two age groups (14 young and 14 old) walked across a linear walking track with embedded force platforms while wearing a fall arresting harness attached to an overhead arresting rig for safety. In order to obtain realistic unexpected slip-induced fall data, a soapy vinyl floor surface was hidden from the subjects and unexpectedly introduced. Synchronized kinematics, kinetic and electromyography (EMG) analyses during the heel contact phase of the gait cycle while walking over slippery and non-slippery floor surfaces were examined in the study. Normalized EMG data were examined in terms of hamstring activation rate and evaluated with heel contact velocity and friction demand characteristic (as measured by peak required coefficient of friction (RCOF)) on the dry vinyl floor surface. Furthermore, slip parameters (i.e. slip distances and slipping velocity) were assessed on the soapy vinyl floor surface. The results indicated that younger adults’ hamstring activation rate was higher than older adults, whereas younger adults’ heel contact velocity was not different from older adults. These results suggested that heel contact velocity in younger adults was sufficiently reduced before the heel contact phase of the gait cycle. This could be due to the outcome of higher hamstring activation rate in younger adults in comparison to older adults. However, lower friction demand (peak RCOF), shorter slip distances, slower peak sliding heel velocity and more falls among older adults suggested that the slip initiation characteristics were not the only factors contributing to slip-induced falls among the elderly.

Lockhart, Thurmon E.; Kim, Sukwon



Pain Genes  

Microsoft Academic Search

Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating

Tom Foulkes; John N. Wood



Pain channelopathies  

PubMed Central

Pain remains a major clinical challenge, severely afflicting around 6% of the population at any one time. Channelopathies that underlie monogenic human pain syndromes are of great clinical relevance, as cell surface ion channels are tractable drug targets. The recent discovery that loss-of-function mutations in the sodium channel Nav1.7 underlie a recessive pain-free state in otherwise normal people is particularly significant. Deletion of channel-encoding genes in mice has also provided insights into mammalian pain mechanisms. Ion channels expressed by immune system cells (e.g. P2X7) have been shown to play a pivotal role in changing pain thresholds, whilst channels involved in sensory transduction (e.g. TRPV1), the regulation of neuronal excitability (potassium channels), action potential propagation (sodium channels) and neurotransmitter release (calcium channels) have all been shown to be potentially selective analgesic drug targets in some animal pain models. Migraine and visceral pain have also been associated with voltage-gated ion channel mutations. Insights into such channelopathies thus provide us with a number of potential targets to control pain.

Cregg, Roman; Momin, Aliakmal; Rugiero, Francois; Wood, John N; Zhao, Jing



Knee Pain  


... when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you'll be able to see the dislocation. Hip or foot pain. If you have hip or foot pain, you ...



SciTech Connect

High Level Waste (HLW) at the Savannah River Site (SRS) is currently stored in aging underground storage tanks. This waste is a complex mixture of insoluble solids, referred to as sludge, and soluble salts. Continued long-term storage of these radioactive wastes poses an environmental risk. Operations are underway to remove and disposition the waste, clean the tanks and fill with grout for permanent closure. Heel removal is the intermediate phase of the waste retrieval and tank cleaning process at SRS, which is intended to reduce the volume of waste prior to treatment with oxalic acid. The goal of heel removal is to reduce the residual amount of radioactive sludge wastes to less than 37,900 liters (10,000 gallons) of wet solids. Reducing the quantity of residual waste solids in the tank prior to acid cleaning reduces the amount of acid required and reduces the amount of excess acid that could impact ongoing waste management processes. Mechanical heel removal campaigns in Tank 12 have relied solely on the use of mixing pumps that have not been effective at reducing the volume of remaining solids. The remaining waste in Tank 12 is known to have a high aluminum concentration. Aluminum dissolution by caustic leaching was identified as a treatment step to reduce the volume of remaining solids and prepare the tank for acid cleaning. Dissolution was performed in Tank 12 over a two month period in July and August, 2011. Sample results indicated that 16,440 kg of aluminum oxide (boehmite) had been dissolved representing 60% of the starting inventory. The evolution resulted in reducing the sludge solids volume by 22,300 liters (5900 gallons), preparing the tank for chemical cleaning with oxalic acid.

Keefer, M.



An innovative design for reconstruction of plantar heel by split partially overlapping anterolateral thigh flap  

Microsoft Academic Search

Introduction  Reconstruction of the weight bearing, thick and durable heel, in soft tissue injuries of the foot remains a difficult and\\u000a challenging problem. The thick glabrous epidermis and dermis, and the fibrous septae of the subcutaneous layer provide unique\\u000a properties for withstanding pressure and shock associated with gait.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  Here, the authors put forward an innovative method for a one-stage

Vigneswaran N; H. W. Ng; Y. M. Samuel Ho; S. Y. Michelle Ho; T. C. Marcus Wong; Guan-Ming Feng; Sheng-Fa Yao; Hsing-Kuang Lai; Patel Hasu; Jagdeep Chana; Chandra Bose; Hung-Chi Chen


Solitary erythematous, tender plaque of the heel in a young infant.  


Calcinosis cutis is a rare disorder resulting from the precipitation and deposition of insoluble calcium and phosphate salts (hydroxyapatite crystals) in the dermis and subcutaneous tissue. It is generally divided into four main groups on the basis of etiology and pathogenesis. Clinical presentation of cutaneous calcinosis cutis varies according to the diagnosis and the underlying process. We report a case of calcinosis cutis of the heel in which both the extravasation of a calcium gluconate infusion and renal failure could have promoted the development of calcinosis cutis. PMID:24050291

Vaccari, Sabina; Ismaili, Alma; Barisani, Alessia; Neri, Iria; Patrizi, Annalisa



[Ulceration of the heel in a woman from Djibouti: squamous cell carcinoma with carcinomatous lymphangitis].  


The purpose of this report is to describe a case in which a heel ulcer with atypical features, i.e., large size and rapid progression, led to diagnosis of squamous cell carcinoma. Patient management was based on specialist advice obtained by "tele-dermatology" based on pictures and comments transmitted over the Internet. However, due to the risk of spreading and impossibility of providing other medical treatment (radiotherapy-chemotherapy), the lower limb was amputated at the top of the thigh. PMID:21585103

Bertani, A; Massoure, P L; Menguy, P; Lamblin, G; Eve, O; Morand, J J



Urination - painful  


... such as yeast or other infections of the vulva and vagina Other causes of painful urination include: ... in the urine ? Are there any rashes or itching in the genital area? What medications are you ...


Ankle Pain  


... or outside of your ankle or along the Achilles tendon, which connects the muscles in your lower leg ... Common causes of ankle pain include: Achilles tendinitis Achilles tendon rupture Avulsion fracture Bone spurs Broken ankle/broken ...


Phantom Pain  


... often results in painful nerve activity. Poor-fitting artificial limb (prosthesis). Talk to your doctor to be sure you're putting your artificial limb on correctly and that it fits properly. If ...


Back Pain  


... with your spinal cord, muscles, nerves or disks. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. ... Devereaux M. Low back pain. Medical Clinics of North America. 2009;93:477. Hoy D, et al. ...


What Is Chronic Pain?  

MedlinePLUS Videos and Cool Tools

... Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ... for Understanding Pain Pain Awareness Toolkits Home Pain Management Tools Videos What Is Chronic Pain? Featured Tool ...


[Wrist pain].  


Acute or chronic wrist pain is a relatively frequent complaint that may involve all age groups. The pain may be of osseous, articular, periarticular, neurologic, vascular origin, or be referred from the cervical spine, shoulder or elbow. The diagnosis should be oriented by a precise history and clinical examination. More specialised exams will be required according to clinical findings. Psychosocial and environmental influences need to be taken into consideration. PMID:17233497

Sadowski, M; Della Santa, D




SciTech Connect

Chemical Sludge Removal (CSR) is the final waste removal activity planned for some of the oldest nuclear waste tanks located at the Savannah River Site (SRS) in Aiken, SC. In 2008, CSR will be used to empty two of these waste tanks in preparation for final closure. The two waste tanks chosen to undergo this process have previously leaked small amounts of nuclear waste from the primary tank into an underground secondary containment pan. CSR involves adding aqueous oxalic acid to the waste tank in order to dissolve the remaining sludge heel. The resultant acidic waste solution is then pumped to another waste tank where it will be neutralized and then stored awaiting further processing. The waste tanks to be cleaned have a storage capacity of 2.84E+06 liters (750,000 gallons) and a target sludge heel volume of 1.89E+04 liters (5,000 gallons) or less for the initiation of CSR. The purpose of this paper is to describe the CSR process and to discuss the most significant technical issues associated with the development of CSR.

Thaxton, D; Timothy Baughman, T



Movement Behavior of High-Heeled Walking: How Does the Nervous System Control the Ankle Joint during an Unstable Walking Condition?  

PubMed Central

The human locomotor system is flexible and enables humans to move without falling even under less than optimal conditions. Walking with high-heeled shoes constitutes an unstable condition and here we ask how the nervous system controls the ankle joint in this situation? We investigated the movement behavior of high-heeled and barefooted walking in eleven female subjects. The movement variability was quantified by calculation of approximate entropy (ApEn) in the ankle joint angle and the standard deviation (SD) of the stride time intervals. Electromyography (EMG) of the soleus (SO) and tibialis anterior (TA) muscles and the soleus Hoffmann (H-) reflex were measured at 4.0 km/h on a motor driven treadmill to reveal the underlying motor strategies in each walking condition. The ApEn of the ankle joint angle was significantly higher (p<0.01) during high-heeled (0.38±0.08) than during barefooted walking (0.28±0.07). During high-heeled walking, coactivation between the SO and TA muscles increased towards heel strike and the H-reflex was significantly increased in terminal swing by 40% (p<0.01). These observations show that high-heeled walking is characterized by a more complex and less predictable pattern than barefooted walking. Increased coactivation about the ankle joint together with increased excitability of the SO H-reflex in terminal swing phase indicates that the motor strategy was changed during high-heeled walking. Although, the participants were young, healthy and accustomed to high-heeled walking the results demonstrate that that walking on high-heels needs to be controlled differently from barefooted walking. We suggest that the higher variability reflects an adjusted neural strategy of the nervous system to control the ankle joint during high-heeled walking.

Alkjaer, Tine; Raffalt, Peter; Petersen, Nicolas C.; Simonsen, Erik B.



Characteristic trends of lower-extremity complex regional pain syndrome.  


Complex regional pain syndrome (CRPS) is a multifaceted, progressive, and potentially devastating disorder generally affecting the extremities. In addition, scant information is available regarding the types of patients who develop lower-extremity CRPS. This is a retrospective chart review study of 64 patients who presented to a pain clinic with CRPS of the lower extremity. The study examined 23 variables broadly classified under demographic characteristics, CRPS characteristics, and healthcare utilization. The sample was found to consist of predominantly white, middle-aged women with CRPS I. Subjective complaints consisted of burning, sharp, throbbing, or aching pain with shooting symptoms. Initial presenting clinical findings included allodynia, edema, erythema, and hyperesthesia. The most common precipitating injuries were blunt trauma of the foot with or without fracture or ankle sprain. The most common inciting surgical events were bunionectomy, tarsal tunnel release, and heel-spur surgery. Referral to the pain clinic was delayed more commonly in trauma patients than in postsurgical patients, with a corresponding increase in pain clinic visits for treatment. This study may act as a guide for physicians treating the lower extremity to aid in the recognition of lower extremity complex regional pain syndrome and its characteristics. PMID:15480404

Harris, John; Fallat, Lawrence; Schwartz, Steven


Clinical implications of unmanaged needle-insertion pain and distress in children.  


Increasing evidence has demonstrated that pain from venipuncture and intravenous cannulation is an important source of pediatric pain and has a lasting impact. Ascending sensory neural pain pathways are functioning in preterm and term infants, yet descending inhibitory pathways seem to mature postnatally. Consequently, infants may experience pain from the same stimulus more intensely than older children. In addition, painful perinatal procedures such as heel lancing or circumcision have been found to correlate with stronger negative responses to venipuncture and intramuscular vaccinations weeks to months later. Similarly, older children have reported greater pain during follow-up cancer-related procedures if the pain of the initial procedure was poorly controlled, despite improved analgesia during the subsequent procedures. Fortunately, both pharmacologic and nonpharmacologic techniques have been found to reduce children's acute pain and distress and subsequent negative behaviors during venipuncture and intravenous catheter insertion. This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain. PMID:18978006

Kennedy, Robert M; Luhmann, Janet; Zempsky, William T



Optimal control of the heel-off to lift-off phase of two maximum height jumps  

Microsoft Academic Search

A Mathematical model is first developed for the following two tasks. Jump as high as possible starting from a deep crouch with your feet flat on the floor. Jump as high as possible starting from a deep crouch with your weight balanced on your toes (heels off the ground throughout). Then, the mathematical model, which takes the form of an

W. Levine; F. Zajac; Y. Cho; M. Zomlefer


The origin and relief of common pain.  


Where pain of the musculoskeletal system is present, commonly, this pain is without objective evidence of disease, trauma, or disorder. Absence of an apparent cause for common pain prompts the consideration of mechanical stress as a contributing factor. The principal stress of the musculoskeletal system is postural. By posture it is usually meant the distribution of body mass with respect to gravity. Past efforts to predict chronic pain by postural analysis or to reduce such pain by strengthening, conscious control or splinting of posture has had marginal success. Past failure to relate posture to pain is attributable to (1) ubiquity of sub-optimal posture that precludes clinical comparison to those with optimal posture; (2) presupposition that the causal relation between posture and pain is of the observational class of causality rather than the manipulable kind; (3) a definition of posture that is too narrow to complete the picture; and (4) inadequate methods for reduction of postural asymmetry to an extent that is sufficient to elicit a significant and enduring effect on sub-optimal posture and related pain. Posture can be defined more broadly as the stance of the body performing within the boundaries of posture and which is mediated by the Postural Control System towards greatest stability (Fx. 1). The stance of the body is the arrangement of the body with respect to gravity and other accelerative forces. The postural boundaries are the set of forces that resist acceleration and thereby provide the limits within which one functions stably, and this resistance is currently approximated by six principal sources of resistance to acceleration: viscous, elastic, neuromuscular, rigid, viscoelastic, and inertial. The Postural Control System is located in the brainstem and modulates body stance to more economically and stably effect and resist acceleration. The rigid boundaries can be so with respect to compressive, tractive, or tensile qualities that permits three kinds of motion: translation, rotation and oscillation. An example of postural boundaries that are rigid with respect to compression and tensile character are the bones that bear weight. In contrast, ligaments provide a tractive rigidity and musculotendons a relatively elastic boundary. Joint surfaces are considered boundaries that are rigid but not perfectly so. Of fundamental importance are those joints that arc lowermost in a column of the musculoskeletal system namely: (1) the feet and ankles that support the entirety of the musculoskeletal system and; (2) the base of the sacrum that supports the vertebral spine. This broadened definition of posture leads to a greatly enhanced manipulability of posture in the upright stance and alleviation of more than two-thirds of common pain by the coherent combination of (1) manual manipulation to reduce somatic dysfunction; (2) foot orthotics to optimize the amplitude of the arches of the feet and vertically align the ankle; (3) a heel lift to level the sacral base; (4) and a group of therapeutic postures configured to minimize restriction of peripheral soft tissue reflective of the earlier posture, all aimed to optimize posture. Mediated by the postural control system, manipulation of postural boundaries accordingly modifies the structure and function of the entire musculoskeletal system. Typically, this relief is maintained by foot orthotic and heel lift alone without maintenance by manual manipulation, medication, or exercise. PMID:11542803

Irvin, R E



Fractional Calculus in Biomechanics: A 3D Viscoelastic Model Using Regularized Fractional Derivative Kernels with Application to the Human Calcaneal Fat Pad  

Microsoft Academic Search

A viscoelastic model of the K-BKZ (Kaye, Technical Report 134, College of Aeronautics, Cranfield 1962; Bernstein et al., Trans Soc Rheol 7: 391–410, 1963) type is developed for isotropic biological tissues and applied to the fat pad of the human heel. To facilitate this pursuit, a class of elastic solids is introduced through a novel strain-energy function whose elements possess

A. D. Freed; K. Diethelm



Foot Kinematics During a Bilateral Heel Rise Test in Participants With Stage II Posterior Tibial Tendon Dysfunction  

PubMed Central

STUDY DESIGN Experimental laboratory study using a cross-sectional design. OBJECTIVES To compare foot kinematics, using 3-dimensional tracking methods, during a bilateral heel rise between participants with posterior tibial tendon dysfunction (PTTD) and participants with a normal medial longitudinal arch (MLA). BACKGROUND The bilateral heel rise test is commonly used to assess patients with PTTD; however, information about foot kinematics during the test is lacking. METHODS Forty-five individuals volunteered to participate, including 30 patients diagnosed with unilateral stage II PTTD (mean ± SD age, 59.8 ± 11.1 years; body mass index, 29.9 ± 4.8 kg/m2) and 15 controls (mean ± SD age, 56.5 ± 7.7 years; body mass index, 30.6 ± 3.6 kg/m2). Foot kinematic data were collected during a bilateral heel rise task from the calcaneus (hindfoot), first metatarsal, and hallux, using an Optotrak motion analysis system and Motion Monitor software. A 2-way mixed-effects analysis of variance model, with normalized heel height as a covariate, was used to test for significant differences between the normal MLA and PTTD groups. RESULTS The patients in the PTTD group exhibited significantly greater ankle plantar flexion (mean difference between groups, 7.3°; 95% confidence interval [CI]: 5.1° to 9.5°), greater first metatarsal dorsiflexion (mean difference between groups, 9.0°; 95% CI: 3.7° to 14.4°), and less hallux dorsiflexion (mean difference, 6.7°; 95% CI: 1.7° to 11.8°) compared to controls. At peak heel rise, hindfoot inversion was similar (P = .130) between the PTTD and control groups. CONCLUSION Except for hindfoot eversion/inversion, the differences in foot kinematics in participants with stage II PTTD, when compared to the control group, mainly occur as an offset, not an alteration in shape, of the kinematic patterns.




Electroencephalographic Activity in Response to Procedural Pain in Preterm Infants Born at 28 and 33 Weeks Gestational Age.  


OBJECTIVES:: Preterm infants undergo frequent painful procedures in the neonatal intensive care unit. Electroencephalography (EEG) changes in reaction to invasive procedures have been reported in preterm and full-term neonates. Frontal EEG asymmetry as an index of emotion during tactile stimulation shows inconsistent findings in full-term infants, and has not been examined in the context of pain in preterm infants. Our aim was to examine whether heel lance for blood collection induces changes in right-left frontal asymmetry, suggesting negative emotional response, in preterm neonates at different gestational age (GA) at birth and different duration of stay in the neonatal intensive care unit. MATERIALS AND METHODS:: Three groups of preterm infants were compared: set 1: group 1 (n=24), born and tested at 28 weeks GA; group 2 (n=22), born at 28 weeks GA and tested at 33 weeks; set 2: group 3 (n=25), born and tested at 33 weeks GA. EEG power was calculated for 30-second artifact-free periods, in standard frequency bandwidths, in 3 phases (baseline, up to 5 min after heel lance, 10 min after heel lance). RESULTS:: No significant differences were found in right-left frontal asymmetry, or in ipsilateral or contralateral somatosensory response, across phases. In contrast, the Behavioral Indicators of Infant Pain scores changed across phase (P<0.0001). Infants in group 1 showed lower Behavioral Indicators of Infant Pain scores (P=0.039). DISCUSSION:: There are technical challenges in recording EEG during procedures, as pain induces motor movements. More research is needed to determine the most sensitive approach to measure EEG signals within the context of pain in infancy. PMID:23446071

Maimon, Neta; Grunau, Ruth E; Cepeda, Ivan L; Friger, Michael; Selnovik, Leonel; Gilat, Shlomo; Shany, Eilon



Small Molecule Inhibitors Targeting the 'Achilles' Heel of Androgen Receptor Activity  

PubMed Central

Androgen ablation therapy remains the gold standard for the treatment of advanced prostate cancer, but unfortunately, it is not curative and eventually the disease will return as lethal castration-resistant prostate cancer (CRPC). There is mounting evidence supporting the concept that development of CRPC is causally related to continued transactivation of androgen receptor (AR). All current therapies that target the AR are dependent on the presence of its C-terminal ligand-binding domain (LBD). However, it is the N-terminal domain (NTD) of the AR that is the “Achilles Heel” of AR activity, with AF-1 being essential for AR activity regardless of androgen. Recent efforts to develop drugs to the AR NTD have yielded EPI-001 a small molecule, sintokamide peptides, and decoys to the AR NTD with EPI-001 the best characterized and most promising for clinical development based upon specificity, low toxicity, and cytoreductive antitumor activity.

Sadar, Marianne D.



Detection of swing heel-off event in gait initiation using force-plate data.  


This study investigated the accuracy and reliability of four methods using force-plate data for detecting the swing heel-off (HO) time in gait initiation. Results of these methods were compared to those obtained by means of a reference method using a footswitch. Ten young healthy adults performed 18 forward gait initiation trials at self-selected speed and at maximal speed. Results showed that the method based on vertical impulse was the most accurate and reliable in determining HO in both speed conditions. The mean error obtained with this method was -8±10ms in the self-selected speed condition (-7±10ms in the maximal speed condition), with no significant effect of gait speed (P>0.05). These findings suggest that this method based on force-plate data is valid and reliable for detecting HO in forward gait initiation in the absence of additional hardware. PMID:22980912

Caderby, T; Yiou, E; Peyrot, N; Bonazzi, B; Dalleau, G



Skin conductance variations compared to ABC scale for pain evaluation in newborns.  


Abstract Objectives: To validate spontaneous skin conductance variations as a specific reliable mean to measure pain in full-term healthy newborns during heel stick, comparing it with the ABC scale. To compare oral sucrose to wrapping effectiveness for non-pharmacological analgesia during the same procedure. Method: All recruited newborns (n?=?158) underwent a heel stick for metabolic screening at 48?h of life with non-pharmacological analgesia by oral sucrose (group A) or wrapping (group B) according to randomization. Their pain was estimated by ABC scale score (standard method) and measured by skin conductance variations. Results: A positive correlation was founded between peaks per sec measure and ABC score (rs?=?0.303, p?pain. Novel technological devices may be a useful support to clinical observation in this field. Oral sucrose is more effective than wrapping in reducing pain. Operators should be well periodically re-trained in performing non pharmacological analgesia during minor procedure on newborns. PMID:23566033

Scaramuzzo, Rosa T; Faraoni, Maddalena; Polica, Elisa; Pagani, Valeria; Vagli, Elena; Boldrini, Antonio



Breast pain  

PubMed Central

Introduction Breast pain may be cyclical (worse before a period) or non-cyclical, originating from the breast or the chest wall, and occurs at some time in 70% of women. Cyclical breast pain resolves spontaneously in 20% to 30% of women, but tends to recur in 60% of women. Non-cyclical pain responds poorly to treatment but tends to resolve spontaneously in half of women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for breast pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, bromocriptine, combined oral contraceptive pill, danazol, diuretics, evening primrose oil, gestrinone, gonadorelin analogues, hormone replacement therapy (HRT), lisuride, low-fat diet, progestogens, pyridoxine, tamoxifen, tibolone, topical or oral non-steroidal anti-inflammatory drugs (NSAIDs), toremifene, and vitamin E.



Central Pain Syndrome  


NINDS Central Pain Syndrome Information Page Table of Contents (click to jump to sections) What is Central Pain Syndrome? ... is being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological ...


Assessing pain in patients.  


This article defines pain and discusses options for pain assessment. Both unidimensional and multidimensional pain assessment scales are considered and described. Nursing skills required to carry out pain assessment are identified and discussed. PMID:18376633

McLafferty, E; Farley, A


Pain Medications After Surgery  


... Modern pain medications and anesthesia can control post-surgical pain and help your body heal. By Mayo ... fewer complications. The time to talk about post-surgical pain relief and pain medications is before you ...


Issues in Defining Pain  

Microsoft Academic Search

We all have experienced pain at one time or the other, but scientifically what is pain? Most of us regard pain as a negative sensation that originates in traumatized tissues and warns of injury. Ancient philosophers considered pain an emotion. Aristotle, for example, called pain a passion of the soul. Pain in humans, and probably in animals, is in part

John S. Church


Shoulder pain  

PubMed Central

Introduction Shoulder pain covers a wide range of problems and affects up to 20% of the population. It is not a specific diagnosis. Shoulder pain can be caused by problems with the acromioclavicular joint, shoulder muscles, or referred pain from the neck. Rotator cuff problems account for 65-70% of cases of shoulder pain. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment; topical drug treatment; local injections; non-drug treatment; and surgical treatment? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 53 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: arthroscopic laser subacromial decompression, corticosteroid injections (intra-articular), corticosteroids (oral, subacromial injection), electrical stimulation, extracorporeal shock wave therapy, guanethidine (intra-articular), ice, laser treatment, manipulation under anaesthesia (plus intra-articular injection in people with frozen shoulder), multidisciplinary biopsychosocial rehabilitation, nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, phonophoresis, physiotherapy (manual treatment, exercises), surgical arthroscopic decompression, transdermal glyceryl trinitrate, ultrasound.



Shoulder pain  

PubMed Central

Introduction Shoulder pain is a common problem with an estimated prevalence of 4% to 26%. About 1% of adults aged over 45 years consult their GP with a new presentation of shoulder pain every year in the UK. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment, topical drug treatment, local injections, non-drug treatment, and surgical treatment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 71 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, arthroscopic subacromial decompression, autologous whole blood injection, corticosteroids (oral, subacromial injection, or intra-articular injection), electrical stimulation, excision of distal clavicle, extracorporeal shock wave therapy, ice, laser treatment, manipulation under anaesthesia, suprascapular nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, physiotherapy (manual treatment, exercises), platelet-rich plasma injection, rotator cuff repair, shoulder arthroplasty, and ultrasound.



Back pain.  

PubMed Central

1. Back pain is very common and can be the result of a wide range of different conditions. A detailed history of the complaint often points towards the cause. Positional backache suggests a mechanical cause, unremitting pain may indicate malignancy or infection especially if accompanied by night sweats, whereas morning stiffness is more often the result of inflammation. 2. Examine the patient lying and standing as outlined. A general examination should also be performed if there is a history of weight loss, night sweats, or if the patient looks ill. 3. The vast majority of cases of backache are mechanical in origin. Plain x-rays are not normally contributory and should be avoided unless there are factors in the history and examination suggestive of infection or malignancy. 4. Patients with backache and sphincter disturbance and/or perineal anaesthesia require immediate hospital admission. 5. Analgesia and bed rest are the mainstays of treatment for acute backache of mechanical origin. Once there has been some improvement, physiotherapy can be beneficial. 6. Chronic back pain is present if the complaint lasts for more than 8 weeks. Investigations should include full blood count, ESR, calcium and alkaline phosphatase. The patient needs to be referred to a rheumatologist or orthopaedic surgeon for further assessment and possible imaging studies. If no cause other than mechanical dysfunction is found the patient should be assessed by a physiotherapist and taught back care.

Beaumont, B.; Paice, E.



Lateral Dominance, Pain Perception, and Pain Tolerance  

Microsoft Academic Search

It has been suggested that lateral dominance influences pain perception and pain tolerance ; but when electric stimulation was used on human teeth, there appeared to be no difference in the pain perception threshold values on each side of the midline. Pain tolerance values seem to support the suggestion, but the results were not statistically significant.

A. V. Newton; J. M. Mumford



Fear of pain in orofacial pain patients  

Microsoft Academic Search

In the present study, we examined whether fear of pain, dental fear, general indices of psychological distress, and self-reported stress levels differed between 40 orofacial pain patients and 40 gender and age matched control general dental patients. We also explored how fear of pain, as measured by the Fear of Pain Questionnaire-III (J Behav Med 21 (1998) 389), relates to

Daniel W McNeil; Anthony R Au; Michael J Zvolensky; Deborah Rettig McKee; Iven J Klineberg; Christopher C. K Ho



Relationship between self-reported high-heeled shoe use and bone mineral density using quantitative ultrasound at a community health fair.  


This is the first known study to examine the relationship between high-heel use and bone mineral density (BMD). Because women are disproportionately affected by osteoporosis, it is important to identify possible modifiable behaviors of women that may adversely affect bone health. Many studies have shown changes in body mechanics when wearing high-heeled shoes in comparison to normal gait. Because the composition of bone changes according to mechanical load and muscle activity, this study investigates whether wearing high heels may alter BMD. Two hundred and twenty-one participants at a community health fair in Lansing, Michigan, were surveyed on high-heel use and bone health risk (gender, thin/small frame, fair skin, family history of fracture, smoking history, walking, dairy consumption, and early menopause or oopherectomy at <45 years old). Quantitative ultrasound (QUS) of the heel by Hologic's Sahara Sonometer was used to measure BMD. The mean age was 45.2 (SD 13.7)?years, and the majority of participants were female (208, 94 %). A significant difference between mean BMD and high-heel use was not found. Independent correlations existed between fair skinned/sunburn easily and BMD, r(212)?=?-0.14, p?=?0.038, as well as history of smoking and BMD, r(212)?=?-0.14, p?=?0.042. Bone health risk score was strongly correlated with heel use binary variable "yes/no," r(210)?=?0.21, p?=?0.003. Our study suggests that wearing high-heeled shoes does not lead to appreciable differences in BMD among community health fair participants as assessed by QUS. PMID:22983265

Glassy, Crystal M; Glassy, Matthew S; Guggenheim, Carla



Quantitative ultrasound variables of the heel in Finnish men aged 18–20 yr: predictors, relationship to bone mineral content, and changes during military service  

Microsoft Academic Search

Introduction  Determinants of BUA and SOS and their changes during military service-associated physical training were studied in 196 army recruits and 50 control men, aged 18–20 years.Methods  Heel ultrasound measurement, DXA, muscle strength test, Cooper’s running test and genetic analyses were performed. Lifestyle factors were recorded. Sex steroids and bone turnover markers were determined. Heel ultrasound was repeated after six months.Results  Exercise was the most

V.-V. Välimäki; E. Löyttyniemi; M. J. Välimäki



Compensatory adjustments in lower extremity kinematics in response to a reduced cushioning of the impact interface in heel–toe running  

Microsoft Academic Search

The response of heel-toe runners to changes in cushioning of the impact interface was investigated. Ground reaction force\\u000a and sagittal plane kinematic data were collected for six heel-toe runners performing barefoot running trials on a conventional\\u000a asphalt surface and an asphalt surface with additional cushioning. Statistical analysis indicated that similar peak impact\\u000a force values were maintained when running on the

S. J. Dixon; A. C. Collop; M. E. Batt



Early mobilization after sliding and Z-lengthening of heel cord: a preliminary experimental study in rabbits  

Microsoft Academic Search

Sliding lengthening and Z-lengthening techniques are widely used in heel cord lengthening. Even though most surgeons performing\\u000a these procedures apply a short leg cast after surgery, their postoperative immobilization intervals vary from 3 to 7 weeks.\\u000a Nather et al. showed that there was no need for immobilization after the musculotendinous lengthening of long, deep flexor\\u000a tendons. In the present study,

Seref Aktas; Selcuk Ercan; Latife Candan; Ulker Moralar; Erol Akata



The oscillatory behavior of the CoM facilitates mechanical energy balance between push-off and heel strike  

Microsoft Academic Search

Humans use equal push-off and heel strike work during the double support phase to minimize the mechanical work done on the center of mass (CoM) during the gait. Recently, a step-to-step transition was reported to occur over a period of time greater than that of the double support phase, which brings into question whether the energetic optimality is sensitive to

Seyoung Kim


The relation between bone mineral density in the heel and pixel intensity in the mandibular jaw bone among elderly women  

PubMed Central

Objectives The purpose of this study was to investigate the correlation between pixel intensity (PI) in digital radiographs of the lower jaw and bone mineral density (BMD) in the heels of post-menopausal women (as measured with DXL, a combination of dual energy X-ray absorptiometry and lasers). Methods Two intraoral periapical digital radiographs were taken in the right and left mandible premolar region, and the digital images were analysed by a computer program (Dimaxis) regarding PI. As the radiographs were taken, the BMD of the patient's left heel was measured via a portable Calscan device. The patient answered a questionnaire concerning risk factors. The correlation between variables was analysed using statistical tests. Results A significant correlation was found between the PI in the left (P = 0.001) and right (P = 0.004) mandible and the BMD of the left heel for the whole group. A pronounced correlation was found to exist for women > 70 years old. Based on a cut-off value of the PI, to differentiate between healthy individuals and those who required further analysis for osteoporosis, the following values were obtained: sensitivity 0.74, specificity 0.50, positive predictive value 0.77 and negative predictive value 0.46. Conclusion A positive correlation was found between PI in digital radiographs of the mandible and the BMD of the heel. The low predictive value does not allow any definite conclusions to be drawn from the present study. A reasonable recommendation could be for future studies to employ a larger study population to explore the effect on this value.

Hedstrom, L; Baigi, A; Bergh, H



The oscillatory behavior of the CoM facilitates mechanical energy balance between push-off and heel strike.  


Humans use equal push-off and heel strike work during the double support phase to minimize the mechanical work done on the center of mass (CoM) during the gait. Recently, a step-to-step transition was reported to occur over a period of time greater than that of the double support phase, which brings into question whether the energetic optimality is sensitive to the definition of the step-to-step transition. To answer this question, the ground reaction forces (GRFs) of seven normal human subjects walking at four different speeds (1.1-2.4 m/s) were measured, and the push-off and heel strike work for three differently defined step-to-step transitions were computed based on the force, work, and velocity. To examine the optimality of the work and the impulse data, a hybrid theoretical-empirical analysis is presented using a dynamic walking model that allows finite time for step-to-step transitions and incorporates the effects of gravity within this period. The changes in the work and impulse were examined parametrically across a range of speeds. The results showed that the push-off work on the CoM was well balanced by the heel strike work for all three definitions of the step-to-step transition. The impulse data were well matched by the optimal impulse predictions (R(2)>0.7) that minimized the mechanical work done on the CoM during the gait. The results suggest that the balance of push-off and heel strike energy is a consistent property arising from the overall gait dynamics, which implies an inherited oscillatory behavior of the CoM, possibly by spring-like leg mechanics. PMID:22035641

Kim, Seyoung; Park, Sukyung



Urologic myofascial pain syndromes  

Microsoft Academic Search

Treatment of pain of urogenital origin, chronic pelvic pain syndrome, can be frustrating for patients and physicians. The\\u000a usual approaches do not always produce the desired results. Visceral pain from pelvic organs and myofascial pain from muscle\\u000a trigger points share common characteristics. Referred pain from myofascial trigger points can mimic visceral pain syndromes\\u000a and visceral pain syndromes can induce trigger

Ragi Doggweiler-Wiygul



Painful hypoadrenalism  

PubMed Central

A 61-year-old man presented with diffuse myalgia and arthralgia. The physical examination showed diffuse musculoskeletal tenderness and joint stiffness without the presence of synovitis or arthritis. Nerve conduction study showed combined mild axonal degenerative and demyelinating change. Muscle biopsy analysis showed unspecific mild muscle atrophy with myopathic changes found on electromyography. A diagnosis of isolated adrenocorticotropic hormone deficiency was made on the basis of endocrinological evaluation. The widespread musculoskeletal pain resolved as a result of administration of physiological dose of hydrocortisone replacement. In a patient with unexplained rheumatic symptoms, adrenocortical insufficiency should be considered in the possible aetiology.

Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru



The ESR1 (6q25) Locus Is Associated with Calcaneal Ultrasound Parameters and Radial Volumetric Bone Mineral Density in European Men  

PubMed Central

Purpose Genome-wide association studies (GWAS) have identified 6q25, which incorporates the oestrogen receptor ? gene (ESR1), as a quantitative trait locus for areal bone mineral density (BMDa) of the hip and lumbar spine. The aim of this study was to determine the influence of this locus on other bone health outcomes; calcaneal ultrasound (QUS) parameters, radial peripheral quantitative computed tomography (pQCT) parameters and markers of bone turnover in a population sample of European men. Methods Eight single nucleotide polymorphisms (SNP) in the 6q25 locus were genotyped in men aged 40–79 years from 7 European countries, participating in the European Male Ageing Study (EMAS). The associations between SNPs and measured bone parameters were tested under an additive genetic model adjusting for centre using linear regression. Results 2468 men, mean (SD) aged 59.9 (11.1) years had QUS measurements performed and bone turnover marker levels measured. A subset of 628 men had DXA and pQCT measurements. Multiple independent SNPs showed significant associations with BMD using all three measurement techniques. Most notably, rs1999805 was associated with a 0.10 SD (95%CI 0.05, 0.16; p?=?0.0001) lower estimated BMD at the calcaneus, a 0.14 SD (95%CI 0.05, 0.24; p?=?0.004) lower total hip BMDa, a 0.12 SD (95%CI 0.02, 0.23; p?=?0.026) lower lumbar spine BMDa and a 0.18 SD (95%CI 0.06, 0.29; p?=?0.003) lower trabecular BMD at the distal radius for each copy of the minor allele. There was no association with serum levels of bone turnover markers and a single SNP which was associated with cortical density was also associated with cortical BMC and thickness. Conclusions Our data replicate previous associations found between SNPs in the 6q25 locus and BMDa at the hip and extend these data to include associations with calcaneal ultrasound parameters and radial volumetric BMD.

Thomson, Wendy; Boonen, Steven; Borghs, Herman; Vanderschueren, Dirk; Gielen, Evelien; Huhtaniemi, Ilpo T.; Adams, Judith E.; Ward, Kate A.; Bartfai, Gyorgy; Casanueva, Felipe; Finn, Joseph D.; Forti, Gianni; Giwercman, Aleksander; Han, Thang S.; Kula, Krzysztof; Labrie, Fernand; Lean, Michael E. J.; Pendleton, Neil; Punab, Margus; Wu, Frederick C. W.; O'Neill, Terence W.




SciTech Connect

Preliminary studies in the EM-21 Alternative Chemical Cleaning Program have focused on understanding the dissolution of Hematite (a primary sludge heel phase) in oxalic acid, with a focus on minimizing oxalic acid usage. Literature reviews, thermodynamic modeling, and experimental results have all confirmed that pH control, preferably using a supplemental proton source, is critical to oxalate minimization. With pH control, iron concentrations as high as 0.103 M have been obtained in 0.11 M oxalic acid. This is consistent with the formation of a 1:1 (iron:oxalate) complex. The solubility of Hematite in oxalic acid has been confirmed to increase by a factor of 3 when the final solution pH decreases from 5 to below 1. This is consistent with literature predictions of a shift in speciation from a 1:3 to 1:1 as the pH is lowered. Above a solution pH of 6, little Hematite dissolves. These results emphasize the importance of pH control in optimizing Hematite dissolution in oxalic acid.

Hay, M.; King, W.; Martino, C.



Variability of neural activation during walking in humans: short heels and big calves.  


People come in different shapes and sizes. In particular, calf muscle size in humans varies considerably. One possible cause for the different shapes of calf muscles is the inherent difference in neural signals sent to these muscles during walking. In sedentary adults, the variability in neural control of the calf muscles was examined with muscle size, walking kinematics and limb morphometrics. Half the subjects walked while activating their medial gastrocnemius (MG) muscles more strongly than their lateral gastrocnemius (LG) muscles during most walking speeds ('MG-biased'). The other subjects walked while activating their MG and LG muscles nearly equally ('unbiased'). Those who walked with an MG-biased recruitment pattern also had thicker MG muscles and shorter heel lengths, or MG muscle moment arms, than unbiased walkers, but were similar in height, weight, lower limb length, foot length, and exhibited similar walking kinematics. The relatively less plastic skeletal system may drive calf muscle size and motor recruitment patterns of walking in humans. PMID:21288939

Ahn, A N; Kang, J K; Quitt, M A; Davidson, B C; Nguyen, C T



Unsupervised segmentation of heel-strike IMU data using rapid cluster estimation of wavelet features.  


When undertaking gait-analysis, one of the most important factors to consider is heel-strike (HS). Signals from a waist worn Inertial Measurement Unit (IMU) provides sufficient accelerometric and gyroscopic information for estimating gait parameter and identifying HS events. In this paper we propose a novel adaptive, unsupervised, and parameter-free identification method for detection of HS events during gait episodes. Our proposed method allows the device to learn and adapt to the profile of the user without the need of supervision. The algorithm is completely parameter-free and requires no prior fine tuning. Autocorrelation features (ACF) of both antero-posterior acceleration (aAP) and medio-lateral acceleration (aML) are used to determine cadence episodes. The Discrete Wavelet Transform (DWT) features of signal peaks during cadence are extracted and clustered using Swarm Rapid Centroid Estimation (Swarm RCE). Left HS (LHS), Right HS (RHS), and movement artifacts are clustered based on intra-cluster correlation. Initial pilot testing of the system on 8 subjects show promising results up to 84.3%±9.2% and 86.7%±6.9% average accuracy with 86.8%±9.2% and 88.9%±7.1% average precision for the segmentation of LHS and RHS respectively. PMID:24109847

Yuwono, Mitchell; Su, Steven W; Moulton, Bruce D; Nguyen, Hung T




SciTech Connect

Mixtures of oxalic acid with nitric acid have been shown to be superior to oxalic acid alone for the dissolution of iron-rich High Level Waste sludge heels. Optimized conditions resulting in minimal oxalate usage and stoichiometric iron dissolution (based on added oxalate ion) have been determined for hematite (a primary sludge iron phase) in oxalic/nitric acid mixtures. The acid mixtures performed better than expected based on the solubility of hematite in the individual acids through a synergistic effect in which the preferred 1:1 Fe:oxalate complex is formed. This allows for the minimization of oxalate additions to the waste stream. Carbon steel corrosion rates were measured in oxalic/nitric acid mixtures to evaluate the impacts of chemical cleaning with these solutions on waste tank integrity. Manageable corrosion rates were observed in the concentration ranges of interest for an acid contact timescale of 1 month. Kinetics tests involving hematite and gibbsite (a primary sludge aluminum phase) have confirmed that {ge}90% solids dissolution occurs within 3 weeks. Based on these results, the chemical cleaning conditions recommended to promote minimal oxalate usage and manageable corrosion include: 0.5 wt. % oxalic acid/0.175 M nitric acid mixture, 50 C, 2-3 week contact time with agitation.

King, W.; Hay, M.; Wiersma, B.; Pennebaker, F.



When Sex Is Painful  


How common is painful sex? Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during ... a long-term problem. What causes pain during sex? Pain during sex may be a sign of ...


Low Back Pain  


MENU Return to Web version Low Back Pain Overview What is low back pain? Low back pain is a common problem for many people. It can be caused by many ... lift and exercise correctly. Symptoms When is low back pain serious? Call your family doctor if: Pain goes ...


Pain in orthodontics  

Microsoft Academic Search

This literature review focuses on previous studies of pain and pain perception in dentistry with special emphasis on orthodontic treatment. The prevalence of pain and background factors such as age, gender and culture\\/society, in addition to pain physiology and the influence of concomitant emotional and cognitive factors, is examined. Pain during orthodontic tooth movement is reported from the point of

Marianne Bergius; Stavros Kiliaridis; Ulf Berggren



Extracephalic Yawning Pain  

Microsoft Academic Search

The aim of this study was to report on two patients with recurrent, paroxysmal, extracephalic pain triggered by yawning. Pain with yawning may occur in several conditions (secondary yawning pain) or develop in the absence of precipitating lesions (primary yawning pain). Primary yawning pain is normally of cephalic location. Methods used were clinical neurological examinations, magnetic resonance imaging of the

DE Jacome



Gabapentin in Pain Management  

Microsoft Academic Search

role of gabapentin in pain treatment will be discussed with an attempt to identify pain symptoms that are likely to be responsive to gabapentin; 2) animal stud- ies of gabapentin on neuropathic pain and other pain behaviors will be evaluated; and 3) possible mecha- nisms of gabapentin actions will be considered in re- lation to mechanisms of neuropathic pain in

Jianren Mao; Lucy L. Chen



[Is postoperative pain only a nociceptive pain?].  


More than 75% of patients undergoing surgery suffer from acute pain. Most of this pain transforms into chronic pain. Currently, treatment of postoperative pain is based mainly on opioids, but results are not quite satisfactory. Postoperative pain is defined as a condition of tissue injury together with muscle spasm after surgery. Recently, peripheral and central sensitization has been shown within the mechanisms of postoperative pain generation. Accordingly, anti-convulsive drugs have been used successfully for the treatment of postoperative pain. Therefore, the issue of whether postoperative pain is purely a nociceptive pain remains a topic of debate. Considering that every surgical intervention might result in a nerve injury, it is not surprising to find neuropathic pain features within the postoperative pain itself. In light of these findings, it would be more precise to define postoperative pain as a combination of inflammatory and neuropathic components instead of as pure pain. Thus, the appropriate postoperative treatment should be planned involving both of these components. PMID:20582745

Ceyhan, Dilek; Güleç, Mehmet Sacit



Pain Management Programs  


... in Cart : 0 Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs ...


American Chronic Pain Association  


... in Cart : 0 Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs ...


Back Pain Prevention  

MedlinePLUS Success Stories Spinal Conditions Treatments Back Pain Prevention Lifestyle Choices Exercise Back Pack Safety Pregnancy and Back Pain Preventing Osteoporosis Back Pain Basics Book Brochures Spine in the News Definitions ...


What Is Back Pain?  


... some types of treatments for chronic back pain. Hot or Cold Packs (or Both) Hot or cold packs can soothe sore, stiff backs. ... helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this ...


A total dietary program emphasizing magnesium instead of calcium. Effect on the mineral density of calcaneous bone in postmenopausal women on hormonal therapy.  


The use of calcium supplementation for the management of primary postmenopausal osteoporosis (PPMO) has increased significantly in the past few years. A review of the published data does not support calcium megadosing during postmenopause. Controlled studies showed no significant effect of calcium intake on mineral density of trabecular bone and a slight effect on cortical bone. Since PPMO is predominantly due to demineralization of trabecular bone, there is no justification for calcium megadosing in postmenopausal women. Soft tissue calcification is a serious risk factor during calcium megadosing under certain conditions. A total dietary program emphasizing magnesium instead of calcium for the management of PPMO takes into account the available data on the effects of magnesium, life-style and dietary habits on bone integrity and PPMO. When this dietary program was tested on 19 postmenopausal women on hormonal replacement therapy who were compared to 7 control postmenopausal women, a significant increase in mineral bone density of the calcaneous bone (BMD) was observed within one year. Fifteen of the 19 women had had BMD below the spine fracture threshold before treatment; within one year, only 7 of them still had BMD values below that threshold. PMID:2352244

Abraham, G E; Grewal, H



Venous leg ulcer pain.  


Venous disease and venous leg ulcers are frequently painful. The pain experienced may be constant or intermittent. Constant pain can originate from vascular structures (superficial, deep phlebitis), pitting edema, collagen (lipodermatosclerosis), infection, or scarring (atrophie blanche). Ulcer region pain is often episodic and may be due to surgical or other debridement procedures. Intermittent pain is often related to dressing removal or recent applications of new dressings. An approach to pain control will consider the cause of pain and utilize local measures, regional approaches to edema control, and systemic medication aimed at constant, episodic, or intermittent pain triggers. PMID:12856289

Ryan, Siobhan; Eager, Cathy; Sibbald, R Gary



[The physiology of pain].  


This article reviews the basic anatomy and physiology of the normal pain system. During recent years, our knowledge of the pain system has been expanded, with increasing insight into the peripheral and central mechanisms underlying both acute and chronic pain. Several differences in the pain system exist for superficial and deep pain. Descending control mechanisms seem to be important in controlling pain, and neuroplastic changes with central reorganisation are frequently seen in patients suffering from pain. This new knowledge will help in understanding and treating patients with chronic pain syndromes. PMID:16768887

Drewes, Asbjørn Mohr



Orofacial pain: a primer.  


Orofacial pain refers to pain associated with the soft and hard tissues of the head, face, and neck. It is a common experience in the population that has profound sociologic effects and impact on quality of life. New scientific evidence is constantly providing insight into the cause and pathophysiology of orofacial pain including temporomandibular disorders, cranial neuralgias, persistent idiopathic facial pains, headache, and dental pain. An evidence-based approach to the management of orofacial pain is imperative for the general clinician. This article reviews the basics of pain epidemiology and neurophysiology and sets the stage for in-depth discussions of various painful conditions of the head and neck. PMID:23809298

De Rossi, Scott S



Predicting pain and pain responses to opioids  

Microsoft Academic Search

The mechanisms behind the wide individual variability in pain experience and relief are an area of intense research activity. Predicting individual clinical pain and the responsiveness to analgesics should increase the efficacy and tolerability of analgesic treatments, and improve the overall treatment outcome. Several factors have shown validity in the prediction of pain, with most studies having been performed in

Clive H. Wilder-Smith



An Achilles' heel in an amyloidogenic protein and its repair: insulin fibrillation and therapeutic design.  


Insulin fibrillation provides a model for a broad class of amyloidogenic diseases. Conformational distortion of the native monomer leads to aggregation-coupled misfolding. Whereas beta-cells are protected from proteotoxicity by hexamer assembly, fibrillation limits the storage and use of insulin at elevated temperatures. Here, we have investigated conformational distortions of an engineered insulin monomer in relation to the structure of an insulin fibril. Anomalous (13)C NMR chemical shifts and rapid (15)N-detected (1)H-(2)H amide-proton exchange were observed in one of the three classical alpha-helices (residues A1-A8) of the hormone, suggesting a conformational equilibrium between locally folded and unfolded A-chain segments. Whereas hexamer assembly resolves these anomalies in accordance with its protective role, solid-state (13)C NMR studies suggest that the A-chain segment participates in a fibril-specific beta-sheet. Accordingly, we investigated whether helicogenic substitutions in the A1-A8 segment might delay fibrillation. Simultaneous substitution of three beta-branched residues (Ile(A2) --> Leu, Val(A3) --> Leu, and Thr(A8) --> His) yielded an analog with reduced thermodynamic stability but marked resistance to fibrillation. Whereas amide-proton exchange in the A1-A8 segment remained rapid, (13)Calpha chemical shifts exhibited a more helical pattern. This analog is essentially without activity, however, as Ile(A2) and Val(A3) define conserved receptor contacts. To obtain active analogs, substitutions were restricted to A8. These analogs exhibit high receptor-binding affinity; representative potency in a rodent model of diabetes mellitus was similar to wild-type insulin. Although (13)Calpha chemical shifts remain anomalous, significant protection from fibrillation is retained. Together, our studies define an "Achilles' heel" in a globular protein whose repair may enhance the stability of pharmaceutical formulations and broaden their therapeutic deployment in the developing world. PMID:20106984

Yang, Yanwu; Petkova, Aneta; Huang, Kun; Xu, Bin; Hua, Qing-Xin; Ye, I-Ju; Chu, Ying-Chi; Hu, Shi-Quan; Phillips, Nelson B; Whittaker, Jonathan; Ismail-Beigi, Faramarz; Mackin, Robert B; Katsoyannis, Panayotis G; Tycko, Robert; Weiss, Michael A



The human foot and heel-sole-toe walking strategy: a mechanism enabling an inverted pendular gait with low isometric muscle force?  


Mechanically, the most economical gait for slow bipedal locomotion requires walking as an 'inverted pendulum', with: I, an impulsive, energy-dissipating leg compression at the beginning of stance; II, a stiff-limbed vault; and III, an impulsive, powering push-off at the end of stance. The characteristic 'M'-shaped vertical ground reaction forces of walking in humans reflect this impulse-vault-impulse strategy. Humans achieve this gait by dissipating energy during the heel-to-sole transition in early stance, approximately stiff-limbed, flat-footed vaulting over midstance and ankle plantarflexion (powering the toes down) in late stance. Here, we show that the 'M'-shaped walking ground reaction force profile does not require the plantigrade human foot or heel-sole-toe stance; it is maintained in tip-toe and high-heel walking as well as in ostriches. However, the unusual, stiff, human foot structure--with ground-contacting heel behind ankle and toes in front--enables both mechanically economical inverted pendular walking and physiologically economical muscle loading, by producing extreme changes in mechanical advantage between muscles and ground reaction forces. With a human foot, and heel-sole-toe strategy during stance, the shin muscles that dissipate energy, or calf muscles that power the push-off, need not be loaded at all--largely avoiding the 'cost of muscle force'--during the passive vaulting phase. PMID:22572024

Usherwood, J R; Channon, A J; Myatt, J P; Rankin, J W; Hubel, T Y



The human foot and heel-sole-toe walking strategy: a mechanism enabling an inverted pendular gait with low isometric muscle force?  

PubMed Central

Mechanically, the most economical gait for slow bipedal locomotion requires walking as an ‘inverted pendulum’, with: I, an impulsive, energy-dissipating leg compression at the beginning of stance; II, a stiff-limbed vault; and III, an impulsive, powering push-off at the end of stance. The characteristic ‘M’-shaped vertical ground reaction forces of walking in humans reflect this impulse–vault–impulse strategy. Humans achieve this gait by dissipating energy during the heel-to-sole transition in early stance, approximately stiff-limbed, flat-footed vaulting over midstance and ankle plantarflexion (powering the toes down) in late stance. Here, we show that the ‘M’-shaped walking ground reaction force profile does not require the plantigrade human foot or heel–sole–toe stance; it is maintained in tip–toe and high-heel walking as well as in ostriches. However, the unusual, stiff, human foot structure—with ground-contacting heel behind ankle and toes in front—enables both mechanically economical inverted pendular walking and physiologically economical muscle loading, by producing extreme changes in mechanical advantage between muscles and ground reaction forces. With a human foot, and heel–sole–toe strategy during stance, the shin muscles that dissipate energy, or calf muscles that power the push-off, need not be loaded at all—largely avoiding the ‘cost of muscle force’—during the passive vaulting phase.

Usherwood, J. R.; Channon, A. J.; Myatt, J. P.; Rankin, J. W.; Hubel, T. Y.



Taking narcotics for back pain  


... Narcotics can provide short-term relief of severe back pain. This can allow you to return to your ... Nonspecific back pain - narcotics; Backache - chronic - narcotics; Lumbar pain - chronic - narcotics; Pain - back - chronic - narcotics; Chronic back pain - low - narcotics


Phantom Limb Pain  

Microsoft Academic Search

This study presents a review of the literature on the attributes and potential mechanisms involved in phantom limb pain, encompassing studies describing pain in the residual limb, phantom sensation and phantom limb pain, and the difficulties that may arise when making these distinctions. A variety of theories have been proposed to explain causal mechanisms for phantom limb pain. Conceptually, research

Anne Hill



Psychological aspects of pain  

Microsoft Academic Search

Manual therapy is based on a biomedical model of illness and places considerable reliance on the patient's report of pain. Reported pain intensity is assumed to bear a close relationship with underlying nociception but research has shown that the experience of pain is also influenced by a wide range of psychological factors. Firstly, response to pain provocation (whether palpation or

C. J. Main; P. J. Watson



Acute pain services  

Microsoft Academic Search

An interdisciplinary acute pain service (APS) team seems the most attractive clinical organization model for postoperative pain management (POPM) to fulfil the intentions of pain management guidelines in practice. The specific knowledge of anaesthesiologists in the use of drugs and techniques for pain alleviation is of specific importance. Therefore, the anaesthetist is usually the team leader and works together with

M Warrén Stomberg; H Haljamäe



Mechanisms of neuropathic pain  

Microsoft Academic Search

Neuropathic pain is defined as 'pain initiated or caused by a primary lesion or dysfunction in the nervous system'.94 The spectrum of neuropathic pain covers a variety of disease states (Table 1) and presents in the clinic with a variety of symptoms.145 Neuropathic pain is often reported as having a lancinating or continuous burning character and is often associated with

D. Bridges; S. W. N. Thompson; A. S. C. Rice



Treating chronic pain.  


Quantifiable and measurable methods accurately assess pain severity and successfully guide physicians in determining which medications and modalities are appropriate and necessary for the treatment of chronic pain. A variety of pain assessment scales and the World Health Organization's three-step analgesic ladder can be the starting point for successful pain management. PMID:9092278

Montauk, S L; Martin, J



Pathobiology of neuropathic pain  

Microsoft Academic Search

This review deals with physiological and biological mechanisms of neuropathic pain, that is, pain induced by injury or disease of the nervous system. Animal models of neuropathic pain mostly use injury to a peripheral nerve, therefore, our focus is on results from nerve injury models. To make sure that the nerve injury models are related to pain, the behavior was

Manfred Zimmermann



Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound  

Microsoft Academic Search

Summary  The relationship between osteoporosis risk factors, bone quantitative ultrasound (QUS) and non-spinal fracture risk was estimated\\u000a in a cohort of 5,201 postmenopausal women from Spain who were prospectively evaluated during three years. Several clinical\\u000a risk factors and low heel QUS values were independently associated with non-spinal fracture risk.\\u000a \\u000a \\u000a \\u000a Introduction  Low-trauma, non-spinal fractures are a growing source of morbidity and mortality in

A. Díez-Pérez; J. González-Macías; F. Marín; M. Abizanda; R. Alvarez; A. Gimeno; E. Pegenaute; J. Vila



Pathophysiology of Neuropathic Pain  

Microsoft Academic Search

Cerebral responses to pain are complex and dynamic in nature and in the case of chronic pain, especially neuropathic pain,\\u000a changes involved are more profound and they are characterized by the involvement of entire pain-related peripheral and central\\u000a nervous system. Functional magnetic resonance imaging studies identified a number of cerebral, cortical, and subcortical structures\\u000a that are activated during pain stimuli.

Misha-Miroslav Backonja


Breakthrough pain: characteristics and impact in patients with cancer pain  

Microsoft Academic Search

Few surveys have been performed to define the characteristics and impact of breakthrough pain in the cancer population. In this cross-sectional survey of inpatients with cancer, patients responded to a structured interview (the Breakthrough Pain Questionnaire) designed to characterize breakthrough pain, and also completed measures of pain and mood (Memorial Pain Assessment Card (MPAC)), pain-related interference in function (Brief Pain

Russell K Portenoy; David Payne; Paul Jacobsen




SciTech Connect

During sluicing operations of tank 241-C-110, a significant amount of solids were unable to be retrieved. These solids (often referred to as the tank 'heel') were sampled in 2010 and chemically and mineralogically analyzed in the 222-S Laboratory. Additionally, dissolution tests were performed to identify the amount of undissolvable material after using multiple water contacts. This report covers the solid phase characterization of six samples from these tests using scanning electron microscopy, polarized light microscopy, and X-ray diffraction. The chemical analyses, particle size distribution analysis, and dissolution test results are reported separately. Two of the samples were from composites created from as-received material - Composite A and Composite B. The main phase in these samples was sodium-fluoride-phosphate hydrate (natrophosphate) - in the X-ray diffraction spectra, this phase was the only phase identifiable. Polarized light microscopy showed the presence of minor amounts of gibbsite and other phases. These phases were identified by scanning electron microscopy - energy dispersive X-ray spectroscopy as sodium aluminosilicates, sodium diuranate, and sodium strontium phosphate hydrate (nastrophite) crystals. The natrophosphate crystals in the scanning electron microscopy analysis showed a variety of erosive and dissolution features from perfectly shaped octahedral to well-rounded appearance. Two samples were from water-washed Composites A and B, with no change in mineralogy compared to the as-received samples. This is not surprising, since the water wash had only a short period of water contact with the material as opposed to the water dissolution tests. The last two samples were residual solids from the water dissolution tests. These tests included multiple additions of water at 15 C and 45 C. The samples were sieved to separate a coarser fraction of > 710 {mu}m and a finer fraction of < 710 {mu}m. These two fractions were analyzed separately. The coarser fraction contained mostly gibbsite with minor amounts of sodium aluminosilicates (cancrinite) and bismuth aluminum-rich phases. The finer fraction was mostly composed of gibbsite, the sodium alumino silicate phase, cancrinite, and a poorly crystalline to non-crystalline phase containing varying amounts of iron, bismuth, aluminum, and phosphorus.




Gait improvement of hemiplegic patients using an ankle-foot orthosis with assistance of heel rocker function.  


The ankle-foot orthosis (AFO) with oil damper, GaitSolution (GS), was previously developed to make heel rocker function possible during the gait of hemiplegic patients. To clarify the characteristics of patients who show adaptation to GS use, a questionnaire was completed by the clinicians responsible for 99 patients with hemiplegia who participated in this study. Clinicians completed items concerning gait data of patients without AFO use and with GS use, adaptation to the use of GS, and patient opinion of GS use. Approximately 60% of patients achieved heel rocker function during the loading response of the paretic limb and improved gait when using GS. A comparison of the patients whose gaits were improved by GS more than by other AFOs revealed the use of GS was well suited to the gait of patients with a relatively higher Brunnstrom stage and a slightly flexed knee joint during the stance phase. Approximately 60% of patients reported feeling comfortable using GS, although patient comfort did not necessarily coincide with the results of gait assessment by clinicians. Patient comfort mainly depended on trunk posture and hip joint outward rotation; hip joint outward rotation could be improved using GS in the recovery phase but not in the maintenance phase. This result implies the importance of gait training in the early stage of rehabilitation. PMID:19961292

Yamamoto, Sumiko; Hagiwara, Akiyoshi; Mizobe, Tomofumi; Yokoyama, Osamu; Yasui, Tadashi



Neuropathic pain in children.  


The International Association for the Study of Pain (IASP) defines neuropathic pain as being caused by a lesion or dysfunction of the nervous system. Characteristics that would define neuropathic pain and differentiate it from other types of pain include: pain and sensory symptoms that persist beyond the healing period; presence, in variable degree, of neurological sensory signs manifesting as negative and positive sensory phenomena; presence, in variable degree, of other neurological signs, including motor, manifesting as negative and positive motor phenomena or autonomic signs. Many of the conditions causing neuropathic pain in adults are rare in children, but some forms of neuropathic pain do affect children and adolescents as complex regional pain syndrome or phantom limb pain. Treatment strategies that have demonstrated to be efficacious in adults have been extrapolated to be used in children, including medications, nerve blocks, physical therapy, and behavioral medicine. A multidisciplinary program that combines all of these approaches provides the best chance of relief. PMID:15181421

Ingelmo, P M; Fumagalli, R



[Chronic pain management].  


Pain is one of the major complaints leading to doctor visits. Therefore basic knowledge of frequent pain diagnoses and possible treatment approaches is essential. Numerous medical and interventional therapeutic options are available for causal or symptomatic treatment of pain. The treatment of neuropathic pain is often difficult and demands special knowledge. Antidepressants like amitriptyline and anticonvulsive drugs are the first choice in these cases. Also interventional approaches are useful, such as spinal cord stimulation for angina pectoris. For the treatment of complex regional pain syndrome and phantom pain the use of mirror feed-back is a new effective method for pain relief. The only way to prevent from development of chronic pain is the early and effective treatment of acute pain. PMID:19688304

Rothstein, D; Zenz, M



Life-course predictors of ultrasonic heel measurement in a cross-sectional study of immigrant women from Southeast Asia.  


Few studies address chronic disease risk for Southeast Asians in the United States. In 1999, the authors conducted a cross-sectional study of bone mineral density (BMD) estimated from ultrasonic calcaneal measurements in women born in Southeast Asia who then lived in Chicago, Illinois. The study addressed three questions: Do Southeast-Asian women have relatively low BMD? What factors before and after immigration are associated with BMD? Are factors that reflect the childhood/adolescent environment equally associated with BMD for postmenopausal and premenopausal women? An interviewer-administered bilingual questionnaire collected immigration, reproductive, and lifestyle data from 213 women (aged 20--80 years) born in Vietnam, Cambodia, or Laos. The authors found that the estimated mean BMD of postmenopausal Southeast-Asian women was lower than the reference values for White women. Four summary indicators of childhood/adolescent environment were predictive of higher BMD: more years of education, earlier age at menarche, lower height, and coastal birth; these indicators were more strongly associated with BMD for premenopausal (multiple-partial R(2) = 0.21) than postmenopausal (R(2) = 0.06) women. Young-adult exposures (e.g., early first pregnancy and age at immigration) and proximal lifestyle factors (e.g., smoking, physical inactivity, vegetarian diet, and betel nut use) were also assessed as potential predictors of BMD. PMID:11257066

Lauderdale, D S; Salant, T; Han, K L; Tran, P L



Pediatric pain management.  


It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

Lederhaas, G



Central modulation of pain.  


It has long been appreciated that the experience of pain is highly variable between individuals. Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage (i.e., nociceptors). However, a direct correlation between activation of nociceptors and the sensory experience of pain is not always apparent. Even in cases in which the severity of injury appears similar, individual pain experiences may vary dramatically. Emotional state, degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience. Here, we review evidence for "top-down" modulatory circuits that profoundly change the sensory experience of pain. PMID:21041960

Ossipov, Michael H; Dussor, Gregory O; Porreca, Frank



Enhanced kangaroo mother care for heel lance in preterm neonates: a crossover trial  

Microsoft Academic Search

Objective:To test if enhancing maternal skin-to-skin contact, or kangaroo mother care (KMC) by adding rocking, singing and sucking is more efficacious than simple KMC for procedural pain in preterm neonates.Study Design:Preterm neonates (n=90) between 32 0\\/7 and 36 0\\/7 weeks' gestational age participated in a single-blind randomized crossover design. The infant was held in KMC with the addition of rocking,

C C Johnston; F Filion; M Campbell-Yeo; C Goulet; L Bell; K McNaughton; J Byron



Sensory Pain Qualities in Neuropathic Pain  

PubMed Central

The qualities of chronic neuropathic pain (NeP) may be informative about the different mechanisms of pain. We previously developed a 2-factor model of NeP that described an underlying structure among sensory descriptors on the Short-Form McGill Pain Questionnaire (SF-MPQ). The goal of this study was to confirm the correlated 2-factor model of NeP. Individual descriptive scores from the SF-MPQ were analyzed. Confirmatory factor analysis (CFA) was used to test a correlated 2-factor model. Factor 1 (stabbing pain) was characterized by high loadings on stabbing, sharp, and shooting sensory items; factor 2 (heavy pain) was characterized by high loadings on heavy, gnawing, and aching items. Results of the CFA strongly supported the correlated 2-factor model.

Mackey, Sean; Carroll, Ian; Emir, Birol; Murphy, T. Kevin; Whalen, Ed; Dumenci, Levent



Bone pain or tenderness  


... cause of the pain, your doctor may prescribe: Antibiotics Anti-inflammatory medicines Hormones Laxatives (if you develop constipation during prolonged bed rest) Pain relievers For osteoporosis treatment, see the article on osteoporosis .


Low back pain - chronic  


... CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev . 2010;(7). Clarke JA, van ... for low-back pain with or without sciatica. Cochrane Database Syst Rev . 2010;(5):CD003010. Smeets RJ, ...


Pain in Blood Cancers  

PubMed Central

Patients with blood-related cancers (BRC) suffer from a substantial symptom burden, including several pain syndromes sustained by different causes and pathogenetic mechanisms. So, with regard to pain, a multifaceted clinical scenario may be observed in this setting. Indeed, pain may be correlated to disease itself, to disease-associated complications, to iatrogenic causes or may be due to unrelated clinical conditions. A close diagnostic procedure for the assessment of the underlying causes of the pain and of its pathogenetic mechanisms may direct the treatment approach which should be based on a multidisciplinary management and requires the integration of etiology-targeted interventions and painkilling drugs. The World Health Organization's three-step analgesic ladder for cancer pain relief can provide adequate pain control using oral drugs in most patients with BRC on pain, although more complex interventions may be necessary for many difficult-to-treat pain syndromes which are not infrequently encountered in this setting.

Niscola, Pasquale; Tendas, Andrea; Scaramucci, Laura; Giovannini, Marco; De Sanctis, Vitaliana



Sleep and Pain  

Microsoft Academic Search

The high prevalence of sleep disturbance in chronic pain conditions is due in part to bi-directional influences in which pain\\u000a disturbs sleep and poor sleep reduces pain thresholds and aggravates pain. Other variables, especially depression and anxiety,\\u000a may mediate this relationship, although supporting data has been equivocal. Trauma exposure and resulting PTSD symptoms have\\u000a not been adequately evaluated in the

Wilfred R. Pigeon; Hyung Park; Michael J. Sateia


Chronic Pain Explained  

Microsoft Academic Search

Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronic pains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronic pain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP)




Cancer pain and anxiety  

Microsoft Academic Search

Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and\\u000a behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than\\u000a cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree\\u000a of anxiety is a normal response to

Paul D. Thielking



Neuropathic low back pain  

Microsoft Academic Search

In this discussion, we hope to advance a clinical approach to low back pain that is more in line with our modern understanding\\u000a of neuropathic pain. We review the current understanding of normal and pathologic neuroanatomy of the lumbar spine and then\\u000a outline how pathology in the different structures can lead to neuropathic pain and cause common pain patterns seen

Joseph F. Audette; Emmanuel Emenike; Alec L. Meleger



Quantitative ultrasound of the heel and serum and urinary cortisol values in assesment of long-term corticotherapy side effects in female bronchial asthma patients  

Microsoft Academic Search

Female asthma patients (26) with and without corticotherapy were studied. The control group included 19 healthy women. Skeletal status was assessed by ultrasound measurement of the heel (Achilles, Lunar, Madison, WI, USA) and serum and urinary corisol expressed adrenal function. Ultrasound and hormonal values were significantly lower in patients treated with glucocorticosteroids (GC) than in controls. In patients without GC,

Beata Kos-Kud?a; Wojciech Pluskiewicz



Sleep and chronic pain  

Microsoft Academic Search

Objective: The ?-EEG sleep anomaly has been associated with chronic benign pain syndromes. Although controversial, the anomaly is believed by some to be an important biologic correlate of certain otherwise poorly explained painful conditions (e.g., fibromyalgia and chronic fatigue syndrome). To shed further light on this phenomenon, this study compared the sleep and psychological characteristics of chronic pain patients who

Jeanetta C Rains; Donald B Penzien



Pain and Symptom Management  

Microsoft Academic Search

During the last decade, the prevalence of cancer pain and the reality of undertreatment have been well documented in both adults and children. There has been a proliferation of educational and regulatory activity setting an expectation that management of pain is a priority. At the same time, pain has come to the attention of the media, advocacy groups, industry, legislators,

Terry Altilio



Pediatric Procedural Pain  

Microsoft Academic Search

This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs are discussed and recommendations are provided. Pharmacological, other medical approaches, and empirically

Ronald L. Blount; Tiina Piira; Lindsey L. Cohen; Patricia S. Cheng



Pediatric Procedural Pain  

ERIC Educational Resources Information Center

This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs…

Blount, Ronald L.; Piira, Tiina; Cohen, Lindsey L.; Cheng, Patricia S.



Breakthrough Cancer Pain  

Microsoft Academic Search

Breakthrough pain (BTP), a transitory exacerbation of pain superimposed on a background of persistent, usually adequately controlled pain, has been reported to occur in 50% to 75% of cancer patients. However, a 23% prevalence of BTP was recently reported in a study of Spanish patients with advanced cancers, showing probably a low detection rate of this clinical problem. The purpose

Xavier Gómez-Batiste; Federico Madrid; Francisco Moreno; Albert Gracia; Jordi Trelis; Maria Nabal; Ramón Alcalde; Josep Planas; Helena Camell



Can we conquer pain?  

Microsoft Academic Search

Pain can be an adaptive sensation, an early warning to protect the body from tissue injury. By the introduction of hypersensitivity to normally innocuous stimuli, pain may also aid in repair after tissue damage. Pain can also be maladaptive, reflecting pathological function of the nervous system. Multiple molecular and cellular mechanisms operate alone and in combination within the peripheral and

Joachim Scholz; Clifford J. Woolf



Tridimensional fuzzy pain assessment  

Microsoft Academic Search

A tridimensional fuzzy pain assessment for repre- senting professional, social, and sexual aspects concerned to the fifth vital sign of medical condition is proposed in this paper. According to the 3D fuzzy pain assessment herein, pain is not only caused by activity in nociceptive information in the brain. The proposed approach embodies such sensorial information simultaneously that contextualize it within

Ernesto Araujo; Susana A. Miyahira



Forebrain Pain Mechanisms  

PubMed Central

Emotional-affective and cognitive dimensions of pain are less well understood than nociceptive and nocifensive components, but the forebrain is believed to play an important role. Recent evidence suggests subcortical and cortical brain areas outside the traditional pain processing network contribute critically to emotional-affective responses and cognitive deficits related to pain. These brain areas include different nuclei of the amygdala and certain prefrontal cortical areas. Their roles in various aspects of pain will be discussed. Biomarkers of cortical dysfunction are being identified that may evolve into therapeutic targets to modulate pain experience and improve pain-related cognitive impairment. Supporting data from preclinical studies in neuropathic pain models will be presented. Neuroimaging analysis provides evidence for plastic changes in the pain processing brain network. Results of clinical studies in neuropathic pain patients suggest that neuroimaging may help determine mechanisms of altered brain functions in pain as well as monitor the effects of pharmacologic interventions to optimize treatment in individual patients. Recent progress in the analysis of higher brain functions emphasizes the concept of pain as a multidimensional experience and the need for integrative approaches to determine the full spectrum of harmful or protective neurobiological changes in pain.

Neugebauer, Volker; Galhardo, Vasco; Maione, Sabatino; Mackey, Sean C.



Cannabinoids in cancer pain  

Microsoft Academic Search

This article of the month presents results of a clinical study conducted in the UK and Romania, which evaluated the efficacy of a THC:CBD cannabis extract (Sativex®) and a THC cannabis ex- tract in the treatment of 177 patients with cancer pain, who experienced inadequate pain reduction despite intake of opioids (Johnson et al. J Pain Symptom Manage, 2010, in

Franjo Grotenhermen



Pediatric Procedural Pain  

ERIC Educational Resources Information Center

|This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related…

Blount, Ronald L.; Piira, Tiina; Cohen, Lindsey L.; Cheng, Patricia S.



The pain inhibiting pain effect: an electrophysiological study in humans  

Microsoft Academic Search

This study examines the counterirritation phenomenon of experimental pain in human subjects. Phasic pain induced by intracutaneous electrical stimuli was simultaneously applied with tonic pain induced by ischemic muscle work. Pain ratings, spontaneous EEG and evoked potentials were measured. We found a significant reduction of phasic pain ratings during and 10 min after tonic pain. The late somatosensory evoked potentials

Andreas Reinert; Rolf-Detlef Treede; Burkhart Bromm



Pain Characteristic Differences Between Subacute and Chronic Back Pain  

Microsoft Academic Search

Back pain is commonly classified based on duration. There is currently limited information regarding differences in the clinical features of back pain between these duration-based groupings. Here, we compared the pain characteristics of patients with subacute (SBP; pain 6–16 weeks, n = 40) and chronic back pain (CBP; pain ?1 year, n = 37) recruited from the general population. CBP

Mona Lisa Chanda; Matthew D. Alvin; Thomas J. Schnitzer; A. Vania Apkarian



Integrating the Concept of Pain Interference into Pain Management  

Microsoft Academic Search

Undertreatment of pain is a significant problem. Nursing pain assessments have been identified as an area for improvement. This concept analysis sought to examine the use of pain interference as a measurement to assist pain management practices. Existing literature including the term pain interference was reviewed for the years 2000-2010. Pain interference is a common outcome measurement in clinical research.

Marian Wilson


Myofascial pain in patients with postthoracotomy pain syndrome  

Microsoft Academic Search

Objective: Postthoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. However, nonneuropathic pain can also occur following thoracic surgery. We present a series of cases with postthoracotomy pain syndrome in which myofascial pain was thought to be a causative component of postthoracotomy pain syndrome.Case Report: Twenty-seven patients (17 men and 10 women) were treated

H. Moriwaki K Hamada; Katsuyuki Moriwaki; Kazuhisa Shiroyama; Hiroyuki Tanaka; Masashi Kawamoto; Osafumi Yuge



Automated method to distinguish toe walking strides from normal strides in the gait of idiopathic toe walking children from heel accelerometry data.  


Toe walking mainly occurs in children due to medical condition or physical injury. When there are no obvious signs of any medical condition or physical injury, a diagnosis of Idiopathic Toe Walking (ITW) is made. ITW children habitually walk on their toes, however can modify their gait and walk with a heel-toe gait if they want to. Correct gait assessment in ITW children therefore becomes difficult. To solve this problem, we have developed an automated way to assess the gait in ITW children using a dual axis accelerometer. Heel acceleration data was recorded from the gait of ITW children using boots embedded with the sensor in the heel and interfaced to a handheld oscilloscope. An innovative signal processing algorithm was developed in IgorPro to distinguish toe walking stride from normal stride using the acceleration data. The algorithm had an accuracy of 98.5%. Based on the statistical analysis of the heel accelerometer data, it can be concluded that the foot angle during mid stance in ITW children tested, varied from 36° to 11.5° while as in normal children the foot stance angle is approximately zero. This algorithm was later implemented in a system (embedded in the heel) which was used remotely to differentiate toe walking stride from normal stride. Although the algorithm classifies toe walking stride from normal stride in ITW children, it can be generalized for other applications such as toe walking in Cerebral Palsy or Acquired Brain Injury subjects. The system can also be used to assess the gait for other applications such as Parkinson's disease by modifying the algorithm. PMID:22300731

Pendharkar, Gita; Percival, Paul; Morgan, David; Lai, Daniel



Posterior knee pain  

PubMed Central

Posterior knee pain is a common patient complaint. There are broad differential diagnoses of posterior knee pain ranging from common causes such as injury to the musculotendinous structures to less common causes such as osteochondroma. A precise understanding of knee anatomy, the physical examination, and of the differential diagnosis is needed to accurately evaluate and treat posterior knee pain. This article provides a review of the anatomy and important aspects of the history and physical examination when evaluating posterior knee pain. It concludes by discussing the causes and management of posterior knee pain.

Perret, D.



Myofascial low back pain.  


Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain. PMID:22945480

Ramsook, Ryan R; Malanga, Gerard A



Intraoral pain disorders.  


Dental and oral diseases are common findings in the general population. Pain associated with dental or periodontal disease is the primary reason why most patients seek treatment from providers. Thus, it is essential that all complaints of pain in the mouth and face include ruling out pain of dental origin. However, intraoral pain is not exclusively a result of dental disorders. This review outlines common somatic intraoral pain disorders, which can originate from disease involving one or more broad anatomic areas: the teeth, the surrounding soft tissues (mucogingival, tongue, and salivary glands), and bone. PMID:23809302

Napeñas, Joel J



Dancing in pain: pain appraisal and coping in dancers.  


This study investigated the relationships between the type of pain experienced (performance pain and injury pain), the cognitive appraisal of pain and pain coping styles in dancers. Fifty-one professional ballet and contemporary dancers (17 males and 34 females), with the mean age of 25.9 years, completed a general pain questionnaire, the Pain Appraisal Inventory, the Survey of Pain Attitudes Control Subscale, and the Sports Inventory for Pain. Multivariate analyses of variance indicated that both the cognitive appraisal of the pain and pain coping styles did not differ according to the type of pain experienced or the pain severity. However, it was found that dancers with performance pain of either low or high severity were more likely to dance in pain than dancers experiencing injury pain. Multiple regression analyses indicated that the appraisal of pain as threatening was predictive of the use of avoidance and catastrophizing pain coping styles. Overall, results indicated that dancers may not differentiate between performance pain and injury pain, or modify their appraisal and coping strategies according to the characteristics of the pain experienced. The study highlighted an opportunity for increased education for dancers in recognizing the difference between pain considered to be a routine aspect of training and pain which is a signal of serious injury. PMID:19618573

Anderson, Ruth; Hanrahan, Stephanie J



Assessment and expression of pain.  


This article, the second in a series of articles on pain, describes the importance of pain assessment. It explores the individuality of patients' pain expression and the effect of healthcare professionals' reactions to people experiencing pain. The role of the nurse is analysed, focusing on multidimensional pain assessment and the use of pain assessment scales. PMID:20949822

Briggs, Emma


[Pathophysiology of abdominal pain].  


Abdominal pain can be induced by stimulation of visceral nociceptors. Activation of nociceptors usually requires previous sensitization by pathological events, such as inflammation, ischemia or acidosis. Although abdominal pain can obviously be caused by pathology of a visceral structure, clinicians frequently observe that such a pathology explains only part of the pain complaints. Occasionally, there is lack of objective signs of visceral lesions. There is clear evidence that pain states are associated with profound changes of the central processing of the sensory input. The main consequences of such alterations for patients are twofold: 1) a central sensitization, i.e. an increased excitability of the central nervous system; 2) an alteration of the endogenous pain modulation, which under normal conditions inhibits the processing of nociceptive signals in the central nervous system. Both phenomena lead to a spread of pain to other body regions and an amplification of the pain perception. The interactions between visceral pathology and alterations of the central pain processes represent an at least partial explanation for the discrepancy between objective signs of peripheral lesions and severity of the symptoms. Today, both central hypersensitivity and alteration in endogenous pain modulation can be measured in clinical practice. This information can be used to provide the patients with an explanatory model for their pain. Furthermore, first data suggest that alterations in central pain processing may represent negative prognostic factors. A better understanding of the individual pathophysiology may allow in the future the development of individual therapeutic strategies. PMID:21796591

Curatolo, Michele



Low-pressure, single-point grout injection for tank heel sludge mixing and in-situ immobilization  

SciTech Connect

This report describes tests conducted in an approximately 9-ft diameter test tank situated outside the 336 building in Hanford`s 300 area. The tests were performed to measure the ability of jets of grout slurry to mobilize and mix simulated tank sludge. The technique is intended for in situ immobilization of tank waste heels. The current approach uses a single, rotated, larger-diameter nozzle driven at lower pressure. Due to the larger diameter, the potential for plugging is reduced and the effective radius around an injection point over which the jet is effective in mobilizing sludge from the tank bottom can be made larger. A total of three grout injection tests were conducted in a 9-ft diameter tank. In each case, a 2-in. layer of kaolin clay paste was placed on a dry tank floor to simulate a sludge heel. The clay was covered with 4 inches of water. The grout slurry, consisting of Portland cement, class F fly ash, and eater, was prepared and delivered by an offsite vendor. In the third test, the sludge in half of the tank was replaced by a layer of 20x50 mesh zeolite, and bentonite clay was added to the grout formulation. After injection, the grout was allowed to set and then the entire grout monolith was manually broken up and excavated using a jack hammer. Intact pieces of clay were visually apparent due to a sharp color contrast between the grout and clay. Remaining clay deposits were collected and weighed and suspended clay pieces within the monolith were photographed. The mobilization performance of the grout jets exceeded expectations.

Whyatt, G.A.; Hymas, C.R.



Avicenna's concept of pain  

PubMed Central

Ibn Sina (Latin name – Avicenna, 980–1037) is a famous Muslim physician who wrote The Canon of Medicine. Pain-related writings within The Canon were identified and analysed and compared to Galen and Modern Pain Theory. We found evidence in The Canon that Avicenna challenged Galen's concept of pain. Galen insisted that injuries (breach of continuity) were the only cause of pain. In contrast, Avicenna suggested that the true cause of pain was a change of the physical condition (temperament change) of the organ whether there was an injury present or not. Avicenna extended Galen's descriptions of 4 to 15 types of pain and used a terminology that is remarkably similar to that used in the McGill Pain Questionnaire.

Tashani, Osama A.; Johnson, Mark I.



Inflammatory Back Pain vs. Mechanical Back Pain  

MedlinePLUS Videos and Cool Tools

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5. Cervical facet pain.  


More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet-related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. The history should exclude risk factors for serious underlying pathology (red flags). Radiculopathy may be excluded with neurologic testing. Direct correlation between degenerative changes observed with plain radiography, computerized tomography, and magnetic resonance imaging and pain has not been proven. Conservative treatment options for cervical facet pain such as physiotherapy, manipulation, and mobilization, although supported by little evidence, are frequently applied before considering interventional treatments. Interventional pain management techniques, including intra-articular steroid injections, medial branch blocks, and radiofrequency treatment, may be considered (0). At present, there is no evidence to support cervical intra-articular corticosteroid injection. When applied, this should be done in the context of a study. Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short-term pain relief (2 B+). Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+). PMID:20415728

van Eerd, Maarten; Patijn, Jacob; Lataster, Arno; Rosenquist, Richard W; van Kleef, Maarten; Mekhail, Nagy; Van Zundert, Jan


Neurological diseases and pain.  


Chronic pain is a frequent component of many neurological disorders, affecting 20-40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain. PMID:22067541

Borsook, David



Pain after earthquake  

PubMed Central

Introduction On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region. Objectives This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009). Methods 958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy. Results A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%). Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions. Conclusions This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations.



Neurological diseases and pain  

PubMed Central

Chronic pain is a frequent component of many neurological disorders, affecting 20–40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain.



Basic science of pain.  


The origin of the theory that the transmission of pain is through a single channel from the skin to the brain can be traced to the philosopher and scientist René Descartes. This simplified scheme of the reflex was the beginning of the development of the modern doctrine of reflexes. Unfortunately, Descartes' reflex theory directed both the study and treatment of pain for more than 330 years. It is still described in physiology and neuroscience textbooks as fact rather than theory. The gate control theory proposed by Melzack and Wall in 1965 rejuvenated the field of pain study and led to further investigation into the phenomena of spinal sensitization and central nervous system plasticity, which are the potential pathophysiologic correlates of chronic pain. The processing of pain takes place in an integrated matrix throughout the neuroaxis and occurs on at least three levels-at peripheral, spinal, and supraspinal sites. Basic strategies of pain control monopolize on this concept of integration by attenuation or blockade of pain through intervention at the periphery, by activation of inhibitory processes that gate pain at the spinal cord and brain, and by interference with the perception of pain. This article discusses each level of pain modulation and reviews the mechanisms of action of opioids and potential new analgesics. A brief description of animal models frames a discussion about recent advances regarding the role of glial cells and central nervous system neuroimmune activation and innate immunity in the etiology of chronic pain states. Future investigation into the discovery and development of novel, nonopioid drug therapy may provide needed options for the millions of patients who suffer from chronic pain syndromes, including syndromes in which the pain originates from peripheral nerve, nerve root, spinal cord, bone, muscle, and disc. PMID:16595445

DeLeo, Joyce A



Pain perception in competitive swimmers.  

PubMed Central

The pain perception of 30 competitive swimmers was studied using experimentally induced ischaemic pain. The pain thresholds and tolerances of this group were compared with those of 30 club swimmers and 26 non-competitive athletes. While pain thresholds showed little difference between the groups, pain tolerances were considerably different. Pain tolerances of the competitive swimmers varied according to the stage of the training season. The relation between ischaemic pain and that experienced during swimming training was studied using a pain questionnaire composed of several systematically structured verbal categories. Both types of pain were classified along similar dimensions, and it was concluded that the experimentally demonstrated pain tolerances could be generalized to the normal pain perception of the subjects. The origins of the enhanced pain tolerances of the competitive swimmers would seem to lie in their systematic exposure to brief periods of intense pain. These data could have relevance for the treatment of chronic pain in certain diseases.

Scott, V; Gijsbers, K



Pain and functional imaging.  


Functional neuroimaging has fundamentally changed our knowledge about the cerebral representation of pain. For the first time it has been possible to delineate the functional anatomy of different aspects of pain in the medial and lateral pain systems in the brain. The rapid developments in imaging methods over the past years have led to a consensus in the description of the central pain responses between different studies and also to a definition of a central pain matrix with specialized subfunctions in man. In the near future we will see studies where a systems perspective allows for a better understanding of the regulatory mechanisms in the higher-order frontal and parietal cortices. Also, pending the development of experimental paradigms, the functional anatomy of the emotional aspects of pain will become better known. PMID:10466155

Ingvar, M



Esophageal pain: Emerging concepts  

Microsoft Academic Search

Esophageal pain manifests as symptoms of heartburn, chest pain, or both. It shares features with other types of visceral pain\\u000a in that it is poorly characterized and not well localized, owing to the divergence of visceral afferents. The esophagus is\\u000a innervated by vagal and visceral spinal afferents, both of which are activated by noxious stimuli and convey information to\\u000a specific

Robert Lee; Ravinder K. Mittal



Managing Breakthrough Pain  

Microsoft Academic Search

Breakthrough cancer pain (BTcP) has been defined as a transitory increase in pain intensity on a baseline pain of moderate\\u000a intensity in patients on regularly administered analgesic treatment. This review provides updated information about the classification,\\u000a assessment, and treatment of BTcP, with special emphasis on the use of opioids. Due to its slow onset to effect, oral opioids\\u000a cannot be

Sebastiano Mercadante


Pediatric Pain Management  

Microsoft Academic Search

\\u000a Over the years, significant advances have been made in the understanding and practice of pediatric pain management. Previous\\u000a myths such as the inability of infants to experience pain or the inessential need to treat perioperative nociception or postoperative\\u000a pain have been debunked by the evidence of mature nociceptive pathways by 30 weeks of gestation (Lowery et al. 2007) and the

Arlyne K. Thung; Rae Ann Kingsley; Brenda C. McClain


Painful Peripheral Neuropathies  

PubMed Central

Peripheral neuropathies are a heterogeneous group of diseases affecting peripheral nerves. The causes are multiple: hereditary, metabolic, infectious, inflammatory, toxic, traumatic. The temporal profile includes acute, subacute and chronic conditions. The majority of peripheral neuropathies cause mainly muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. When pain is present, however, it is usually extremely intense and among the most disabling symptoms for the patients. In addition, the neurological origin of the pain is often missed and patients receive inadequate or delayed specific treatment. Independently of the disease causing the peripheral nerve injury, pain originating from axonal pathology or ganglionopathy privileges neuropathies affecting smaller fibres, a clinical observation that points towards abnormal activity within nociceptive afferents as a main generator of pain. Natural activation of blood vessels or perineurial nociceptive network by pathology also causes intense pain. Pain of this kind, i.e. nerve trunk pain, is among the heralding symptoms of inflammatory or ischemic mononeuropathy and for its intensity represents itself a medical emergency. Neuropathic pain quality rekindles the psychophysical experience of peripheral nerves intraneural microstimulation i.e. a combination of large and small fibres sensation temporally distorted compared to physiological perception evoked by natural stimuli. Pins and needles, burning, cramping mixed with numbness, and tingling are the wording most used by patients. Nociceptive pain instead is most often described as aching, deep and dull. Good command of peripheral nerve anatomy and pathophysiology allows timely recognition of the different pain components and targeted treatment, selected according to intensity, type and temporal profile of the pain.

Marchettini, P; Lacerenza, M; Mauri, E; Marangoni, C



Gender role expectations of pain: relationship to experimental pain perception  

Microsoft Academic Search

The primary purpose of this study was to investigate the influence of an individual's Gender Role Expectations of Pain (GREP) on experimental pain report. One hundred and forty-eight subjects (87 females and 61 males) subjects underwent thermal testing and were asked to report pain threshold, pain tolerance, VAS ratings of pain intensity and unpleasantness, and a computerized visual analogue scales

Emily A Wise; Donald D Price; Cynthia D Myers; Marc W Heft; Michael E Robinson



Pain Responses to Experimental Chewing in Myofascial Pain Patients  

Microsoft Academic Search

Although patients with myofascial pain of the masticatory muscles often report that chewing exacerbates their pain, this has never been verified experimentally. In this study, pain was assessed before and after chewing in 20 asymptomatic subjects and in 61 patients with muscle pain. First, self-reports of pain were obtained with a checklist and on five-point category scales (CAT) at the

T. T. T. Dao; J. P. Lund; G. J. Lavigne



Pain-autonomic interactions.  


There are extensive interactions between the neural structures involved in pain sensation and autonomic control. The insular and anterior cingulate cortices, amygdala, hypothalamus, periaqueductal grey, parabrachial nucleus, nucleus of the solitary tract, ventrolateral medulla and raphe nuclei receive converging nociceptive and visceral inputs from the spinal and trigeminal dorsal horns and initiate arousal, affective, autonomic, motor and pain modulatory responses to painful stimuli. This review will focus on some central pain-autonomic interactions potentially relevant for the pathophysiology of primary headache. PMID:16688616

Benarroch, E E



[Pain therapy in proctology].  


Pain in the anorectal region can be quite considerable. They can be treated effectively however. Before treatment the correct diagnosis is important. In each pain regimen it is important that patients have a normally sized stool (Bristol stool form scale type 4). Diclofenac (3 dd 50 mg) should be routinely used in anorectal pain. If diclofenac does not sufficiently relieve the pain, one should add metamizole or tramadole. Topically relaxing or analgetic agents (glyceryl trinitrate, botulinum toxin A, diltiazem, nifedipin, metronidazole, cincho- or lignocaine) might be used in selected cases. If edema exists topical steroids might have an analgetic effect. PMID:20687461

Jongen, Johannes; Kahl, Imme; Pflug, Annette; Kahlke, Volker



Personalized treatment of pain.  


Despite advances made in its understanding and treatment, chronic pain remains an unsolved and all too common problem. One of the main obstacles to successful management of pain is the high variability of many patients regarding both response to treatment and susceptibility to adverse effects, which curtails the utility of therapeutic intervention. Understanding the causes of this variability is an important challenge which may lead to a new era in rational pain management. As described in this review, however, there currently seems to be more than one possible explanation of this variability. Rational personalized pain management must take into consideration both ever-increasing knowledge of pharmacogenetics and pharmacokinetics and a broad, clinically based attitude incorporating co-morbidities, both physical and psychiatric, and concomitant medications. Novel models for testing in-vivo pain processing, for example assessment of conditioned pain modulation (CPM), are also promising approaches to use of rational data for empirical treatment of pain. Last, listening to the patient and understanding the context in which pain has affected his or her life is an important part of maintaining the personal nature of therapeutic interaction with patients suffering from pain. PMID:23292814

Ablin, Jacob N; Buskila, Dan



Painful boney metastases.  


Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics. PMID:23861996

Smith, Howard S; Mohsin, Intikhab



Pain management in ferrets.  


The growing popularity of ferrets as pets has created the demand for advanced veterinary care for these patients. Pain is associated with a broad range of conditions, including acute or chronic inflammatory disease, neoplasia, and trauma, as well as iatrogenic causes, such as surgery and diagnostic procedures. Effective pain management requires knowledge and skills to assess pain, good understanding of the pathophysiology of pain, and general knowledge of pharmacologic and pharmacodynamic principles. Unfortunately, scientific studies on efficacy, pharmacokinetics, pharmacodynamics, and safety of analgesic drugs in the ferret are limited. However, basic rules on the treatment of pain and mechanisms of action, safety, and efficacy of analgesic drugs in other species can be adapted and applied to pain management in ferrets. This article aims to make an inventory of what is known on the recognition of pain in ferrets, what analgesic drugs are currently used in ferrets, and how they can be adopted in a patient-orientated pain management plan to provide effective pain relief while reducing and monitoring for unwanted side effects. PMID:21074706

van Oostrom, Hugo; Schoemaker, Nico J; Uilenreef, Joost J



DREAMing about arthritic pain  

PubMed Central

The experience of acute pain serves a crucial biological purpose: it alerts a living organism to environmental dangers, inducing behavioural responses which protect the organism from further damage. In contrast, chronic pain arising from disease states and/or pathological functioning of the nervous system offers no advantage and may be debilitating to those afflicted. Despite recent advances in our understanding of pain mechanisms, the satisfactory management of pathological pain eludes current treatment strategies. We have demonstrated in a previous study on dream deficient mice the pivotal role of downstream regulatory element antagonistic modulator (DREAM) in modulating pain sensitivity in a number of behavioural models, including acute and chronic neuropathic pain. DREAM is a novel calcium binding transcriptional repressor for the prodynorphin gene in spinal cord neurones. The marked attenuation in pain behaviour exhibited by dream–/– mice was shown, by pharmacological and biochemical analyses, to be due to increased activation of the endogenous ?-opioid system. Importantly, loss of DREAM also attenuated inflammatory pain. Thus, DREAM and the DREAM pathway constitute a novel therapeutic paradigm for the treatment of chronic pain in arthritis.

Cheng, H; Penninger, J



[Idiopathic facial pain other than vascular pain].  


Cluster Headache associates a severe pain generally unilateral and autonomic symptoms with a remarkable periodicity. In the first part we tried to explain the conception of physiopathology of these short lasting headache syndromes and in the second part we described the clinical features. The short lasting primary headaches are divided into two groups: those with marked autonomic activation which comprise chronic and episodic paroxysmal hemicrania, short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) and cluster headache. The second group includes two entities, one without autonomic activation: Hypnic Headache and one with mild autonomic features: Hemicrania Continua. The paroxysmal hemicranias are characterized by attack frequency ranges from 15 to 20 per day of short lasting attacks of unilateral pain that typically last 2 to 10 minutes, the severe pain is associated with autonomic symptoms and responds to treatment with indomethacin. The SUNCT syndrome has a less severe pain but marked autonomic activation during attacks, this syndrome is actually resistant to proposed therapy. The Hypnic Headache and the Hemicrania Continua have yet less severe pain with very mild or without autonomic features. PMID:11139750

Valade, D; El Amrani, M



Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete  

PubMed Central

Summary Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient’s return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment. Level of Evidence: II

Saxena, Amol; Fournier, Magali; Gerdesmeyer, Ludger; Gollwitzer, Hans



Locating the Beginnings of Pain  

Microsoft Academic Search

This paper examines the question of whether a fetus can feel pain. The question is divided into four sub questions: What is pain? What is the neurology of pain processing? What is the fetus? Are there good reasons for holding that fetuses feel pain? Pain is suggested to be a multi-dimensional phenomenon drawing on emotional and sensory processes – a

Stuart W. G. Derbyshire



Heel-strike in walking: assessment of potential sources of intra- and inter-subject variability in the activation patterns of muscles stabilizing the knee joint.  


The electromyographic (EMG) signal is known to show large intra-subject and inter-subject variability. Adaptation to, and preparation for, the heel-strike event have been hypothesized to be major sources of EMG variability in walking. The aim of this study was to assess these hypotheses using a principal component analysis (PCA). Two waveform shapes with distinct characteristic features were proposed based on conceptual considerations of how the neuro-muscular system might prepare for, or adapt to, the heel-strike event. PCA waveforms obtained from knee muscle EMG signals were then compared with the predicted characteristic features of the two proposed waveforms. Surface EMG signals were recorded for ten healthy adult female subjects during level walking at a self-selected speed, for the following muscles; rectus femoris, vastus medialis, vastus lateralis, semitendinosus, and biceps femoris. For a period of 200 ms before and after heel-strike, EMG power was extracted using a wavelet transformation (19-395 Hz). The resultant EMG waveforms (18 per subject) were submitted to intra-subject and inter-subject PCA. In all analyzed muscles, the shapes of the first and second principal component (PC-) vectors agreed well with the predicted waveforms. These two PC-vectors accounted for 50-60% of the overall variability, in both inter-subject and intra-subject analyses. It was also found that the shape of the first PC-vector was consistent between subjects, while higher-order PC-vectors differed between subjects. These results support the hypothesis that adaptation to, and preparation for, a variable heel-strike event are both major sources of EMG variability in walking. PMID:23518206

Huber, Cora; Federolf, Peter; Nüesch, Corina; Cattin, Philippe C; Friederich, Niklaus F; Tscharner, Vinzenz von



Sleep and pain  

Microsoft Academic Search

Noxious stimuli and painful disorders interfere with sleep, but disturbances in sleep also contribute to the experience of pain.Chronic paroxysmal hemicrania and possibly cluster headaches are related to REM sleep. Whereas headache is associated with snoring and sleep apnea, morning headaches are not specific for any primary sleep disorder. Nevertheless, the management of the sleep disorder ameliorates both morning headache

Harvey Moldofsky



Opioids in pain management  

Microsoft Academic Search

Dose titration and differences between clinical and laboratory pharmacology The clinical use of opioids shows a difference between their clinical pharmacology and their laboratory pharmacology. What happens when opioids are given to someone in pain is different from what happens when they are given to someone not in pain. The respiratory depression that results from the acute use of opioids

Henry McQuay



Athletes' leg pains  

Microsoft Academic Search

The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes,

S. Orava; J. Puranen



Chemical Interventions for Pain.  

ERIC Educational Resources Information Center

|Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,…

Aronoff, Gerald M.; And Others



Chapter 4; Arthritis Pain  

Microsoft Academic Search

Arthritic pain is a common and disabling problem for many older adults. There is widespread evidence that despite its prevalance and debilitating effects on the physical, emotional and cognitive status of older adults, arthritic pain remains under-treated in those age 65 and older. This condition significantly and negatively impacts older adults' quality of life and is a critical problem that

Eunkyung Yoon; John B. Doherty



Recurrent Abdominal Pain  

ERIC Educational Resources Information Center

|The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

Banez, Gerard A.; Gallagher, Heather M.



[Pain management in urology].  


This article reviews aspects of postoperative and chronic pain management in urology patients. Continuous epidural techniques are recommended for extensive retroperitoneal und transperitoneal surgery due to its excellent analgesia and facilitation of enhanced recovery. In patients without regional analgesia techniques, intravenous or oral non-opioid analgesics should be combined with titration of fast acting opioids on an as-needed basis. Oral slow-release opioids are increasingly being used as part of systemic pain management although little evidence exists. Local wound infiltration and transcutaneous electrical nerve stimulation (TENS) treatment are simple and effective supplements for postoperative pain management. In 70-90% of urological cancer patients pain can be adequately relieved by consistent adherence to the WHO cancer pain recommendations. Additional pain relief approaches, such as radiation as well as psychosocial and spiritual needs of these patients have to be considered. In long-term treatment of non-cancer pain, effective use of opioids is not evidence-based. These patients often benefit from multimodal, interdisciplinary pain management comprising psychological and educational approaches as well as activating physiotherapy. PMID:23529794

Zimmer, A; Greul, F; Meißner, W



No DREAM, No Pain  

Microsoft Academic Search

Pain transmission in the spinal cord is regulated by a balance of facilitatory and inhibitory influences operating on the neural circuits of the somatosensory system. The transcriptional repressor DREAM acts constitutively to suppress prodynorphin expression in spinal cord neurons. Knocking out DREAM results in sufficient dynorphin expression to produce a strong reduction in generalized pain behavior, highlighting the role that

Michael Costigan; Clifford J. Woolf



Chronic pain after childbirth.  


With over four million deliveries annually in the United States alone and a constant increase in cesarean delivery rate, childbirth is likely to have a huge impact on the occurrence of acute and possibly chronic postpartum pain. Recent awareness that chronic pain may occur after childbirth has prompted clinicians and researchers to investigate this topic. Current evidence points towards a relatively low incidence of chronic pain after cesarean delivery, with rates ranging between 1% and 18%. To provide a potential mechanistic explanation for the relatively low occurrence of chronic pain after cesarean delivery compared with that after other types of surgery, it has been proposed that endogenous secretion of oxytocin may confer specific protection. Clinical interventions to reduce the incidence and severity of chronic post-surgical pain have not been consistently effective. Likely explanations are that the drugs that have been investigated were truly ineffective or that the effect was too modest because with a low incidence of chronic pain, studies were likely to be underpowered and failed to demonstrate an effect. In addition, since not all women require preventive therapies, preoperative testing that may identify women vulnerable to pain may be highly beneficial. Further research is needed to identify valid models that predict persistent pain to allow targeted interventions to women most likely to benefit from more tailored anti-hyperalgesic therapies. PMID:23477888

Landau, R; Bollag, L; Ortner, C



PACU pain management algorithm  

Microsoft Academic Search

Effective and safe pain management for a patient emerging from the effects of anesthesia is a specialized skill that is often acquired only through years of experience. This article provides perianesthesia nurses with a technique to assess the cognitively impaired postanesthesia patient and to incorporate vital circumstantial criteria in determining the presence of pain. Intervention recommendations are also included. The

Helen E. Buss; Karen Melderis



Patients' Perspectives on Pain  

PubMed Central

Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. Unfortunately, these are only partly successful in relieving pain. Qualitative studies report that individuals with SCI-related long-lasting pain seek alternatives to medication due to the limited efficacy, unwanted side effects, and perceived risk of dependency. They spend time and money searching for additional treatments. Many have learned coping strategies on their own, including various forms of warmth, relaxation, massage, stretching, distraction, and physical activity. Studies indicate that many individuals with SCI are dissatisfied with their pain management and with the information given to them about their pain, and they want to know more about causes and strategies to manage pain. They express a desire to improve communication with their physicians and learn about reliable alternative sources for obtaining information about their pain and pain management. The discrepancy between treatment algorithms and patient expectations is significant. Clinicians will benefit from hearing the patient´s voice.

Norrbrink, Cecilia; Lofgren, Monika; Hunter, Judith P.; Ellis, Jaqueline



Complex regional pain syndrome  

Microsoft Academic Search

Since the early musings in the mid-1800s of Claude Bernard and his French neurological colleagues on the association of pain with the sympathetic nervous system, complex regional pain syndrome (CRPS) has both fascinated and perplexed practitioners. Some of the clearest and most interesting descriptions of 'causalgia' come from the American Civil War by one of Bernard's students, Silas Weir-Mitchell. The

R. N. Harden



Effect of continuing or stopping smoking during pregnancy on infant birth weight, crown-heel length, head circumference, ponderal index, and brain:body weight ratio.  


The objective of this study was to determine whether stopping smoking between the first prenatal care visit and the 32nd week of pregnancy affects the smoking-associated changes in five infant anthropometric indices. The study population consisted of 15,185 births in the Swedish Medical Birth Register from 1991 and 1992. The associations between birth weight, crown-heel length, head circumference, ponderal index, brain:body weight ratio, maternal smoking status at the first prenatal care visit and at 32 weeks' gestation, and other maternal and infant characteristics were assessed using multivariate linear regression. The infants of 946 women who stopped smoking before week 32 of pregnancy were statistically indistinguishable from the 9,802 infants of nondaily smokers in terms of birth weight, head circumference, and brain:body weight ratio, but they retained a significant deficit in crown-heel length of 0.23 cm (standard error, 0.08) and a significant elevation in ponderal index of 0.027 (standard error, 0.009). In this study, stopping smoking between the first prenatal care visit and week 32 of pregnancy prevented smoking-associated deficits in infant birth weight, head circumference, and brain:body weight ratio, but did not completely prevent deficits in crown-heel length in comparison with nonsmokers' infants of the same age, and did not prevent elevation of ponderal index in comparison with nonsmokers' infants of the same weight and age. PMID:10933268

Lindley, A A; Becker, S; Gray, R H; Herman, A A



An archaeology of pain  

NASA Astrophysics Data System (ADS)

Pain is a discursive construct of science and medicine. Through the discourses of biopower and technoscience pain is used to construct and maintain the social body. Biopower and technoscience are discursive practices that are enveloped within the disciplines of Western society. Specifically, the disciplines of education, science, and medicine use biopower and technoscience to normalize the body and construct binaries which create the abnormal. The cyborg is a discursive practice used to implode the binaries of the disciplines which maintain the social body. Through the implosion of binaries, the binary of mind/body is no longer plausible in the explanation of pain. Neuropathic chronic pain and phantom limb pain become cyborg discourses which operate to deconstruct the pedagogies of science and medicine.

Gruber, Dennis Michael


Easing Back Pain During Pregnancy  


What causes back pain during pregnancy? Back pain in pregnancy has many possible causes. It usually is caused by strain on the ... too mobile. What can I do to prevent back pain during pregnancy? To help prevent or ease back ...


Back Pain Facts and Statistics  


Back Pain Facts & Statistics Although chiropractors care for more than just back pain, many patients visit chiropractors looking for relief from ... condition. In fact, 31 million Americans experience low-back pain at any given time. 1 A few interesting ...


Back Pain and Emotional Distress  


North American Spine Society Public Education Series Back Pain and Emotional Distress Common Reactions to Back Pain Four out of five adults will experience an episode of significant back pain sometime during ...


Managing Chemotherapy Side Effects: Pain  


... anD human services national institutes of health Managing Chemotherapy Side Effects Pain Call the doctor or nurse ... and am able to enjoy life more!” Managing Chemotherapy Side Effects: Pain Keep track of the pain. ...


The Measurement of Suprathreshold Pain.  

National Technical Information Service (NTIS)

The study of both subjective and physiological responses to painful stimulation is fraught with a number of difficulties, one of which is the difference in functional relationships between the threshold and suprathreshold of pain, such as surgical pain. B...

J. Voevodsky L. M. Cooper A. H. Morgan E. R. Hilgard



Culture, pain, and culturally sensitive pain care  

Microsoft Academic Search

One of the factors that can influence a person's perception of the pain experience is culture. With the large increase in the immigrant population in the United States, particularly immigrants coming from nontraditional regions such as Southeast Asia and Latin America, clinicians need to develop increased sensitivity to the influence of culture on health care beliefs and practices. To more

Kathryn Eilene Lasch



Myofascial pain: Diagnosis and management  

Microsoft Academic Search

Clinical understanding and management of myofascial pain is overlooked frequently when dealing with pain. Myofascial pain\\u000a is defined as pain or autonomic phenomena referred from active trigger points, with associated dysfunction. The trigger point\\u000a is a focus of hyperirritability in the muscle that, when compressed, is locally tender and, if sensitized, gives rise to referred\\u000a pain and tenderness. The pain

Steven B. Graff-Radford



The effect of lateral heel studs on the kinematics of the equine digit while cantering on grass.  


This study aimed to assess the effect of lateral heel studs on foot-ground interaction in the horse by quantifying foot slip during stance whilst cantering on a grass surface. It was hypothesised that using studs would decrease foot slip distance on the ground conditions tested. Nine horses were ridden with and without a stud placed laterally in the shoe of each of the 4 feet. High speed video-analysis was used to track hoof markers and to provide data quantifying foot slip distance, slip duration and stance duration. Using studs resulted in a significant decrease in foot slip distance in all four limbs (all P values<0.004). The magnitude of the difference in slip distance with and without studs was greatest in the trailing limbs. The results supported the hypothesis that using studs will decrease foot slip distance in horses cantering on a grass surface, and additionally, highlights that stud efficacy may vary between limbs. The decrease in slip distance with studs demonstrated increased traction and a more stable foot-ground interaction, although this may cause a concomitant increase in the required energy dissipation, either within the limb or via surface deformation. The effect of repetitive usage of studs in the aetiology of musculoskeletal conditions should therefore be investigated further. PMID:21752677

Harvey, Alison M; Williams, Sarah B; Singer, Ellen R



The heel and toe of the cell's foot: A multifaceted approach for understanding the structure and dynamics of focal adhesions  

PubMed Central

Focal adhesions (FAs) are large clusters of transmembrane receptors of the integrin family and a multitude of associated cytoplasmic “plaque” proteins, which connect the extracellular matrix-bound receptors with the actin cytoskeleton. The formation of nearly stationary focal adhesions defines a boundary between dense and highly dynamic actin network in lamellipodium and the sparser and more diverse cytoskeletal organization in the lamella proper, creating a template for the organization of entire actin network. The major “mechanical” and “sensory” functions of FAs, namely, the nucleation and regulation of the contractile, myosin-II-containing, stress fibers and the mechanosensing of external surfaces depend, to a major extent, on the dynamics of molecular components within FAs. A central element in FA regulation concerns the positive feedback loop, based on the most intriguing feature of FAs, namely, their dependence on mechanical tension developing by the growing stress fibers. FAs grow in response to such tension, and rapidly disassemble upon its relaxation. In this article we address the mechanistic relationships between the process of FA development, maturation and dissociation and the dynamic molecular events, which take place in different regions of the FA, primarily in the distal end of this structure (the “toe”) and the proximal “heel”, and discuss the central role of local mechanical forces in orchestrating the complex interplay between FAs and the actin system.

Wolfenson, Haguy; Henis, Yoav I.; Geiger, Benjamin; Bershadsky, Alexander D.



A systemic review of Toxic Death in clinical oncology trials: an Achilles' heel in safety reporting revisited  

PubMed Central

Background: Toxic death is defined as study treatment-related mortality and as such is considered as an iatrogenic death. This belongs to unnatural death where an autopsy is advised. Until now, conventional autopsy is the gold standard to discriminate between pre- and post-mortem discrepancies. Methods: The consequences of lack of systematically performing an autopsy will be explored in the setting of oncological clinical trials. Results: During more than one decade, 6428 Serious Adverse Events have been registered in the EORTC Safety database on a total of 34?734 subjects. The number of deaths were 764 (mortality rate of 2.2%) whereof 255 (rate of 0.7%) toxic deaths. In 89.8% of these toxic deaths, no autopsy has been done; in 25.1% (64 cases) an inconsistent cause of death was found based on studying of the medical narrative. The autopsy rate was only 10.2% (26 out of 255) and, in 46.2% of the performed autopsies, there was a clinical pathological discrepancy. conclusion: When no autopsy is performed, there is a high risk for a wrong diagnosis in case of suspected toxic death. The high discrepancy rate, possibly due to a low autopsy rate, shows that toxic death is an Achilles' heel in iatrogenic mortality.

Penninckx, B; Van de Voorde, W M; Casado, A; Reed, N; Moulin, C; Karrasch, M



Thermal-hydraulic analysis of an annular fuel element: The Achilles' heel of the particle bed reactor  

NASA Astrophysics Data System (ADS)

The low pressure nuclear thermal propulsion (LPNTP) concept offers significant improvements in rocket engine specific impulse over rockets employment chemical propulsion. This study investigated a parametric thermal-hydraulic analysis of an annular fueld element, also referred to as a fuel pipe, using the computer code ATHENA (Advanced Thermal Hydraulic Energy Network Analyzer). The fuelpipe is an annular particle bed fuel element of the reactor with radially inward flow of hydrogen through the element. In this study, the outlet temperature of the hydrogen is parametrically related to key effects, including the reactor power at two different pressure drops, the effect of power coupling for in-core testing, and the effect of hydrogen flow rates. Results show that the temperature is linearly related to the reactor power, but not to pressure drop, and that cross flow inside the fuelpipe occurs at approximately 0.3 percent of the radial flow rates. More importantly, because of limited properties data for hydrogen and the probable yet uncharacterized dynamic distribution of packed fuel particles in the fuel pin during reactor operations, results from any thermal-hydraulic code, including ATHENA, do not give designs of satisfactory fidelity. This lack of design confidence is the Achilles' heel for current LPNTP reactors.

Dibben, Mark J.; Tuttle, Ronald F.



Low back pain: pharmacologic management.  


Adequate treatment of low back pain is essential, but has been challenging for many primary care physicians. Most patients with low back pain can be treated in the primary care environment, provided the physician has enough knowledge of the medications used to treat low back pain. The main treatment goal for acute low back pain is to control the pain and maintain function. For patients with chronic back pain, the goal is continual pain management and prevention of future exacerbations. This article reviews current pharmacological options for the treatment of low back pain, and possible future innovations. PMID:22958559

Miller, Susan M



Evaluation of skin surface hydration state and barrier function of stratum corneum of dorsa of hands and heels treated with PROTECT X2 skin protective cream.  


Skin roughness is a term commonly used in Japan to describe a poor skin condition related to a rough and dry skin surface that develops as a result of various damaging effects from the environment or skin inflammation. Recovery from skin roughness requires skin care for a long period, thus it is important to prevent development of such skin changes. PROTECT X2 contains agents used for a protective covering of the skin from frequent hand washing or use of alcohol-based disinfectants. These unique components are also thought to be effective to treat skin roughness of the dorsa of the hands and heels. In the present study, we evaluated the effectiveness of PROTECT X2 to increase skin surface hydration state, as well as enhance the barrier function of the stratum corneum of the dorsa of the hands and heels in elderly individuals. A total of 8 elderly subjects and their caretakers without any skin diseases participated in the study. They applied PROTECT X2 by themselves to the dorsum area of 1 hand and heel 3 to 5 times daily for 1 month, while the opposite sides were left untreated. We measured stratum corneum (SC) hydration and transepidermal water loss (TEWL) before beginning treatment, then 1 week and 1 month after the start of treatment to compare between the treated and untreated skin. SC hydration state after applications of PROTECT X2 was 1.5- to 3.0-fold higher than that of the untreated skin in the dorsa of both hands and heels, indicating that the moisturizing ingredients accompanied by water were replenished in those areas where the cream was applied. Also, TEWL in the dorsum of the hands was 17.0-27.9% lower on the treated side, indicating improvement in SC barrier function. On the basis of these findings, we concluded that PROTECT X2 enhances water-holding in the SC and aids the barrier function of the skin in the dorsum of the hands. In addition, we consider that this formulation is useful for not only protecting the hands from the effects of such agents as detergents and alcohol-based disinfectants, but also for protecting heel skin covered by a thick SC from dry and cold conditions such as those encountered in winter. However, since the SC in that area is much thicker than that of the hands, the barrier function was not significantly improved within 1 month of daily treatments. PMID:22890206

Kubota, Takahiro



Sodium channelopathies and pain.  


Chronic pain often represents a severe, debilitating condition. Up to 10% of the worldwide population are affected, and many patients are poorly responsive to current treatment strategies. Nociceptors detect noxious conditions to produce the sensation of pain, and this signal is conveyed to the CNS by means of action potentials. The fast upstroke of action potentials is mediated by voltage-gated sodium channels, of which nine pore-forming alpha-subunits (Nav1.1-1.9) have been identified. Heterogeneous functional properties and distinct expression patterns denote specialized functions of each subunit. The Nav1.7 and Nav1.8 subunits have emerged as key molecules involved in peripheral pain processing and in the development of an increased pain sensitivity associated with inflammation and tissue injury. Several mutations in the SCN9A gene encoding for Nav1.7 have been identified as important cellular substrates for different heritable pain syndromes. This review aims to cover recent progress on our understanding of how biophysical properties of mutant Nav1.7 translate into an aberrant electrogenesis of nociceptors. We also recapitulate the role of Nav1.8 for peripheral pain processing and of additional sodium channelopathies which have been linked to disorders with pain as a significant component. PMID:20101409

Lampert, Angelika; O'Reilly, Andrias O; Reeh, Peter; Leffler, Andreas



Pain pathways and transmission.  

PubMed Central

Pain has been a major concern of humankind since the ancient times, and it remains one of the most important subjects of all health care professionals. Despite the obvious overwhelming clinical importance, the major advances in its diagnosis and therapy have been made only recently. "How do the sensory apparatus of the body and system of signal transmission relate to pain of peripheral origin?" is the topic of discussion. To do this, it is important to understand what constitutes the total pain experience. It consists of: 1) signal transduction at the peripheral receptor site, 2) signal conduction along the peripheral nerve, 3) pain modulation at the level of the spinal cord, 4) pain perception at the supraspinal site, and 5) the associated sensations, emotional reactions, and effective state. The signal transmission related to pain may be modified by various analgesic agents. Specific analgesic agent has a specific site of action which may be at peripheral receptors, at peripheral nerves, at the level of the spinal cord, at supraspinal levels by activating descending inhibitory systems, or at more cephalad levels by reducing the affective component of pain.

Kitahata, L. M.



Modulations of pain sensations.  


Representation of time may affect pain perception. We investigated a group of volunteers looking at different clocks while they were being exposed to the same intensity of pain in two experiments. In one case, they saw the actual time, while in the other, they gazed at a clock that made it seem like the stimulation was shortened, even though it wasn't. These results show that simply believing that time is on your side can make anything more bearable. The results were not influenced by the color of the clock (red or green), or the presence of indexes such as (sad or smiling) smileys. The effects were maximal for high intensities of stimulation (pain threshold +1°C) if the stimulation lasted for at least 25s but were absent if the stimulation was short (15 min). These results suggest that pain modulation by time context is mainly available for long and intense painful stimulations. The right upper and posterior parietal cortex may support this effect. These findings are discussed with regard to previous literature of pain modulations but also with regard to the concept of the "pain matrix", its inputs and the temporal dynamics of its constitutive responses. PMID:23040700

Peyron, R; Pomares, F-B; Faillenot, I; Barral, F-G; Laurent, B



Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation  

Microsoft Academic Search

Ehde DM, Czerniecki JM, Smith DG, Campbell KM, Edwards WT, Jensen MP, Robinson LR. Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Arch Phys Med Rehabil 2000;81:1039-44. Objectives: To determine the characteristics of phantom limb sensation, phantom limb pain, and residual limb pain, and to evaluate pain-related disability associated with phantom limb

Dawn M. Ehde; Joseph M. Czerniecki; Douglas G. Smith; Kellye M. Campbell; W. Thomas Edwards; Mark P. Jensen; Lawrence R. Robinson



Painful Bladder Syndrome  

Microsoft Academic Search

\\u000a Painful bladder syndrome\\/interstitial cystitis (PBS\\/IC), also known as bladder pain syndrome (BPS\\/IC), is primarily based\\u000a on symptoms of urgency, frequency, and pain in the bladder and\\/or pelvis. Its etiology is not known and clinical characteristics\\u000a vary among patients. Early recognition of BPS\\/IC is very important because the symptoms are quite disabling, affecting quality\\u000a of life and resulting in patients being

Mauro Cervigni; Franca Natale; Albert Mako; Loredana Nasta


[Phantom limb pain].  


Almost everyone who has amputated a limb will experience a phantom limb. They have the vivid impression, that the limb is still present. 60 to 70% of these amputees will suffer from phantom limb pain. The present paper gives an overview of the incidence and the characteristics of the so called "post amputation syndrome". Possible mechanism of this phenomena are presented, including peripheral, spinal, and central theories. Treatment of phantom limb pain is sometimes very difficult. It includes drug therapy, psychological therapy, physiotherapy as well as the prevention of phantom limb pain with regional analgesia techniques. PMID:16804788

Steffen, Peter



Myofascial pelvic pain.  


Myofascial pelvic pain is fraught with many unknowns. Is it the organs of the pelvis, is it the muscles of the pelvis, or is the origin of the pelvic pain from an extrapelvic muscle? Is there a single source or multiple? In this state of confusion what is the best way to manage the many symptoms that can be associated with myofascial pelvic pain. This article reviews current studies that attempt to answer some of these questions. More questions seem to develop as each study presents its findings. PMID:22648177

Kotarinos, Rhonda



Pain, cancer, and older adults.  


Pain is the most common symptom associated with cancer. Despite the fact that appropriate pain management exists, cancer pain often is inadequately controlled. Sixty percent to 85% of individuals with advanced cancer have either severe or chronic pain. Issues associated with cancer pain and pain management in later life include the effect of pain on the person, friends, and family; the influence of hope; the perception that older adults are less sensitive to painful stimuli; the special problems of drug management in older adults; and the unique issues of older women affected by cancer. This article concludes with implications for nurses. Future research needs to be directed to pain management at home, the ethics of pain management, pain in the cognitively impaired person, and the specific needs of older women. PMID:10703349

All, A C; Huycke, L I


Animal Models of Cancer Pain  

PubMed Central

Modern cancer therapies have significantly increased patient survival rates in both human and veterinary medicine. Since cancer patients live longer they now face new challenges resulting from severe, chronic tumor-induced pain. Unrelieved cancer pain significantly decreases the quality of life of such patients; thus the goal of pain management is to not only to alleviate pain, but also to maintain the patient's physiological and psychological well-being. The major impediment for developing new treatments for cancer pain has been our limited knowledge of the basic mechanisms that drive cancer pain and the lack of adequate animal cancer pain models to study the molecular, biochemical and neurobiological pathways that generate and maintain cancer pain. However this situation has recently changed with the recent development of several novel animal models of cancer pain. This review will focus on describing these animal models, many of them in rodents, and reviewing some of the recent information gained from the use of these models to investigate the basic mechanims that underlie the development and maintenance of cancer pain. Animal models of cancer pain can be divided into the following five categories: bone cancer pain models, non-bone cancer pain models, cancer invasion pain models, cancer chemotherapeutic-induced peripheral neuropathy models, and spontaneous occurring cancer pain models. These models will be important not only for enhancing our knowledge of how cancer pain is generated, but more importantly for the development of novel therapeutic regimes to treat cancer pain in both domestic animals and humans.

Pacharinsak, Cholawat; Beitz, Alvin



Olfactory experience mediates response to pain in preterm newborns.  


We assessed the effects of a familiar odor during routine blood draws in healthy preterm newborns. Infants were observed as they were undergoing either a capillary puncture on the heel (heelstick) or a venous puncture on the hand. During the procedure, one third of the infants were presented with an odor they had been familiarized with prior to the procedure, one third of the infants were presented with an odor, they had not been previously exposed to, and one third were presented with no odor. Heelsticks elicited more behavioral distress than venipunctures. Infants who were presented with a familiar odor during venipuncture showed no significant increase in crying and grimacing during the procedure compared to baseline levels. By comparison, infants presented with an unfamiliar odor or with no odor either during the heelstick or the venipuncture had a significant increase in crying and grimacing. When the pain was milder, i.e., during a venipuncture, and a familiar odor was presented, infants showed little to no crying. These results are consistent with a body of evidence on early memory and olfactory competence in fetuses and newborns. PMID:12555281

Goubet, Nathalie; Rattaz, Cécile; Pierrat, Véronique; Bullinger, André; Lequien, Pierre



Lamotrigine in the treatment of pain syndromes and neuropathic pain.  


Anti-epileptic drugs are increasingly used in the treatment of pain syndromes and neuropathic pain. Sodium channel blockers can be effective in the treatment of pain. The object of our interest is the efficiency of lamotrigine in treating the pain. A MEDLINE search was conducted to identify pertinent studies, case reports, letters, and reviews in English published from 1986 to May 2007. The search has indicated efficiency in treating a number of painful syndromes and neuropathic pain; central pain, trigeminal neuralgia and trigeminal neuralgia in multiple sclerosis, pain in multiple sclerosis, SUNCT syndrome, cluster headache, glossopharyngeal neuralgia, neuropathic pain, allodynia, neuralgia after nerve section, postherpetic neuralgia, HIV-associated neuropathy. Further researches are required on the role of lamotrigine in treating the spinal cord injury pain, neuralgia after nerve section, postoperative analgesic requirement, and in migraine (Tab. 1, Ref. 46). Full Text (Free, PDF) PMID:19040151

Titlic, M; Jukic, I; Tonkic, A; Josipovic-Jelic, Z; Boschi, V; Mihalj, M; Punda, A



Transformation of acute cancer pain to chronic cancer pain syndromes.  


For many cancer survivors, disease-related long-term morbidities and the application of advanced cancer treatments have resulted in the development of a chronic pain state. This brief review explores the relationship between what is known about the treatment of active cancer pain syndromes-both continuous pain and breakthrough pain-and persisting pain syndromes in cancer survivors. We also posit that because there is evidence to suggest that poorly treated acute pain can lead to protracted pain conditions, acute pain should be recognized and treated promptly, both for short- and long-term gain. In the short term, better acute pain treatment can improve functionality and psychological well-being, whereas in the long term, mounting evidence suggests that it could prevent of future chronic pain. PMID:22284639

Burton, Allen W; Fine, Perry G; Passik, Steven D



Knee pain (image)  


... knee is commonly related to injuries to the collateral ligaments, arthritis, or tears to the meniscuses. Pain ... associated with damage or problems with the meniscuses, collateral ligaments, or patella tracking.


Palliative care - managing pain  


... aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin), diclofenac Narcotics or opioids, such as codeine, morphine, oxycodone, or ... stools, can be treated. Few people who take narcotics to treat pain become addicted to them. If ...


Back Pain in Children  


... topic.cfm?topic=A00053) Slipped Vertebra In this drawing of spondylolisthesis, a lower back vertebra has shifted ... following symptoms. Pain in the lower back or abdomen and stiffness of the spine Walking with a ...


Sickle Cell Pain  


... anemia, as well. Some patients may be prescribed hydroxyurea, a medication that might reduce the chance that ... doctor for relief from sickle cell pain are: Hydroxyurea (e.g., Hydrea and Droxia) Anti-inflammatory medications, ...


Angina | Chest Pain  


... many types of angina, including acute coronary syndrome, angina pectoris, chest pain, coronary artery spasms, microvascular angina, Prinzmetal's ... and how they differ is important. Stable Angina / Angina Pectoris Unstable Angina Variant (Prinzmetal) Angina Microvascular Angina Understand ...


Pain: Hope through Research  


... over-accumulation of certain trophic factors in the nerve cells of animals results in heightened pain sensitivity, and ... the spinal cord is "rewired" following trauma as nerve cell axons make new contacts, a phenomenon known as " ...


Overview of Neck Pain  


... people who sit at desks or work at computers. Treatment Options The rehabilitation of neck injuries occurs in three phases. During the first phase, called the acute phase, physiatrists treat pain ...


Block That Pain!  


... combination produces a unique effect, blocking pain-sensing neurons without impairing signals from other cells. In contrast, ... surgical procedures block activity in all types of neurons. This can cause numbness, paralysis, and other nervous ...


Complex Regional Pain Syndrome  


... any treatment? Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms. Doctors may ... cord. What is the prognosis? The prognosis for CRPS ... What research is being done? The National Institute ...


Hemiplegic shoulder pain.  


This article reviews the literature relevant to the possible causes, prevention, and treatment of hemiplegic shoulder pain. Shoulder pain and stiffness impede the rehabilitation of patients with hemiplegia. The cause of this complication is unknown, but it may be related to the severity of neurological deficits, preexisting or posthemiplegic soft tissue injury, subluxation, brachial plexus injury, or shoulder-hand syndrome. Shoulder pain may be preventable if risk factors can be identified and appropriate prophylaxis applied. Resolution of the condition depends on diagnosis and effective treatment at the onset of the symptoms. More clinical research is needed to clarify the cause of hemiplegic shoulder pain and to document the efficacy of prophylactic and treatment methods. PMID:2431421

Griffin, J W



Anesthesia and pain control.  


Successful anesthetic management of the critically ill patient requires familiarity with the pharmacologic properties of a variety of anesthetic drugs. An understanding of the altered physiology present in the critically ill allows an anesthetic regimen to be selected that prevents an anesthetic-induced decompensation. Pain should never go untreated because of a fear of causing excessive physiologic depression. There are numerous options available to control pain. A technique suitable in one instance may be unsuitable in another; for example, an animal that has a significant degree of respiratory compromise may not tolerate the additional respiratory insult associated with narcotic use. A local anesthetic technique may be preferred in this situation. Often a local technique is all that is necessary to control postoperative pain. Furthermore, if pain is controlled for the first 4 to 6 h post-insult, often no further analgesic drugs need to be administered. PMID:2688289

Bednarski, R M



Mechanisms of Neuropathic Pain  

PubMed Central

Neuropathic pain refers to pain that originates from pathology of the nervous system. Diabetes, infection (herpes zoster),nerve compression, nerve trauma, “channelopathies,” and autoimmune disease are examples of diseases that maycause neuropathic pain. The development ofbothanimal models and newer pharmacological strategies has led to an explosion of interest in the underlying mechanisms. Neuropathic pain reflects both peripheral and central sensitization mechanisms. Abnormal signals arise not only from injured axons but also from the intact nociceptors that share the innervation territory of the injured nerve. This review focuses on how both human studies and animal models are helping to elucidate the mechanisms underlying these surprisingly common disorders. The rapid gain in knowledge about abnormal signaling promises breakthroughs in the treatment of these often debilitating disorders.

Campbell, James N.; Meyer, Richard A.



Chronic Pelvic Pain  


... a specific diagnosis What you should know: The pelvic floor muscles act as a muscular sling that supports ... causes Chronic constipation or diarrhea can lead to pelvic floor dysfunction and pelvic pain can become very debilitating ...


Greater trochanteric pain syndrome.  


Pain around the greater trochanter is still a common clinical problem that may be secondary to a variety of either intra-articular or periarticular pathologies. Gluteal tendon pathologies are one of the primary causes of greater trochanteric pain, with attrition of the fasciae latae against the gluteus medius and minimus tendons, and the trochanteric bursa being possible causes. Key sonographic findings of gluteal tendinopathy, bursitis, and differential diagnosis are described in this overview. Clinical diagnosis and treatment of greater trochanteric pain syndrome is still challenging; therefore ultrasound is helpful to localize the origin of pain, determine underlying pathology, and, based on these findings, to guide local aspiration and/or injection in cases of tendinopathy and/or bursitis. PMID:23487333

Klauser, Andrea S; Martinoli, Carlo; Tagliafico, Alberto; Bellmann-Weiler, Rosa; Feuchtner, Gudrun M; Wick, Marius; Jaschke, Werner R



Mechanism of Cancer Pain  

PubMed Central

Ongoing and breakthrough pain is a primary concern for the cancer patient. Although the etiology of cancer pain remains unclear, animal models of cancer pain have allowed investigators to unravel some of the cancer-induced neuropathologic processes that occur in the region of tumor growth and in the dorsal horn of the spinal cord. Within the cancer microenvironment, cancer and immune cells produce and secrete mediators that activate and sensitize primary afferent nociceptors. Pursuant to these peripheral changes, nociceptive secondary neurons in spinal cord exhibit increased spontaneous activity and enhanced responsiveness to three modes of noxious stimulation: heat, cold, and mechanical stimuli. As our understanding of the peripheral and central mechanisms that underlie cancer pain improves, targeted analgesics for the cancer patient will likely follow.

Schmidt, Brian L.; Hamamoto, Darryl T.; Simone, Donald A.; Wilcox, George L.



Chest Pain: First Aid  


... or changes, becoming unstable, seek medical attention immediately. Pulmonary embolism Pulmonary embolism occurs when a clot — usually from the veins ... rest of your body. Signs and symptoms of pulmonary embolism may include: Sudden, sharp chest pain often accompanied ...


Postamputation pain: studies on mechanisms.  


Amputation is followed by both painful and non-painful phantom phenomena in a large number of amputees. Non-painful phantom sensations rarely pose any clinical problem, but 60-80% of all amputees also experience painful sensations (i.e. phantom pain) located to the missing limb. The severity of phantom pain usually decreases with time, but severe pain persists in 5-10% of patients. Pain in the residual limb (i.e. stump pain) is another consequence of amputation. Both stump and phantom pain can be very difficult to treat. Treatment guidelines used for other neuropathic pain conditions are probably the best approximation, especially for the treatment of stump pain. The aim of the present doctoral thesis was to explore some of the mechanisms underlying pain after amputation. Ten studies were carried out (I-X). My PhD thesis from 1998 dealt with pain before the amputation and showed that preamputation pain increases the risk of phantom pain after amputation (I). A perioperative epidural blockade, however, did not reduce the incidence of pain or abnormal sensory phenomena after amputation (II, III). The importance of sensitization before amputation for the subsequent development of pain is supported by study IV, in which pressure pain thresholds obtained at the limb before amputation were inversely related to stump and phantom pain after 1 week. Afferent input from the periphery is likely to contribute to postamputation pain as sodium channels were upregulated in human neuromas (VI), although neuroma removal did not always alleviate phantom pain (V). Sensitization of neurons in the spinal cord also seems to be involved in pain after amputation as phantom pain was reduced by ketamine, an NMDA-receptor antagonist. Another NMDA-receptor antagonist, memantine, and gabapentin, a drug working by binding to the ?2?-subunit of voltage-gated calcium channels, had no effect on phantom pain (VII-IX). Supraspinal factors are also important for pain after amputation as catastrophizing was associated with phantom pain (X). In conclusion, the present doctoral thesis confirmed and expanded the findings by others that several mechanisms are involved in the development and maintenance of phantom pain. A better understanding of the underlying mechanisms will hopefully lead to improved treatment of pain after amputation in the future. PMID:23158899

Nikolajsen, Lone



Sleep and pain.  


Noxious stimuli and painful disorders interfere with sleep, but disturbances in sleep also contribute to the experience of pain.Chronic paroxysmal hemicrania and possibly cluster headaches are related to REM sleep. Whereas headache is associated with snoring and sleep apnea, morning headaches are not specific for any primary sleep disorder. Nevertheless, the management of the sleep disorder ameliorates both morning headache and migraine.Noxious stimuli administered into muscles during slow-wave sleep (SWS) result in decreases in delta and sigma but an increase in alpha and beta EEG frequencies during sleep. Noise stimuli that disrupt SWS result in unrefreshing sleep, diffuse musculoskeletal pain, tenderness, and fatigue in normal healthy subjects. Such symptoms accompany alpha EEG sleep patterns that often occur in patients with fibromyalgia. The alpha EEG patterns include phasic and tonic alpha EEG sleep as well as periodic K alpha EEG sleep or frequent periodic cyclical alternating pattern. Moreover, alpha EEG sleep, as well as sleep-related breathing disorder and periodic limb movement disorder, occur in some patients with fibromyalgia, rheumatoid arthritis and osteoarthritis. Depression and not alpha EEG sleep are features of somatoform pain disorder. Disturbances in sleep, pain behaviour and psychological distress influence return to work in workers who have suffered a soft tissue injury, e.g. low back pain. Patients with irritable bowel disorder have disturbed sleep and have increased REM sleep. In conclusion, there is a reciprocal relationship between sleep quality and pain. The recognition of disturbed or unrefreshing sleep influences the management of painful medical disorders. PMID:12531004

Moldofsky, Harvey



Functional Abdominal Pain  

Microsoft Academic Search

Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by\\u000a the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits,\\u000a or menstrual periods (Drossman Gastroenterology 130:1377–1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently

Madhusudan Grover; Douglas A. Drossman



Pain assessment and management.  


Assessment and management of pain is crucial to the success of any program of care for dying patients and their families. With appropriate assessment and management, often using home health or hospice teams, pain can be controlled in more than 90% of patients. This article focuses on the symptomatic care of patients who are dying. The legal and regulatory issues that may inhibit delivery of adequate opioid therapy are also reviewed. PMID:11406435

Abrahm, J L; Snyder, L



Surgical management of pain.  


This article presents an overview of the neuroanatomical, neurochemical, and neurophysiological substrates of nociception relevant to the neurosurgical treatment of chronic pain. Consideration is given to the various procedures currently employed in the treatment of patients suffering from medically intractable chronic pain of both benign and malignant diseases, including their indications, techniques, and results. Particular attention is given to the modern neuroaugmentative methods, such as electrical stimulation and CNS drug infusion, that are progressively overshadowing the previously developed ablative procedures. PMID:1726524

Goodman, R R



Complex regional pain syndromes  

Microsoft Academic Search

Complex regional pain syndromes (CRPS) (formerly reflex sympathetic dystrophy and causalgia) are neuropathic pain conditions\\u000a that are initiated by an extremity trauma or peripheral nerve lesion. Clinical definition and scientific understanding of\\u000a CRPS are still evolving; however, both the clinical picture and therapeutic options are significantly influenced by a dysfunction\\u000a of the sympathetic nervous system. Recent investigations suggest functional central

Ralf Baron; Gunnar Wasner



Low back pain (acute)  

PubMed Central

Introduction Low back pain affects about 70% of people in resource-rich countries at some point in their lives. Acute low back pain can be self-limiting; however, 1 year after an initial episode, as many as 33% of people still have moderate-intensity pain and 15% have severe pain. Acute low back pain has a high recurrence rate; 75% of those with a first episode have a recurrence. Although acute episodes may resolve completely, they may increase in severity and duration over time. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatments for acute low back pain? What are the effects of local injections for acute low back pain? What are the effects of non-drug treatments for acute low back pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics (paracetamol, opioids), back exercises, back schools, bed rest, behavioural therapy, electromyographic biofeedback, epidural corticosteroid injections, lumbar supports, massage, multidisciplinary treatment programmes, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), spinal manipulation, temperature treatments (short-wave diathermy, ultrasound, ice, heat), traction, and transcutaneous electrical nerve stimulation (TENS).



Sodium channelopathies and pain  

Microsoft Academic Search

Chronic pain often represents a severe, debilitating condition. Up to 10% of the worldwide population are affected, and many\\u000a patients are poorly responsive to current treatment strategies. Nociceptors detect noxious conditions to produce the sensation\\u000a of pain, and this signal is conveyed to the CNS by means of action potentials. The fast upstroke of action potentials is mediated\\u000a by voltage-gated

Angelika Lampert; Andrias O. O’Reilly; Peter Reeh; Andreas Leffler



Tonsillolithiasis and orofacial pain.  


Tonsilloliths are rare calcified structures that usually result from chronic inflammation of the tonsils. Concretions show differences in size, shape and colour. They are usually asymptomatic but can be associated with halitosis, foreign body sensation, dysphagia and odynophagia, otalgia, and neck pain. A patient was referred because panoramic radiography performed by a general dentist revealed radiopaque shadows over the ascending rami of the mandible, located bilaterally: a solitary structure on the higher portion of the right side and two small structures on the left side. Paroxysmal attacks of orofacial pain and symptoms such as dysphagia and swallowing pain on the left side distributed within the tonsillar fossa and pharynx and the angle of the lower jaw were present. The computed tomography images revealed bilateral tonsilloliths. Clinically, there was no sign of inflammation, and the patient's past history revealed an approximately 2-year history of dysphagia, swallowing pain and left-sided neck pain. At the request of the patient, no surgical intervention was carried out. Glossopharyngeal neuralgia is a rare entity, and the aim of this report was to indicate the importance of tonsilloliths as a cause of orofacial pain. PMID:21615468

Siber, Stjepan; Hat, Josip; Brakus, Ivan; Bio?i?, Josip; Brajdi?, Davor; Zajc, Ivan; Bošan-Kilibarda, Ingrid; Macan, Darko



Spinal glia and chronic pain  

Microsoft Academic Search

Therapeutic management of chronic pain has not been widely successful owing to a lack of understanding of factors that initiate and maintain the chronic pain condition. Efforts to delineate the mechanisms underlying pain long have focused on neuronal elements of pain pathways, and both opiate- and non–opiate-based therapeutics are thought largely to target neurons. Abnormal neuronal activity at the level

James P. O'Callaghan; Diane B. Miller



Pain management after ambulatory surgery  

Microsoft Academic Search

Numerous studies have reported inadequate pain management after ambulatory surgery. Uncontrolled pain is associated with increased incidence of nausea, anxiety and delirium, prolonged postanesthesia care unit stay, delayed discharge from ambulatory facility, unanticipated hospital admissions and delayed resumption of normal activities. The management of pain after ambulatory surgery poses unique challenges because of the need to balance pain relief with

Girish P. Joshi



Lower Back Pain in Athletes  


AOSSM SPORTS TIPS LOWER BACK PAIN IN ATHLETES HOW COMMON IS LOW BACK PAIN? Low back pain is a very common problem in industrialized countries, affecting over 70 percent of the working population. Back pain is also common in such sports as football, ...


Pain: You Can Get Help  


... pain. These include antidepressants, anticonvulsive medicine, and local pain killers like nerve blocks or patches. As people age, ... a pain specialist. Most people who take narcotic drugs as prescribed by a ... an addiction problem. The side effects from pain medicine usually ...


Chronic pain in elderly people  

Microsoft Academic Search

Chronic pain in elderly people has only recently begun to receive serious empirical consideration. There is compelling evidence that a significant majority of the elderly experience pain which may interfere with normal functioning. Nonetheless, a significant proportion of these individuals do not receive adequate pain management. Three significant factors which may contribute to this are (1) lack of proper pain

Lucy Gagliese; Ronald Melzack



Pain characteristic differences between subacute and chronic back pain  

PubMed Central

Back pain is commonly classified based on duration. There is currently limited information regarding differences in the clinical features of back pain between these duration-based groupings. Here, we compared the pain characteristics of patients with subacute (SBP; pain 6–16 weeks, n = 40) and chronic back pain (CBP; pain ? 1year, n = 37) recruited from the general population. CBP patients reported significantly higher pain intensity on the Visual Analogue Scale (VAS) compared to SBP patients. Based on this finding, we investigated group differences and their dependence on VAS for the Beck Depression Inventory (BDI), sensory and affective dimensions of the McGill Pain Questionnaire (MPQ-S and MPQ-A), Neuropathic Pain Scale (NPS) and the variability of spontaneous pain. Correction for VAS abolished significant group differences on the MPQ-S, MPQ-A and NPS. Only a significant difference in the variability of spontaneous pain was independent of VAS. Finally, whereas SBP patients displayed a higher incidence of unilateral pain radiating down the legs/buttocks, there was a shift towards more bilateral pain in CBP patients. In summary, SBP and CBP groups differ on three independent parameters: VAS ratings, pain location and temporal dynamics of spontaneous pain.

Chanda, Mona Lisa; Alvin, Matthew D.; Schnitzer, Thomas J; Apkarian, A. Vania



Native American lithic procurement along the international border in the boot heel region of southwestern New Mexico  

NASA Astrophysics Data System (ADS)

Multidisciplinary field projects can be very useful to a more fundamental understanding of the world around us, though these projects are not as common as they should be. In particular, the combination of archeology and geology combines our understanding of human behavior and human use of the landscape with an intimate knowledge of geologic processes and the materials available for human use in order to gain a broader understanding of human-Earth interaction. Here we present data from a cross-disciplinary project that uses a common dataset, archeological artifacts, to explore the anthropological and geologic implications of useage patterns. Archeological excavations and surveys conducted by the Office of Contract Archeology in 2007 along the route of the proposed international border fence reveal patterns of use of geologic materials by Archaic, Formative and Protohistoric Native Americans in the Boot Heel of southwestern New Mexico. Thousands of artifacts were recorded in multiple sites from Guadalupe Pass in the southern Peloncillo Mountains to the Carrizalillo Hills west of Columbus. We identified the lithologies of artifacts, ranging from projectile points to groundstones, and then constructed material movement maps based on either known procurement sites ("quarries") or outcrops identified as the closest source to a given site for each lithology. Not unexpectedly, the majority of the rock types utilized by native peoples are local siliceous volcanic materials. However, several artifacts constructed from obsidian were transported into the region from northern Mexico and eastern Arizona, indicating long-distance travel and/or trade routes. We also examine useage pattern difference between Archaic, Formative and Protohistoric sites. Additionally, a dramatic change in distribution of sources for geologic materials occurs between one pre-Spanish site and one post-Spanish site that are adjacent to one another.

Zeigler, K. E.; Hughes, C.; Kurota, A.; Hogan, P.



Native American lithic procurement along the international border in the boot heel region of southwestern New Mexico  

NASA Astrophysics Data System (ADS)

Multidisciplinary field projects can be very useful to a more fundamental understanding of the world around us, though these projects are not as common as they should be. In particular, the combination of archeology and geology combines our understanding of human behavior and human use of the landscape with an intimate knowledge of geologic processes and the materials available for human use in order to gain a broader understanding of human-Earth interaction. Here we present data from a cross-disciplinary project that uses a common dataset, archeological artifacts, to explore the anthropological and geologic implications of useage patterns. Archeological excavations and surveys conducted by the Office of Contract Archeology in 2007 along the route of the proposed international border fence reveal patterns of use of geologic materials by Archaic, Formative and Protohistoric Native Americans in the Boot Heel of southwestern New Mexico. Thousands of artifacts were recorded in multiple sites from Guadalupe Pass in the southern Peloncillo Mountains to the Carrizalillo Hills west of Columbus. We identified the lithologies of artifacts, ranging from projectile points to groundstones, and then constructed material movement maps based on either known procurement sites ("quarries") or outcrops identified as the closest source to a given site for each lithology. Not unexpectedly, the majority of the rock types utilized by native peoples are local siliceous volcanic materials. However, several artifacts constructed from obsidian were transported into the region from northern Mexico and eastern Arizona, indicating long-distance travel and/or trade routes. We also examine useage pattern difference between Archaic, Formative and Protohistoric sites. Additionally, a dramatic change in distribution of sources for geologic materials occurs between one pre-Spanish site and one post-Spanish site that are adjacent to one another.

Zeigler, K. E.; Hogan, P.; Hughes, C.; Kurota, A.



Utilization of the MPI Process for in-tank solidification of heel material in large-diameter cylindrical tanks  

SciTech Connect

A major problem faced by the US Department of Energy is remediation of sludge and supernatant waste in underground storage tanks. Exhumation of the waste is currently the preferred remediation method. However, exhumation cannot completely remove all of the contaminated materials from the tanks. For large-diameter tanks, amounts of highly contaminated ``heel'' material approaching 20,000 gal can remain. Often sludge containing zeolite particles leaves ``sand bars'' of locally contaminated material across the floor of the tank. The best management practices for in-tank treatment (stabilization and immobilization) of wastes require an integrated approach to develop appropriate treatment agents that can be safely delivered and mixed uniformly with sludge. Ground Environmental Services has developed and demonstrated a remotely controlled, high-velocity jet delivery system termed, Multi-Point-Injection (MPI). This robust jet delivery system has been field-deployed to create homogeneous monoliths containing shallow buried miscellaneous waste in trenches [fiscal year (FY) 1995] and surrogate sludge in cylindrical (FY 1998) and long, horizontal tanks (FY 1999). During the FY 1998 demonstration, the MPI process successfully formed a 32-ton uniform monolith of grout and waste surrogates in about 8 min. Analytical data indicated that 10 tons of zeolite-type physical surrogate were uniformly mixed within a 40-in.-thick monolith without lifting the MPI jetting tools off the tank floor. Over 1,000 lb of cohesive surrogates, with consistencies similar to Gunite and Associated Tank (GAAT) TH-4 and Hanford tank sludges, were easily intermixed into the monolith without exceeding a core temperature of 100 F during curing.

Kauschinger, J.L.; Lewis, B.E.



Pain Perception during Menstrual Cycle  

Microsoft Academic Search

Sexual hormones influence complex brain function and pain perception. Many psychophysical studies attempted to establish pain\\u000a perception changes across menstrual cycle in animal models and healthy women or those with chronic pain. General results are\\u000a quite uncertain in regard to consistent menstrual-related fluctuations of pain perception. The few studies applying neurophysiological\\u000a procedures to test pain-related changes during menstrual cycle suggested

Marina de Tommaso


Gender role expectations of pain is associated with pain tolerance limit but not with pain threshold  

Microsoft Academic Search

Gender role expectations of pain (GREP) was suggested to predict sex differences in pain perception. Our aim was to explore sex differences in GREP and investigate its relationship with heat-pain threshold (HPT) and heat-pain tolerance limit (HPTL). University students (115 males, 134 females) filled the GREP questionnaire. HPT and HPTL were measured in a sample of 72 students. Additionally, GREP

Ruth Defrin; Libby Shramm; Ilana Eli



Factor analysis of human pain responses: Pain endurance as a specific pain factor  

Microsoft Academic Search

Induced cutaneous and deep somatic pain with chemical, electrical, and thermal noxious stimuli in 60 18-69 yr. Old chronic arthritis patients. Pain threshold, pain tolerance, and pain sensitivity range (psr) were measured psychophysically and correlated within and between techniques. The correlations were subjected to the centroid method of factor analysis and the 1st 4 factors extracted and rotated to a

B. Berthold Wolff



Catastrophizing, Pain, and Pain Interference in Individuals with Disabilities  

PubMed Central

Objective To examine the influence of sex and disability on catastrophizing, pain intensity, and pain interference in individuals with a spinal cord injury (SCI) or multiple sclerosis (MS). Design A cross-sectional survey design was employed. 248 community-dwelling adults with a physical disability (SCI=124; MS=124) and chronic pain completed measures of demographic and clinical characteristics, pain intensity and interference, psychological functioning, and pain catastrophizing. Results Men reported marginally greater catastrophizing (p<.10) than women across both disability groups; however, there was no significant difference in catastrophizing between disability groups. Catastrophizing was the only significant predictor of pain intensity in the multivariate regression analysis, with greater catastrophizing associated with greater pain. Pain intensity and catastrophizing were the only significant variables in the regression analyses predicting pain interference and psychological functioning; as hypothesized, greater pain intensity and catastrophizing were associated with more pain interference and poorer psychological functioning. There was also a trend (p<.10) for females, relative to males, to have a stronger association between catastrophizing and pain interference. Conclusions These findings are consistent with a biopsychosocial conceptualization of pain and functioning in individuals with chronic pain secondary to a physical disability. In addition, these data suggest that assessment and treatment (when indicated) of catastrophizing should be a regular part of the clinical management of these patients.

Hirsh, Adam T.; Bockow, Tamara B.; Jensen, Mark P.



Interventional pain medicine: retreat from the biopsychosocial model of pain.  


The field of pain medicine has shifted from multidisciplinary rehabilitation to procedure-focused interventional pain medicine (IPM). Considerable controversy exists regarding the efficacy of IPM and its more narrow focus on nociception as an exclusive target of pain treatment. This topical review aims to examine pain research and treatment outcome studies that support a biopsychosocial model of pain, and to critique the clinical practice of IPM given its departure from the premises of a biopsychosocial model. A modern definition of pain and findings from clinical and basic science studies indicate that pain-related psychological factors are integral to pain perception. The clinical viability of IPM is challenged based upon its biomedical view of peripheral nociception as a primary source of pain and the potential of this viewpoint to foster maladaptive pain attributions and discourage the use of pain coping strategies among chronic pain patients. IPM should adopt a biopsychosocial perspective on pain and operate within a framework of multidisciplinary pain rehabilitation to improve its effectiveness. PMID:24073101

Roth, Randy S; Geisser, Michael E; Williams, David A



Factors Affecting Delivery of Evidence-Based Procedural Pain Care in Hospitalized Neonates  

PubMed Central

Objective To examine the effects of nurse, infant, and organizational factors on delivery of collaborative and evidence-based pain care by nurses. Design Cross sectional. Setting Two Level III neonatal intensive care units in 2 large tertiary care centers in Canada. Participants A convenience sample of 93 nurses completed survey data on procedures they performed on ill neonates. The 93 nurses performed a total of 170 pain producing procedures on 2 different shifts. Main Outcome Nurse use of evidence-based protocols to manage procedure related pain using a scorecard of nurses’ assessment, management, and documentation. Results Procedural pain care was more likely to meet evidence-based criteria when nurse participants rated nurse-physician collaboration higher (odds ratio, 1.44; 95% confidence intervals 1.05–1.98), cared for higher care intensity infants (odds ratio, 1.21; 95% confidence intervals, 1.06–1.39), and experienced unexpected increases in work assignments (odds ratio, 1.55; 95% confidence intervals, 1.04–2.30). Nurses’ knowledge about the protocols, educational preparation and experience were not significant predictors of evidence-based care for the most common procedures: heel lance and intravenous initiation. Conclusion Nurse-physician collaboration and nurses’ work assignments were more predictive of evidence-based care than infant and nurse factors. Nurses’ knowledge regarding evidence-based care was not a predictor of implementation of protocols. In the final statistical modeling, collaboration with physicians, a variable amenable to intervention and further study, emerged as a strong predictor. The results highlight the complex issue of translating knowledge to practice, however, specific findings related to pain assessment and collaboration provide some direction for future practice and research initiatives.

Latimer, Margot A.; Johnston, Celeste C.; Ritchie, Judith A.; Clarke, Sean P.; Gilin, Debra



Functional abdominal pain  

PubMed Central

Functional abdominal pain or functional abdominal pain syndrome (FAPS) is an uncommon functional gut disorder characterised by chronic or recurrent abdominal pain attributed to the gut but poorly related to gut function. It is associated with abnormal illness behaviour and patients show psychological morbidity that is often minimised or denied in an attempt to discover an organic cause for symptoms. Thus the conventional biomedical approach to the management of such patients is unhelpful and a person's symptom experience is more usefully investigated using a biopsychosocial evaluation, which necessarily entails a multidisciplinary system of healthcare provision. Currently the pathophysiology of the disorder is poorly understood but is most likely to involve a dysfunction of central pain mechanisms either in terms of attentional bias, for example, hypervigilance or a failure of central pain modulation/inhibition. Although modern neurophysiological investigation of patients is promising and may provide important insights into the pathophysiology of FAPS, current clinical management relies on an effective physician-patient relationship in which limits on clinical investigation are set and achievable treatment goals tailored to the patient's needs are pursued.

Matthews, P; Aziz, Q



[Chest pain evaluation project].  


The evaluation of acute chest pain remains challenging, despite many insights and innovations over the past two decades. The percentage of patients presenting at the emergency department with acute chest pain who are subsequently admitted to the hospital appears to be increasing. Patients with acute coronary syndromes who are inadvertently discharged from the emergency department have an adverse short-term prognosis. However, the admission of a patient with chest pain who is at low risk for acute coronary syndrome can lead to unnecessary tests and procedures, with their burden of costs and complications. Therefore, with increasing economic pressures on health care, physicians and administrators are interested in improving the efficiency of care for patients with acute chest pain. Since the emergency department organization (i.e. the availability of an intensive observational area) and integration of care and treatment between emergency physicians and cardiologists greatly differ over the national territory, the purpose of the present position paper is two-fold: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the basic critical pathways (describing key steps for care and treatment) that need to be implemented in order to standardize and expedite the evaluation of chest pain patients, making their diagnosis and treatment as uniform as possible across the country. PMID:19292020

Filippo, Ottani; Nicola, Binetti; Casagranda, Ivo; Cassin, Matteo; Cavazza, Mario; Grifoni, Stefano; Lenzi, Tiziano; Lorenzoni, Roberto; Sbrojavacca, Rodolfo; Tanzi, Pietro; Vergara, Giuseppe



Canadian survey of postsurgical pain and pain medication experiences  

Microsoft Academic Search

Purpose  To assess the postoperative pain and pain medication experiences of Canadians.\\u000a \\u000a \\u000a \\u000a Methods  Three hundred and five general population subjects from across Canada who had surgery in the previous three years were retrospectively\\u000a questioned regarding pain experiences in the surgical facility and at home, pain medication efficacy and pain medication satisfaction.\\u000a \\u000a \\u000a \\u000a Results  While in the surgical facility, pain was experienced by 68% of

Angela Rocchi; Frances Chung; Lindy Forte



Congenital Idiopathic Clubfoot Deformities  

Microsoft Academic Search

Clubfoot is a birth defect that is marked primarily by a deformed talus (ie, ankle) and calcaneous (ie, heel) that give the foot a characteristic “club-like” appearance. In congenital idiopathic clubfoot (ie, talipes equinovarus), the infant's foot points downward (ie, equinus) and turns inward (ie, varus), while the forefoot curls toward the heel (ie, adduction). This congenital disorder has an

Susan P. Kyzer; Sharon Lee Stark



Patterns of physical activity and ultrasound attenuation by heel bone among Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): population based study  

PubMed Central

Objectives To study associations between patterns of physical activity and ultrasound attenuation by the heel bone in men and women. Design Cross sectional, population based study. Setting Norfolk. Participants 2296 men and 2914 women aged 45-74 registered with general practices participating in European Prospective Investigation into Cancer (EPIC Norfolk). Results Self reported time spent in high impact physical activity was strongly and positively associated with ultrasound attenuation by the heel bone, independently of age, weight, and other confounding factors. Men who reported participating in ?2 hours/week of high impact activity had 8.44 dB/MHz (95% confidence interval 4.49 to 12.40) or 9.5%, higher ultrasound attenuation than men who reported no activity of this type. In women, the difference in ultrasound attenuation between those reporting any high impact activity and those reporting none was 2.41 dB/MHz (0.45 to 4.37) or 3.4% higher. In women this effect was similar in size to that of an age difference of four years. Moderate impact activity had no effect. However, climbing stairs was strongly independently associated with ultrasound attenuation in women (0.64 dB/MHz (0.19 to 1.09) for each additional five flights of stairs). There was a significant negative association in women between time spent watching television or video and heel bone ultrasound attenuation, which decreased by 0.08 dB/MHz (0.02 to 0.14) for each additional hour of viewing a week. Conclusions High impact physical activity is independently associated with ultrasound attenuation by the heel bone in men and women. As low ultrasound attenuation has been shown to predict increased risk of hip fracture, interventions to promote participation in high impact activities may help preserve bone density and reduce the risk of fracture. However, in older people such interventions may be inappropriate as they could increase the likelihood of falls.

Jakes, Rupert W; Khaw, Kay-Tee; Day, Nicholas E; Bingham, Sheila; Welch, Ailsa; Oakes, Suzy; Luben, Robert; Dalzell, Nicola; Reeve, Jonathan; Wareham, Nicholas J



Neuropathic pain after dental treatment.  


The head and neck regions are the most common sites of the human body to be involved in chronic pain conditions. Neuropathic pain is a chronic pain condition, and refers to all pain initiated or caused by a primary lesion or dysfunction or transitory perturbation in the peripheral or central nervous system (CNS). Trigeminal neuralgia, atypical odontalgia (phantom tooth pain), burning mouth syndrome, traumatic neuropathies, postherpetic neuralgias and complex regional pain syndrome are neuropathic pain conditions in the orofacial region that can be encountered in pain and dental clinics. The majority of the time this problem is misdiagnosed by the dentist, which can lead to unnecessary treatments. These treatments may include endodontic treatment and extraction of the tooth or teeth in the region. In this review, only post-traumatic peripheral pain neuropathies seen after dental treatments will be discussed. PMID:23588863

T?nastepe, Neslihan; Oral, Koray



Pain experience of the elderly.  


Too often, the elderly suffer silently and needlessly with chronic pain. To investigate the pain experience of the elderly living in the community, a descriptive research design was used. The aims of the study were to determine the prevalence of pain in an older population living in the community, to obtain a description of the older adult's pain experience, and to determine strategies used to manage their pain. The results of the study indicated that >90% of the elderly living in the community experienced pain within the past month, with 41% reporting discomforting, distressing, horrible, or excruciating pain. Musculoskeletal pain was found to be the most predominant pain, and inactivity was the most effective strategy used to lessen pain. Pain in the elderly continues to be a challenge which needs to be addressed more effectively by health care providers. Based on the high prevalence of pain experienced by the elderly and the expected demographic shifts in the next two decades, it is imperative to continue research in this area to assure the highest quality of life, as well as maximum functional ability, for the elderly. Health care providers need to understand the multidimensional pain experience that occurs in the daily life of the community-dwelling older adult and the most effective management strategies that can be used to provide pain relief. PMID:22117750

Brown, Sylvia T; Kirkpatrick, Mary K; Swanson, Melvin S; McKenzie, Ila Leigh



The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control  

Microsoft Academic Search

Goals: Little is known about Israeli elders' cancer pain ex- perience. The purpose of this study was to explore the cancer pain expe- rience, including pain intensity, pain management index, pain interference, symptom severity, and knowledge and attitudes toward pain and pain control. Patients and methods: Descriptive cross-sectional methods were used to obtain data with four instruments. The patients were

Marlene Z. Cohen; Catherine F. Musgrave; Deborah B. McGuire; Neville E. Strumpf; Mark F. Munsell; Tito R. Mendoza; Maya Gips



Physiology of acute pain in preterm infants  

Microsoft Academic Search

Abstract Understanding the pain physiology of the preterm infant is essential to the provision of effective pain prevention and pain management. Peripheral and ascending pain pathways are mature by 20 weeks of gestation so infants are completely capable of feeling pain. The expression of pain in preterm infants is well documented. However, the immature descending pain pathway and lack of

Jane Cooper Evans



Pathobiology of neuropathic pain.  


This review deals with physiological and biological mechanisms of neuropathic pain, that is, pain induced by injury or disease of the nervous system. Animal models of neuropathic pain mostly use injury to a peripheral nerve, therefore, our focus is on results from nerve injury models. To make sure that the nerve injury models are related to pain, the behavior was assessed of animals following nerve injury, i.e. partial/total nerve transection/ligation or chronic nerve constriction. The following behaviors observed in such animals are considered to indicate pain: (a) autotomy, i.e. self-attack, assessed by counting the number of wounds implied, (b) hyperalgesia, i.e. strong withdrawal responses to a moderate heat stimulus, (c) allodynia, i.e. withdrawal in response to non-noxious tactile or cold stimuli. These behavioral parameters have been exploited to study the pharmacology and modulation of neuropathic pain. Nerve fibers develop abnormal ectopic excitability at or near the site of nerve injury. The mechanisms include unusual distributions of Na(+) channels, as well as abnormal responses to endogenous pain producing substances and cytokines such as tumor necrosis factor alpha (TNF-alpha). Persistent abnormal excitability of sensory nerve endings in a neuroma is considered a mechanism of stump pain after amputation. Any local nerve injury tends to spread to distant parts of the peripheral and central nervous system. This includes erratic mechano-sensitivity along the injured nerve including the cell bodies in the dorsal root ganglion (DRG) as well as ongoing activity in the dorsal horn. The spread of pathophysiology includes upregulation of nitric oxide synthase (NOS) in axotomized neurons, deafferentation hypersensitivity of spinal neurons following afferent cell death, long-term potentiation (LTP) of spinal synaptic transmission and attenuation of central pain inhibitory mechanisms. In particular, the efficacy of opioids at the spinal level is much decreased following nerve injury. Repeated or prolonged noxious stimulation and the persistent abnormal input following nerve injury activate a number of intracellular second messenger systems, implying phosphorylation by protein kinases, particularly protein kinase C (PKC). Intracellular signal cascades result in immediate early gene (IEG) induction which is considered as the overture of a widespread change in protein synthesis, a general basis for nervous system plasticity. Although these processes of increasing nervous system excitability may be considered as a strategy to compensate functional deficits following nerve injury, its by-product is widespread nervous system sensitization resulting in pain and hyperalgesia. An important sequela of nerve injury and other nervous system diseases such as virus attack is apoptosis of neurons in the peripheral and central nervous system. Apoptosis seems to induce neuronal sensitization and loss of inhibitory systems, and these irreversible processes might be in common to nervous system damage by brain trauma or ischemia as well as neuropathic pain. The cellular pathobiology including apoptosis suggests future strategies against neuropathic pain that emphasize preventive aspects. PMID:11698024

Zimmermann, M



Positive Traits Linked to Less Pain through Lower Pain Catastrophizing.  


The present study examined the association between positive traits, pain catastrophizing, and pain perceptions. We hypothesized that pain catastrophizing would mediate the relationship between positive traits and pain. First, participants (n = 114) completed the Trait Hope Scale, the Life Orientation Test- Revised, and the Pain Catastrophizing Scale. Participants then completed the experimental pain stimulus, a cold pressor task, by submerging their hand in a circulating water bath (0º Celsius) for as long as tolerable. Immediately following the task, participants completed the Short-Form McGill Pain Questionnaire (MPQ-SF). Pearson correlation found associations between hope and pain catastrophizing (r = -.41, p < .01) and MPQ-SF scores (r = -.20, p < .05). Optimism was significantly associated with pain catastrophizing (r = -.44, p < .01) and MPQ-SF scores (r = -.19, p < .05). Bootstrapping, a non-parametric resampling procedure, tested for mediation and supported our hypothesis that pain catastrophizing mediated the relationship between positive traits and MPQ-SF pain report. To our knowledge, this investigation is the first to establish that the protective link between positive traits and experimental pain operates through lower pain catastrophizing. PMID:22199416

Hood, Anna; Pulvers, Kim; Carrillo, Janet; Merchant, Gina; Thomas, Marie



Pain symptomatology and pain medication use in civilian PTSD.  


The comorbidity of pain syndromes and trauma-related syndromes has been shown to be high. However, there have been limited data, especially in civilian medical populations, on the role of trauma-related disorders such as posttraumatic stress disorder (PTSD) on chronic pain and pain medication use. We analyzed 647 general hospital patients in primary care and obstetrics and gynecological waiting rooms for the experience of trauma and PTSD-related stress disorders. PTSD symptoms were found to be significantly positively correlated with pain ratings (r=.282, P<0.001) and pain-related functional impairment (r=0.303, P<0.001). Those with a current PTSD diagnosis had significantly higher subjective pain and pain-related impairment ratings than those with no PTSD. Furthermore, those with a current diagnosis of PTSD were significantly more likely to have used opioid analgesics for pain control compared to those without a diagnosis of PTSD (?(2)=8.98, P=0.011). When analyzing the separate PTSD symptom subclusters (re-experiencing, avoidance, and hyperarousal), all symptom clusters were significantly related to pain and pain-related impairment ratings, but only the avoidance cluster was significantly related to prior opioid pain medication use. We conclude that PTSD and trauma-related disorders are common in impoverished medical populations and that their presence should be examined in patients with pain syndromes. Furthermore, these data suggest that PTSD and pain may share a vulnerability pathway, including the endogenous opioid neurotransmission systems. PMID:21665366

Phifer, Justine; Skelton, Kelly; Weiss, Tamara; Schwartz, Ann C; Wingo, Aliza; Gillespie, Charles F; Sands, Lauren A; Sayyar, Saleem; Bradley, Bekh; Jovanovic, Tanja; Ressler, Kerry J



Pain Symptomatology and Pain Medication Use in Civilian PTSD  

PubMed Central

The comorbidity of pain syndromes and trauma related syndromes has been shown to be high. However, there have been limited data, especially in civilian medical populations, on the role of trauma related disorders such as Post Traumatic Stress Disorder (PTSD) on chronic pain and pain medication use. We analyzed 647 general hospital patients in primary care and obstetrics and gynecological waiting rooms for the experience of trauma and PTSD related stress disorders. PTSD symptoms were found to be significantly positively correlated with pain ratings (r=.282, p<.001) and pain related function impairment (r=.303, p<.001). Those with a current PTSD diagnosis had significantly higher subjective pain and pain related-impairment ratings than those with no PTSD. Furthermore, those with a current diagnosis of PTSD were significantly more likely to have used opioid analgesics for pain control compared to those without a diagnosis of PTSD (?2=8.98, p=.011). When analyzing the separate PTSD symptom subclusters, (re-experiencing, avoidance and hyper-arousal), all symptom clusters were significantly related to pain and pain-related impairment ratings, but only the avoidance cluster was significantly related to prior opioid pain medication use. We conclude that PTSD and trauma-related disorders are common in impoverished medical populations and that their presence should be examined in patients with pain syndromes. Furthermore, these data suggest that PTSD and pain may share a vulnerability pathway including the endogenous opioid neurotransmission systems.

Phifer, Justine; Skelton, Kelly; Weiss, Tamara; Schwartz, Ann; Wingo, Aliza; Gillespie, Charles F.; Sands, Lauren; Sayyar, Saleem; Bradley, Bekh; Jovanovic, Tanja; Ressler, Kerry



Investigation of central pain processing in shoulder pain: converging results from two musculoskeletal pain models  

PubMed Central

Recent reports suggest deficits in conditioned pain modulation (CPM) and enhanced suprathreshold heat pain response (SHPR) potentially play a role in the development of chronic pain. The purpose of this study was to investigate whether central pain processing was altered in 2 musculoskeletal shoulder pain models. The goals of this study were to determine whether central pain processing: 1) differs between healthy subjects and patients with clinical shoulder pain, 2) changes with induction of exercise induced muscle pain (EIMP), and 3) changes 3 months after shoulder surgery. Fifty eight patients with clinical shoulder pain and 56 age and sex matched healthy subjects were included in these analyses. The healthy cohort was examined before inducing EIMP, and 48 and 96 hours later. The clinical cohort was examined before shoulder surgery and 3 months later. CPM did not differ between the cohorts, however; SHPR was elevated for patients with shoulder pain compared to healthy controls. Induction of acute shoulder pain with EIMP resulted in increased shoulder pain intensity but did not change CPM or SHPR. Three months following shoulder surgery clinical pain intensity decreased but CPM was unchanged from pre-operative assessment. In contrast SHPR was decreased and showed values comparable with healthy controls at 3 months. Therefore, the present study suggests that: 1) clinical shoulder pain is associated with measurable changes in central pain processing, 2) exercise-induced shoulder pain did not affect measures of central pain processing, and 3) elevated SHPR was normalized with shoulder surgery. Collectively our findings support neuroplastic changes in pain modulation were associated with decreases in clinical pain intensity only, and could be detected more readily with thermal stimuli.

Valencia, Carolina; Kindler, Lindsay L.; Fillingim, Roger B.; George, Steven Z.



Treatment of Neck Pain  

PubMed Central

Study Design Best evidence synthesis. Objective To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease. Summary of Background Data There have been no comprehensive systematic literature or evidence-based reviews published on this topic. Methods We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis. Results Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term out comes are improved with the surgical treatment of cervical radiculopathy compared to non operative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%–20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients. Conclusion Surgical treatment and limited injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments. Percutaneous and open surgical treatment for neck pain alone, without radicular symptoms or clear serious pathology, seems to lack scientific support.

Hurwitz, Eric L.; Cheng, Ivan; Carroll, Linda J.; Nordin, Margareta; Guzman, Jaime; Peloso, Paul; Holm, Lena W.; Cothe, Pierre; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Cassidy, J. David; Haldeman, Scott



Individualized pain medicine  

PubMed Central

Since the first draft of the human genome was published 10 years ago, scientists have tried to develop new treatment strategies for various types of diseases based on individual genomes. It is called personalized (or individualized) medicine and is expected to increase efficacy and reduce adverse reactions of drugs. Much progress has been made with newly developed technologies, though individualized pain medicine is still far from realization. Efforts on the integrative genomic analyses along with understandings of interactions between other related factors such as environment will eventually translate complex genomic information into individualized pain medicine.

Kim, Hyungsuk; Dionne, Raymond A.



Noncardiac Chest Pain  

PubMed Central

Noncardiac chest pain (NCCP) is very common, affecting up to 25% of the adult population in the United States. Treatment for NCCP has markedly evolved in the past decade and is presently focused on gastroesophageal reflux disease (GERD) and visceral hypersensitivity. Aggressive treatment with proton pump inhibitors has become the standard of care for GERD-related NCCP. Pain modulators such as tricyclics, trazodone, and selective serotonin reuptake inhibitors are considered the mainstay of therapy for non-GERD-related NCCP Other therapeutic modalities such as botulinum toxin injections and hypnotherapy have demonstrated promise in small clinical trials.

Schey, Ron; Villarreal, Autumn



[Management of breakthrough cancer pain].  


Breakthrough cancer pain has been defined as a transitory increase in pain intensity that occurs despite relatively stable and adequately controlled background pain. More than half of cancer patients with chronic pain suffer by some form of breakthrough cancer pain. The management of breakthrough cancer pain is comprehensive and includes pharmacological and nonpharmacological approaches. The principal treatment strategies are optimization of regular analgesic medication combined with effective rescues medication. The new transmucosal forms of fentanyl represent an important improvement in our treatment options. PMID:23763322

Sláma, O



Pain management in neurocritical care.  


The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the presentation, assessment, and development of pain in the clinical spectrum of patients with associated neurological problems seen in a general intensive care setting. Many conditions predispose to the development of chronic pain. There is evidence that swift and targeted pain management may improve the outcome. Importantly pain management is multidisciplinary. The available non-invasive, pharmacological, and invasive treatment strategies are discussed. PMID:23893074

Petzold, Axel; Girbes, Armand



Pain site and impairment in individuals with amputation pain  

Microsoft Academic Search

Marshall HM, Jensen MP, Ehde DM, Campbell KM. Pain site and impairment in individuals with amputation pain. Arch Phys Med Rehabil 2002;83:1116-9. Objective: To determine the association between pain site and pain interference with activities of daily living (ADLs) among persons with acquired amputation. Design: Survey. Setting: Community-based survey from clinical databases, flyer postings, and an advertisement in the inMotion

Helen M. Marshall; Mark P. Jensen; Dawn M. Ehde; Kellye M. Campbell



Low Back Pain: Where Does the Pain Come From?  

Microsoft Academic Search

\\u000a The pain mechanisms in patients with low back pain are unclear. Different theories exist about the mechanisms behind the experienced\\u000a pain, and different originating tissues are suggested to be of importance. The mechanisms in acute low back pain with recovery\\u000a within a few days are believed to be totally different compared to those in more long-standing (usually referred to as

Helena Brisby


Vicarious pain while observing another in pain: an experimental approach  

PubMed Central

Objective: This study aimed at developing an experimental paradigm to assess vicarious pain experiences. We further explored the putative moderating role of observer's characteristics such as hypervigilance for pain and dispositional empathy. Methods: Two experiments are reported using a similar procedure. Undergraduate students were selected based upon whether they reported vicarious pain in daily life, and categorized into a pain responder group or a comparison group. Participants were presented a series of videos showing hands being pricked whilst receiving occasionally pricking (electrocutaneous) stimuli themselves. In congruent trials, pricking and visual stimuli were applied to the same spatial location. In incongruent trials, pricking and visual stimuli were in the opposite spatial location. Participants were required to report on which location they felt a pricking sensation. Of primary interest was the effect of viewing another in pain upon vicarious pain errors, i.e., the number of trials in which an illusionary sensation was reported. Furthermore, we explored the effect of individual differences in hypervigilance to pain, dispositional empathy and the rubber hand illusion (RHI) upon vicarious pain errors. Results: Results of both experiments indicated that the number of vicarious pain errors was overall low. In line with expectations, the number of vicarious pain errors was higher in the pain responder group than in the comparison group. Self-reported hypervigilance for pain lowered the probability of reporting vicarious pain errors in the pain responder group, but dispositional empathy and the RHI did not. Conclusion: Our paradigm allows measuring vicarious pain experiences in students. However, the prevalence of vicarious experiences of pain is low, and only a small percentage of participants display the phenomenon. It remains however unknown which variables affect its occurrence.

Vandenbroucke, S.; Crombez, G.; Van Ryckeghem, D. M. L.; Brass, M.; Van Damme, S.; Goubert, L.



Neurophysiological characterization of postherniotomy pain.  


Inguinal herniotomy is one of the most frequent surgical procedures and chronic pain affecting everyday activities is reported in approximately 10% of patients. However, the neurophysiological changes and underlying pathophysiological mechanisms of postherniotomy pain are not known in detail, thereby precluding advances in treatment strategies and prophylaxis. Therefore, we examined forty-six patients reporting moderate to severe postherniotomy pain affecting daily activities for more than a year postoperatively, and compared them with a control group of patients without pain 1 yr postoperatively. A quantitative sensory testing protocol was used, assessing sensory dysfunction type, location and severity. We assessed the protocol test-retest variability using data from healthy control subjects. All patients (pain and pain-free) had signs of nerve damage, seen as sensory dysfunction. Detection thresholds for tactile and warmth stimulation were significantly increased while cold detection and pressure pain detection thresholds were significantly decreased in pain patients compared to controls. Repetitive punctuate and brush stimulation resulted in significantly more frequent and intense pain on the painful side than on the unaffected side in pain patients, and was not observed in controls. Our findings showed large and small fiber dysfunction in both pain and pain-free patients but more profound in pain patients and with signs of central sensitization (abnormal temporal summation). The specific finding of reduced pain detection threshold over the external inguinal annulus is consistent with damage to the cutaneous innervation territory of nervous structures in the inguinal region. The correspondence between pain location and sensory disturbance suggests that the pain is neuropathic in nature. Whether the underlying pathophysiological mechanisms are related to direct intraoperative nerve injury or nerve injury due to an inflammatory mesh response remains to be determined. PMID:17976914

Aasvang, Eske Kvanner; Brandsborg, Birgitte; Christensen, Bente; Jensen, Troels Staehelin; Kehlet, Henrik



The validity and reliability of a portable slip meter for determining floor slipperiness during simulated heel strike.  


A previously developed test rig was used as starting point for designing a portable slip meter with two new features. First, an inflatable pneumatic test wheel, consisting of six slider units, was introduced as the impacting contact element relative to floor surface. Second, an inductive trigger was built into the system to facilitate a precise timing of the slider-floor contact during the test. This new test rig was designed to measure transitional friction properties of contaminated floor surfaces during simulated heel strike, which is considered the most critical phase of gait from the slip and fall point of view. Another objective was to quantify the validity and reliability of this test method in the laboratory, but not yet in the field. The measurement process was evaluated on eight wet and oily floor surfaces (vinyl and ceramic tile floorings) using two slider materials (plain, profiled), two normal loads (100, 200 N), and two sliding velocities (0.15, 0.30 m/s) as independent variables. The outputs of the portable slip meter, in terms of transitional friction coefficients, were compared to force platform-based friction values and to slip resistance values obtained with a slip simulator apparatus for laboratory testing of shoes and floor surfaces. The outputs were also evaluated against slipperiness ratings made by three male subjects in paired comparison trials, in which the subjects walked over eight wet floor surfaces wearing shoes with the plain soling material. The results showed that test option 200 N and 0.15m/s led to optimum validity despite its tendency to promote frictional vibrations (stick-slip) in the contact surface. Compared to the lower sliding speed, the higher speed reduced both stick-slip and measurement bias. Test option 200 N and 0.30 m/s was the most reliable one in this experiment. It yielded lower friction coefficients than any other test option and reduced the likelihood of underestimating slip and fall hazards. The results implied that the minimum friction coefficient was 0.25 for preventing a fall on wet floor surfaces, whereas the limit for preventing a slip was in the range 0.30-0.35. Transitional friction measurement was found to be a valid and reliable indicator for slip resistance. A more accurate control of the normal force during testing is needed for actual field use of the test method. PMID:12504142

Grönqvist, Raoul; Hirvonen, Mikko; Rajamäki, Erkki; Matz, Simon



Greek Brief Pain Inventory: Validation and Utility in Cancer Pain  

Microsoft Academic Search

Objective: The Brief Pain Inventory (BPI) is a pain assessment tool. It has been translated into and validated in several languages. The purpose of this study was the translation into and validation of the BPI in Greek. Moreover, we wanted to detect cultural and social differences, if any, of pain interference in patients’ lives. Methods: The translation and validation of

Kyriaki Mystakidou; Tito Mendoza; Eleni Tsilika; Sofia Befon; Efi Parpa; George Bellos; Lambros Vlahos; Charles Cleeland



Postoperative pain control - the impact of an acute pain team  

Microsoft Academic Search

A two year prospective audit of the severity of postoperative pain and sedation in 1,781 patients receiving either patient controlled or epidural infusion analgesia (PCA or EIA) is presented. The introduction of an acute pain team (APT) led to sequential changes in procedures and policies, including nurse prescribing. The percentage of patients with moderate to severe pain fell from 35

Colm Lanigan; Nikki Luffingham



Experience with Dental Pain and Fear of Dental Pain  

Microsoft Academic Search

Anxious people tend to overestimate the intensity of aversive events such as fear and pain. When an aversive event has been experienced personally, prediction is based on experience and is possibly less subject to bias due to anxiety. Therefore, it was hypothesized that subjects will overestimate fear of specific dental pains relative to subjects who experienced the pain or procedure

A. J. van Wijk; J. Hoogstraten



Putting pain assessment into practice: Why is it so painful?  

PubMed Central

OBJECTIVE: To explore some of the reasons for poor compliance with the use of standardized pain assessment tools in clinical practice, despite numerous guidelines and standards mandating their use. METHODS: First, a review of research and clinical audit literature on the effects of standardized pain assessment tools on patient or process outcomes was conducted, and findings were critiqued. Second, a synthesis of recent literature on the biopsychosocial mechanisms of human detection and recognition of pain in others was presented. Third, the implications for pain assessment in pediatric clinical settings were discussed. RESULTS: There is a lack of good-quality evidence for the efficacy, effectiveness or cost-benefit of standardized pain assessment tools in relation to pediatric patient or process outcomes. Research suggests that there may be greater variability than previously appreciated in the ability and motivation of humans when assessing pain in others. It remains unknown whether pain detection skills or motivation to relieve pain in others can be improved or overcome by standardized methods of pain assessment. DISCUSSION: Further research is needed to understand the intra- and interpersonal dynamics in clinical assessment of pain in children and to test alternative means of achieving diagnosis and treatment of pain. Until this evidence is available, guidelines recommending standardized pain assessment must be clearly labelled as being based on principles or evidence from other fields of practice, and avoid implying that they are ‘evidence based’.

Franck, Linda S; Bruce, Elizabeth



The new JCAHO pain standards: Implications for pain management nurses  

Microsoft Academic Search

The newly approved Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards present an important opportunity for widespread and sustainable improvement in pain assessment and management. Unrelieved pain is a major, yet avoidable, public health problem. Despite 20 years of work by educators, clinicians, and professional organizations and the publication of clinical practice guidelines, there have been, at

Patricia H Berry; June L Dahl



Writing: A Painful Process.  

ERIC Educational Resources Information Center

|Based on the observation that freshman composition students associate writing with pain and unpleasantness and have been given little opportunity to engage in enjoyable writing, this paper advocates a method for making freewriting and the journal central and integral dimensions of the writing class. After discussing the techniques and the…

Moss, Anita


Empathy and pain  

NSDL National Science Digital Library

When your parents punish you and say, "this hurts me as much as it hurts you," they might not be making it up. Feeling empathy activates some, but not all, of the pain-processing regions of the human brain, according to a new brain-scan study.

American Association for the Advancement of Science (AAAS;)



[Suffering, pain and care].  


While psychic pain is linked to melancholy, to the loss of an object, psychological suffering indicates difficult affective phenomena, which are not necessarily connected to a personality structure or to a particular pathology, but which can be explained by the very nature of our humanity. PMID:23050357

Perrin-Niquet, Annick


Radiotherapy for Pain  

Microsoft Academic Search

Radiotherapy has been proven to be an effective treatment for the palliation of symptomatic bone metastases. Despite its widespread use and long history, there remains considerable debate over whether a single 8Gy fraction or multiple fraction schemes are more effective at alleviating bone pain. Recent meta-analyses have shown equal efficacy between the different treatment regimens. One of the reasons supporting

S. Culleton; S. Kwok; E. Chow



Cannabinoids and pain management  

Microsoft Academic Search

controlled, parallel-group trial studying the analgesic effects of two different doses of nabilone, a synthetic analogue of THC, in managing acute postoperative pain following major surgery. 5 Unfortunately, the study was prematurely terminated after 18 months. The results of this study demonstrated that nabilone administration was not associated with a decrease in morphine consumption in patients following major surgery. In

Orlando Hung; Mary E. Lynch; Alexander J. Clark



Vertebroplasty for Spine Fracture Pain  


MENU Return to Web version Vertebroplasty for Spine Fracture Pain Vertebroplasty for Spine Fracture Pain More than 40 million people in the ... bones that puts them at risk for spine fractures (broken bones). Thinning of the bones can occur ...


Psychological treatment of chronic pain.  


Psychological treatment has emerged as a common component of a multidimensional and interdisciplinary plan of pain care for many persons with persistent pain. Treatments are informed by a biopsychosocial model of pain and a long history of psychological research that has identified the central role of behavioral, cognitive, and emotional factors that are believed to contribute to the perpetuation, if not the development, of chronic pain and pain-related disability and emotional distress. Empirically supported self-regulatory, behavioral, cognitive-behavioral, and acceptance and commitment interventions are reviewed, and current and future interventions are highlighted. Important issues related to individual differences and disparities in the experience of pain and pain treatment are discussed. In particular, race and ethnicity are considered, and special considerations for the management of pain in children and older adults are discussed. PMID:21128783

Kerns, Robert D; Sellinger, John; Goodin, Burel R



Other Causes of Leg Pain  


... Home Current Issue Past Issues Special Section Other Causes of Leg Pain Past Issues / Summer 2008 Table of ... A.D. Other non-P.A.D. common causes of leg pain may include: A muscle cramp (also ...


Chronic pain in torture survivors.  


According to Amnesty International government-sanctioned torture is verified in one third of the countries in the world. The physical and psychological sequelae are numerous. This study focuses on pain diagnosis, characterising pain types as nociceptive, visceral or neuropathic. Torture victims from the Middle East, treated at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen, participated in the study. The patients were referred to a pain specialist for evaluation of unsolved pain problems. Eighteen male torture victims were examined. Twelve patients experienced pain at more than three locations. Nociceptive and neuropathic pain were demonstrated in all patients. Specific neuropathic pain conditions were related to the following four types of physical torture: Palestinian hanging, falanga, beating and kicking of the head, and positional torture. When treating torture victims, it is important to know about torture methods, to think differently than normal on etiological and pathogenetic factors and always consider the presence of neuropathic pain. PMID:10737462

Thomsen, A B; Eriksen, J; Smidt-Nielsen, K



Use Caution With Pain Relievers  

Center for Drug Evaluation (CDER)

Text Version... cough remedy may have the same active ingredient ... are basically two types of OTC pain relievers ... relieve the minor aches and pains associated with ... More results from


[Psychological pain diagnosis in children].  


Pain in premature infants, neonates, and young children impairs their development to a great extent and may lead to long-lasting pain memories and undertreatment of pain. Up to 15 years ago, the opinion prevailed that babies -- especially neonates -- could not feel pain generally, because they could not report their pain sensations to adults and were not able to verbalize their feelings. In the past decade, standardized scales have been developed to assess pain in children. While in neonates and children up to 2 years standardized scales were developed for observation of their reactions, for children 3 years and older self-report scales are used to assess pain sensations. The text describes a variety of standardized pain assessment scales which fulfil the requirements of reliability and validity. PMID:15040370

Kropp, P



Back pain during growth.  


It is wrong to believe that back pain only burdens adults: the yearly incidence during growth ranges from 10-20%, continuously increasing from childhood to adolescence. Rapid growth-related muscular dysbalance and insufficiency, poor physical condition in an increasingly sedentary adolescent community or - vice versa - high level sports activities, account for the most prevalent functional pain syndromes. In contrast to adults the correlation of radiographic findings with pain is high: the younger the patient, the higher the probability to establish a rare morphologic cause such as benign or malignant tumours, congenital malformations and infections. In children younger than 5 years old, the likelihood is more than 50%. The following red flags should lower the threshold for a quick in-depth analysis of the problem: Age of the patient <5 years, acute trauma, functional limitation for daily activities, irradiating pain, loss of weight, duration >4 weeks, history of tumour, exposition to tuberculosis, night pain and fever. High level sport equals a biomechanical field test which reveals the biologic individual response of the growing spine to the sports-related forces. Symptomatic or asymptomatic inhibitory or stimulatory growth disturbances like Scheuermann disease, scoliosis or fatigue fractures represent the most frequent pathomorphologies. They usually occur at the disk-growth plate compound: intraspongious disk herniation, diminuition of anterior growth with vertebral wedging and apophyseal ring fractures often occur when the biomechanical impacts exceed the mechanical resistance of the cartilaginous endplates. Spondylolysis is a benign condition which rarely becomes symptomatic and responds well to conservative measures. Associated slippage of L5 on S1 is frequent but rarely progresses. The pubertal spinal growth spurt is the main risk factor for further slippage, whereas sports activity - even at a high level - is not. Therefore, the athlete should only be precluded from training if pain persists or in case of high grade slips. Perturbance of the sagittal profile with increase of lumbar lordosis, flattening of the thoracic spine and retroflexion of the pelvis with hamstrings contractures are strong signs for a grade IV olisthesis or spondyloptosis with subsequent lumbosacral kyphosis. Idiopathic scoliosis is not related to pain unless it is a marked (thoraco-) lumbar curve or if there is an underlying spinal cord pathology. Chronic back pain is an under recognised entity characterised by its duration (>3 months or recurrence within 3 months) and its social impacts such as isolation and absence from school or work. It represents an independent disease, uncoupled from any initial trigger. Multimodal therapeutic strategies are more successful than isolated, somatising orthopaedic treatment. Primary and secondary preventive active measures for the physically passive adolescents, regular sports medical check-up's for the young high level athletes, the awareness for the rare but potentially disastrous pathologies and the recognition of chronic pain syndromes are the cornerstones for successful treatment of back pain during growth. PMID:23299906

Hasler, Carol C



Repetitive painful stimulation produces an expansion of withdrawal reflex receptive fields in humans.  


The aims of the present study were to investigate whether temporal summation of the nociceptive withdrawal reflex depends on the stimulation site on the sole of the human foot, and to characterize the reflex receptive fields (RRF) of lower limb muscles to repetitive stimulation. The cutaneous RRFs were assessed in 15 subjects in sitting position by recording the EMG from five lower leg muscles and the kinematic responses (ankle, knee, and hip joints) to repetitive painful electrical stimulation. The stimulus consisted of a series of five stimuli (frequency: 3 Hz) delivered randomly at 10 different sites on the sole of the foot. The size of the reflexes increased generally between the first and the second stimulus, however, the increment depended on the stimulation site. In tibialis anterior, the RRF covered the distal sole of the foot and gradually expanded during the stimulus train. No expansion toward the heel area was detected. In soleus, the reflexes were facilitated after the second stimulus at all sites and remained in this state until the last stimulus. In vastus lateralis, biceps femoris, and iliopsoas a gradual expansion of the RRF was seen, resulting in RRFs covering the lateral, distal foot, and part of the proximal foot (iliopsoas). Knee and hip flexion were evoked at all sites. Ankle dorsiflexion was evoked at the distal foot, while ankle plantarflexion was evoked at the heel. The enlargement of the RRF reflects spinal temporal summation leading to gradually stronger reflex responses. The degree of temporal summation was dependent on stimulation site. The facilitation of the withdrawal reflex responses due to repetitive stimulation might have potential applications in the rehabilitation engineering field, where these reflexes could be used to assist gait of patients with central nervous system injuries. PMID:15725222

Spaich, Erika G; Arendt-Nielsen, Lars; Andersen, Ole K



Painful diabetic neuropathy management.  


Diabetic neuropathy is the most common complication of diabetes as it affects a significant number of patients. The management of patients with diabetic neuropathy is complicated by several factors including the varied symptoms and response to the various treatments available. Strict blood glucose control remains the key to the management thus far nonetheless; it is associated with complications such as hypoglycaemia. In order to provide the most up-to-date evidence-based clinical recommendations pertinent to the management of diabetic neuropathy, several databases and clinical practice guidelines were searched for this evidence-based report. The main outcome measures are reduction in pain associated with diabetic neuropathy and the number of withdrawal rates due to adverse effects of the medications both of which are discussed in this report. Various pharmacological and non-pharmacological treatments are available with varying degrees of success in pain relief. The current evidence suggests that use of tricyclics antidepressants and conventional anticonvulsants for the short term of pain relief is beneficial. Combination therapy of opioids and anticonvulsants has also been found to be superior to monotherapy. Other treatment modalities such as the use of alpha-lipoic acid as an antioxidant and evening primrose oil through increased PGE1 synthesis have also been trialled with evidence of improvement in neuropathic pain. Evidence also supports non-pharmacological treatment such as the use of percutaneous electrical nerve stimulation. There is a scope for further improvement of the reporting of rating pain scales and including various outcomes measures such as quality of life and physical function when trialling new therapies for better evaluation of future treatments. PMID:23448333

Khalil, Hanan



The Pain Management in Orthodontics  

PubMed Central

Pain and discomfort are the frequent side-effects of the orthodontic therapy with fixed appliances. The people who experience orthodontic pain are likely to self-medicate with nonprescription pain relievers before seeing the dentist. It is imperative for an orthodontist to address questions that might arise in a clinical setting from the viewpoint of the clinicians and the patients/parents. This article will provide an overview of the current management strategies which are employed for alleviating orthodontic pain.

Shenoy, Nandita; Shetty, Siddarth; Ahmed, Junaid; Shenoy K., Ashok



Recurrent Pain in College Students  

Microsoft Academic Search

The authors investigated the prevalence of recurrent pain in a college student sample. Of the 1,564 students surveyed, 467 (29%) indicated that they had experienced recurrent pain at an intensity that was mostly in the mild-to-moderate range. Students who reported having recurrent pain were significantly older and more depressed than students who did not indicate they suffered from recurrent pain.

Britton W. Brewer; Paul Karoly



Knowledge Translation and Pain Management  

Microsoft Academic Search

Over the last few decades, there has been substantial growth in pediatric pain research, yet children continue to endure pain\\u000a despite this well-established body of evidence. Assessing, treating, and managing pain in children is complex because of the\\u000a developmental issues involved in assessing and understanding the child’s pain, the nature and the structure of health care\\u000a professionals’ work, the immense

Shannon Scott-Findlay; Carole A. Estabrooks


Neuropathic Pain: A Clinical Perspective  

Microsoft Academic Search

\\u000a Neuropathic pain syndromes, i.e., pain after a lesion or disease of the peripheral or central nervous system, are clinically\\u000a characterized by spontaneous pain (ongoing, paroxysms) and evoked types of pain (hyperalgesia, allodynia). A variety of distinct\\u000a pathophysiological mechanisms in the peripheral and central nervous system operate in concert: In some patients the nerve\\u000a lesion triggers molecular changes in nociceptive neurons

Ralf Baron


Pharmacologic treatment of neuropathic pain  

Microsoft Academic Search

Neuropathic pain, or pain after nervous system injury, can be very refractory to pharmacologic interventions. Through a better\\u000a understanding of the pathophysiology of neuropathic pain, it has been suggested that nonopioid agents, such as antidepressants\\u000a and anticonvulsants, may be more efficacious in the treatment of neuropathic pain than common analgesics, such as opioids\\u000a or nonsteroidal anti-inflammatory drugs. However, this has

Mark S. Wallace



Interventional Strategies for Pain Management  

Microsoft Academic Search

\\u000a The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience\\u000a associated with actual or potential tissue damage, or described in terms of such damage.” While pain is traditionally thought\\u000a of as a part of the body’s defense system, triggering a reflex reaction to retract or withdraw from a painful stimulus, in\\u000a certain

Kulbir S. Walia; Frederick W. Luthardt; Maneesh C. Sharma; Peter S. Staats


Remote Management of Pediatric Pain  

Microsoft Academic Search

\\u000a Many children and adolescents will experience pain that is recurrent or chronic in nature, and the provision of pain care\\u000a presents a challenge to many pediatricians. Pediatric pain care for patients and families who live at a distance from specialist\\u000a care add another dimension to these challenges. The overall approach to pain management is the same for patients and families

Paula A. Forgeron; Patrick J. McGrath


Substance Abuse in Cancer Pain  

Microsoft Academic Search

In the oncology community, opioids recently have become the cornerstone of cancer pain management. This has led to a rapid\\u000a increase in opioid prescribing in an effort to address the growing public health problem of chronic pain. A new paradigm in\\u000a noncancer pain management has emerged, that of risk assessment and stratification in opioid therapy. Techniques foreign to\\u000a cancer pain

Tatiana D. Starr; Lauren J. Rogak; Steven D. Passik



Myofascial pain syndrome and fibromyalgia  

Microsoft Academic Search

Myofascial pain syndrome and fibromyalgia represent two of the most common musculoskeletal disorders seen in clinical practice.\\u000a Although evidence is not conclusive, these two syndromes appear to be distinct pathophysiologically. Trigger points represent\\u000a a hallmark of myofascial pain whereas fibromyalgia is characterized by diffuse pain complaints. Characterization of the pain\\u000a with fibromyalgia has been reproducible across patients and mapped out

Richard L. Rauck



Caffeine and chronic back pain  

Microsoft Academic Search

Objective: Tobacco use and other behavioral factors are associated with chronic back pain. Anecdotes suggest excess caffeine use may also be associated with chronic back pain. We compared caffeine consumption by chronic back pain patients with caffeine consumption by controls.Design: Retrospective case-control study.Setting: A multispecialty outpatient facility.Patients: Sixty new, consecutive patients with chronic back pain compared to 60 new, consecutive

John M. McPartland; Julie A. Mitchell



Endpoints in pediatric pain studies  

Microsoft Academic Search

Assessing pain intensity in (preverbal) children is more difficult than in adults. Tools to measure pain are being used as\\u000a primary endpoints [e.g., pain intensity, time to first (rescue) analgesia, total analgesic consumption, adverse effects, and\\u000a long-term effects] in studies on the effects of analgesic drugs. Here, we review current and promising new endpoints used\\u000a in pediatric pain assessment studies.

Monique van Dijk; Ilse Ceelie; Dick Tibboel



Pain catastrophizing and pain-related fear in osteoarthritis patients: relationships to pain and disability.  


This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps < or = 0.05) of variance in measures of pain (partial r(2) [pr(2)] = 0.10), psychological disability (pr(2) = 0.20), physical disability (pr(2) = 0.11), and gait velocity at normal (pr(2) = 0.04), fast (pr(2) = 0.04), and intermediate speeds (pr(2) = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr(2) = 0.07) and walking at a fast speed (pr(2) = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear. PMID:19041218

Somers, Tamara J; Keefe, Francis J; Pells, Jennifer J; Dixon, Kim E; Waters, Sandra J; Riordan, Paul A; Blumenthal, James A; McKee, Daphne C; LaCaille, Lara; Tucker, Jessica M; Schmitt, Daniel; Caldwell, David S; Kraus, Virginia B; Sims, Ershela L; Shelby, Rebecca A; Rice, John R



The Brain and Chronic Pain  

Microsoft Academic Search

Objective: To review investigations into an association between brain changes and chronic pain; to synthesize the findings in the hope of generating interest among psychiatrists and casting some light on the road ahead. Conclusions: There is good evidence that chronic pain is associated with changes in brain function. It is possi- ble that these brain changes compound chronic pain and

Saxby Pridmore; Hazel Samilowitz; Gajinder Oberoi



Radiographic Assessment for Back Pain  


Radiographic Assessment for Back Pain What are Radiographic Assessments? When Should I get an X-ray for Low Back Pain? Other Reasons for Having an X-ray What ... What are Radiographic Assessments? Radiographic assessments for low back pain involve the use of X-rays to determine ...


How Do Pain Relievers Work?  


... The Pink Locker Society How Do Pain Relievers Work? KidsHealth > Kids > Q&A > Q & A > How Do Pain Relievers Work? Print A A A Text Size Yow! Your ... the spot that hurts so much. Pain relievers work with your cells, your body's nerve endings, your ...


[Differential diagnosis of groin pain].  


Groin pain is frequent but often problematic as it covers a very broad differential diagnosis. The localisation of pain in one of the five anterior hip regions helps to establish a precise diagnosis and an adapted treatment. We review the differential diagnosis and treatment of anterior hip pain. PMID:18277763

Wettstein, Michael; Mouhsine, Elyazid; Borens, Olivier; Theumann, Nicolas



Central Neuroplasticity and Pathological Pain  

Microsoft Academic Search

The traditional specificity theory of pain perception holds that pain involves a direct transmission system from somatic receptors to the brain. The amount of pain perceived, moreover, is assumed to be directly proportional to the extent of injury. Recent research, however, indicates far more complex mechanisms. Clinical and experimental evidence shows that noxious stimuli may sensitize central neural structures involved

Ronald Melzack; Terence J. Coderre; Joel Katz; Anthony L. Vaccarino



Cancer pain management in children  

Microsoft Academic Search

The World Health Organization document Cancer Pain Relief and Palliative Care in Children (WHO, 1998) advocates the global application of the principles of pain management and palliative care for children with cancer. The principles of pain management include the application of the WHO analgesic ladder, appropriate opioid dose escalation, the use of adjuvant analgesics, and the use of non-pharmacological methods

John J. Collins



Food Deprivation Sensitizes Pain Perception  

Microsoft Academic Search

While food deprivation has known effects on sympathovagal balance, little is known about hunger’s influence on the perception of pain. Since autonomic activities influence many cognitive and emotional processes, this suggests that food deprivation should interact with the perception of pain. This study analyzed the possible effects of short-term food deprivation on pain sensitivity in healthy female participants. This study

Olga Pollatos; Beate M. Herbert; Jürgen Füstös; Katja Weimer; Paul Enck; Stephan Zipfel



The dimensionality of pain: palliative care and chronic pain patients differ in their reports of pain intensity and pain interference.  


The accurate, precise, and consistent assessment of pain is of particular importance in palliative care. The European Palliative Care Research Collaborative is developing a computer-based pain assessment instrument and has been evaluating the content and dimensionality of existing pain questionnaires. The most important dimensions of pain are intensity and interference. However, since pain interference is a consequence of and largely reflects pain intensity, we postulated that it might either provide information to enhance the evaluation of intensity, or that an overall summary measure of pain severity could be constructed by combining the 2 dimensions. Cancer patients in palliative care (n=395) and chronic pain patients (n=168) completed questionnaires that included 23 pain items culled from existing questionnaires. Psychometric analyses confirmed the existence of 2 main dimensions, intensity and interference, and also guided identification of items that contributed most strongly to these dimensions. However, there was strong evidence that the relationship between the intensity and the interference items differs markedly in palliative care patients compared to chronic pain patients. As hypothesized, there was strong correlation between intensity and interference, lending support to the possibility that, for some purposes, these dimensions may be combined to provide a higher-level summary measure of patients' pain experience. We conclude that these dimensions should be kept distinct when assessing patients in general, although for a single type of patient (such as palliative care patients), it may be possible to regard intensity and interference as contributing to an overall measure of pain severity. PMID:21458921

Fayers, Peter M; Hjermstad, Marianne J; Klepstad, Pål; Loge, Jon Håvard; Caraceni, Augusto; Hanks, Geoffrey W; Borchgrevink, Petter; Kaasa, Stein



Sever's Injury: A Clinical Diagnosis.  


Background: The diagnosis of Sever's injury (apophysitis calcanei) has previously been partly based on radiographic findings in the calcaneal apophysis. Sclerosis and fragmentation have been supposed to represent signs of inflammation due to tractions from the Achilles tendon. The clinical findings, diagnostic criteria, and studied population are often poorly defined. We sought to define diagnostic criteria by analyzing clinical and radiographic characteristics in a population with Sever's injury and to compare the findings with those of a control group of matched, symptom-free children. Methods: We assessed 30 consecutive children with Sever's injury with high levels of pain but high physical activity levels in sports activities and 15 pain-free matched controls. Results: One-leg heel standing showed 100% sensitivity; the squeeze test, 97%; and the palpation test, 80%. All three tests showed 100% specificity. All of the patients and controls showed increased density of the apophysis. Half of the pain-free controls showed fragmentation versus almost 90% of children with heel pain. Conclusions: The diagnosis of Sever's injury is clinical, not radiologic. Radiologic findings of increased density and fragmentation are found also in pain-free controls with high levels of physical activity and may, therefore, represent normal growth and development. We suggest that the diagnosis of Sever's injury should be based on patient history and the results of two specific clinical tests. PMID:24072363

Perhamre, Stefan; Lazowska, Dagmara; Papageorgiou, Sofia; Lundin, Fredrik; Klässbo, Maria; Norlin, Rolf


Cognitive behavioral therapy for back pain  


... CBT) can help many people deal with chronic back pain. ... Nonspecific back pain - cognitive behavioral; Backache - chronic - cognitive behavioral; Lumbar pain - chronic - cognitive behavioral; Pain - back - chronic - cognitive behavioral; Chronic ...


Non-Drug Pain Relief: Imagery  


... and language needs, call (614) 293-3259. Non-Drug Pain Relief: Imagery Relaxation helps lessen tension. One ... your pain. Imagery does not replace your pain medicine. It works with your pain medicine to help ...


Transition to Chronic Pain in Men With Low Back Pain: Predictive Relationships Among Pain Intensity, Disability, and Depressive Symptoms  

Microsoft Academic Search

Pain intensity, disability, and depressive symptoms are hallmarks of chronic pain conditions, but little is known about the relationships among these symptoms in the transition from acute to chronic pain. In this study, an inception cohort of men with low back pain (N = 78) was assessed at 2, 6, and 12 months after pain onset. At 6 months, pain

JoAnne E. Epping-Jordan; Dennis R. Wahlgren; Rebecca A. Williams; Sheri D. Pruitt; Mark A. Slater; Thomas L. Patterson; Igor Grant; John S. Webster; J. Hampton Atkinson



Calcaneus (Heel Bone) Fractures  


... They are held together with special screws or metal plates and screws. Percutaneous screw fixation. Sometimes, if the ... bone fragments and holding them in place with metal plates and screws. Top of page Recovery Bones have ...


Post Amputation Chronic Pain Profile and Management  

Microsoft Academic Search

\\u000a The pain profile following amputation is complex and can be considered as an amalgam of acute post-operative pain, nociceptive\\u000a pain of the stump, neuropathic pain of the stump, phantom limb pain, mechanical back pain, and pain in more remote sites (such\\u000a as proximal ipsilateral joints, the contralateral limb) caused indirectly by amputation of the limb. The composition of the\\u000a pain

Jai Kulkarni; Kate Grady


Hypnosis and pain in children.  


The development of studies on neuroimaging applied to hypnosis and to the study of pain not only helps to validate the existence of a hypnotic state but also to ratify its therapeutic effects. These studies also enable us to understand how hypnosis is effective on the cortical level. It also helps us see, from another perspective, the mechanisms of pain leading perhaps to a different definition of pain. This article develops the latest knowledge in the domain of hypnosis and pain, and approaches the clinical practices and their applications in the management of pain in children. PMID:18243640

Wood, Chantal; Bioy, Antoine



Pain management: a regulatory issue.  


Pain is a significant public health issue in the United States, and pain management has serious implications for the regulation of healthcare professionals. Pain management is recognized as important and integral to the practice of nursing. This article describes the legal and regulatory framework for pain management and identifies 4 specific regulatory issues. The public protection responsibility of boards of nursing is complicated by the need to appropriately concentrate on investigative, educational, and disciplinary work of the boards while not interfering with safe, effective pain management nursing care. Proactive board functions are suggested to support boards in maintaining this balance. PMID:18813085

Brekken, Shirley A; Sheets, Vickie


Acculturation and Cancer Pain Experience  

PubMed Central

Purpose: Using a feminist perspective, the relationship between acculturation and cancer pain experience was explored. Design: This was a cross-sectional, correlational Internet study among 104 Hispanic and 114 Asian cancer patients. The instruments included both unidimensional and multidimensional cancer pain measures. Findings: There were significant differences in cancer pain scores by country of birth. Yet, there was no significant association of acculturation to cancer pain scores. Discussion and Conclusions: This study indicated inconsistent findings. Implications for Practice: To provide directions for adequate cancer pain management, further studies with a larger number of diverse groups of immigrant cancer patients are needed.

Im, Eun-Ok; Ho, Tsung-Han; Brown, Adama; Chee, Wonshik



[Neurosurgical treatment of chronic pain].  


Neurosurgical treatment of pain is based on 3 concepts: 1) lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (cordotomy, radicotomy...), they are indicated to treat morphine-resistant cancer pain; 2) neuromodulation techniques try to decrease pain by reinforcing inhibitory mechanisms, using chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation...) to treat chronic neuropathic pain; 3) intrathecal infusion of analgesics (morphine, ziconotide), using implantable pumps, allows to increase their efficacy and to reduce their side effects. These techniques can improve, sometimes dramatically, patients with severe and chronic pain, refractory to all other treatments. PMID:23923757

Fontaine, Denys



Exercise in muscle pain disorders.  


Muscle pain disorders range from local or regional (myofascial pain) to widespread (fibromyalgia). Many people with muscle pain have decreased fitness. Exercise intolerance is a common feature as well, and yet exercise plays an important role in the treatment of muscle pain disorders. Results of studies have shown repeatedly, via multiple modes and methods of delivery, that exercise is at least as effective as the best pharmacologic treatments. An understanding by clinicians and their patients of the unique benefits of a carefully crafted exercise program is one step in the successful management of these often frustrating muscle pain disorders. PMID:23174555

Thompson, Jeffrey M



Pain in multiple sclerosis: A biopsychosocial perspective  

Microsoft Academic Search

Clinically significant pain has been found in as many as 65% of persons diagnosed with multiple sclerosis (MS). Acute pain conditions include trigeminal neuralgia, painful optic neuritis, and Lhermitte's syndrome. Chronic pain conditions such as dysesthesias in the limbs, joint pain, and other musculoskeletal or mechanical pain problems develop as a function of spasticity and deconditioning associated with MS. These

Robert D. Kerns; Marilyn Kassirer; John Otis


Mal-united fracture of calcaneum treated with lateral decompression.  


Fracture calcaneum is commonly complicated with mal-union. Mal-union is usually presented with broadening of the lateral wall of the calcaneum, irregularity of the sub-talar joint and loss of the vertical height of the body of calcaneum with varus rotation. In this study twenty three (n=23) patients underwent a lateral decompression for pain on lateral aspect of foot on walking and tip toeing, secondary to a mal-united calcaneal fracture with or without sub-talar intra-articular involvement. Almost every patient had ballooned out body of calcaneum with impingement of peroneal tendon sheath with its content and lateral heel pain as a result of deformity. So in current study the operative procedure selected was excision of a lateral calcaneal bony mass and decompression of the peroneal tendon to relieve pain. Peroneal tenogram was a routine procedure before surgery to detect presence and site of blockade within tendon sheath. The average follow-up was for a period of 31.6 months. Result was assessed according to American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Scale. Two patients (n=2, 8.69%) had excellent (Category 1) result, seventeen (n=17, 73.9%) were good (Category 2), two (n=2, 8.69%) were fair (Category 3) and rest two (n=2, 8.69%) were with poor (Category 4) outcome. Every four out of five patients got back painless Heel and Ankle after surgery. The results suggest that the lateral decompression procedure is a technically simpler yet viable alternative to late sub-talar fusion for lateral pain following a mal-united fracture of calcaneum. PMID:23416823

Bhattacharyya, A; Raman, R



TRP Channels and Pain.  


Nociception is the process whereby primary afferent nerve fibers of the somatosensory system detect noxious stimuli. Pungent irritants from pepper, mint, and mustard plants have served as powerful pharmacological tools for identifying molecules and mechanisms underlying this initial step of pain sensation. These natural products have revealed three members of the transient receptor potential (TRP) ion channel family-TRPV1, TRPM8, and TRPA1-as molecular detectors of thermal and chemical stimuli that activate sensory neurons to produce acute or persistent pain. Analysis of TRP channel function and expression has validated the existence of nociceptors as a specialized group of somatosensory neurons devoted to the detection of noxious stimuli. These studies are also providing insight into the coding logic of nociception and how specification of nociceptor subtypes underlies behavioral discrimination of noxious thermal, chemical, and mechanical stimuli. Biophysical and pharmacological characterization of these channels has provided the intellectual and technical foundation for developing new classes of analgesic drugs. PMID:24099085

Julius, David



Mysterious Abdominal Pain  

PubMed Central

A man presented to the emergency room with recurrent episodes of abdominal pain. He had a history of coronary artery bypass grafting of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery and the right gastroepiploic artery to the posterior descending artery. After numerous gastrointestinal evaluations, a stress test was performed, which was positive. Coronary angiography showed a proximal occlusion of the LAD and right coronary artery and a normal functioning LIMA bypass. Aortography showed a 95% stenosis of the celiac trunk. Angioplasty and stent implantation of the celiac trunk was successfully performed. Six months later the patient was completely asymptomatic with a negative stress test. In conclusion, abdominal pain in patients who have undergone coronary artery bypass surgery using the right gastroepiploic artery should raise suspicion not only of a stenosis of the arterial conduit but also of a potential stenosis of the celiac trunk.

Cappelletti, Alberto; Cristell, Nicole; Mazzavillani, Monica; Margonato, Alberto



Depression, pain, and hemispheric activation.  


The present study attempts to delineate the role of hemispheric activation in depression and pain. It was hypothesized that the right hemisphere is specialized to become activated by and to process negative affective stimuli, and that this specialization may play a role in the co-occurrence of depression and pain. The relationship between depression, experimental pain, and cerebral laterality was investigated in 16 depressed and 16 nondepressed, right-handed, female students. Cerebral laterality was measured via tasks assessing visual and auditory biases, and pain was assessed via a cold pressor task. The proposition that the right hemisphere mediates the co-occurrence of pain and depression was not supported, but specific findings did suggest that the right hemisphere may play a unique role in pain perception. Data from the visual task indicated that prior exposure to pain results in increased right hemisphere activation as indicated by a left visual field bias. Pain perception was a complex function of mood, preceding tasks, and the hand tested, and it was suggested that exposure to a typical right-hemisphere task increased the left side lateralization of pain in nondepressed subjects. Implications of these findings are discussed for coexisting problems of pain and depression and for the lateralization of pain in disorders judged to involve a significant psychogenic component. PMID:2703826

Otto, M W; Dougher, M J; Yeo, R A



Elbow pain in pediatrics  

Microsoft Academic Search

The pediatric and adolescent elbow is subject to both acute and chronic overuse injuries. The practitioner should develop\\u000a a classification system to evaluate all such injuries, with first focusing on whether the injury represents an acute episode\\u000a or rather it represents a more chronic problem. In addition, localizing the area of pain as being either medial, lateral,\\u000a or posterior can

Marshall Crowther



Basic Mechanisms of Pain  

Microsoft Academic Search

Pain itself occurs in the central nervous system (CNS), while the peripheral nervous system reports on tissue damage via a\\u000a mechanical event, termed nociception, characterized by the discharge of high-threshold primary afferent fibers. Neuronal responses\\u000a in these peripheral fibers drive spinal cord activity and result in signals ascending to the brainstem and thalamus through\\u000a spinal cord tracts. It is from

Frank Willard


The Ethical Pain  

Microsoft Academic Search

The intriguing issue of pain and suffering in patients with disorders of consciousness (DOCs), particularly in Unresponsive\\u000a Wakefulness Syndrome\\/Vegetative State (UWS\\/VS) and Minimally Conscious State (MCS), is assessed from a theoretical point of\\u000a view, through an overview of recent neuroscientific literature, in order to sketch an ethical analysis. In conclusion, from\\u000a a legal and ethical point of view, formal guidelines

Michele Farisco


MAP kinase and pain  

Microsoft Academic Search

Mitogen-activated protein kinases (MAPKs) are important for intracellular signal transduction and play critical roles in regulating neural plasticity and inflammatory responses. The MAPK family consists of three major members: extracellular signal-regulated kinases (ERK), p38, and c-Jun N-terminal kinase (JNK), which represent three separate signaling pathways. Accumulating evidence shows that all three MAPK pathways contribute to pain sensitization after tissue and

Ru-Rong Ji; Robert W. Gereau IV; Marzia Malcangio; Gary R. Strichartz



Gynecologic Pelvic Pain  

PubMed Central

The family physician dealing with gynecologic pelvic pain (acute or chronic) enters at the beginning of the problem as diagnostician, refers the patient to a specialist in the interim, and resumes care in the follow-up period. Patients with chronic pelvic pain (pelvic pain that has lasted for at least six months) can be difficult to treat because they often have a history of dysfunctional family life, sexual and marital problems, and often a hidden history of sexual molestation or incest. The family physician can best care for the patient with empathy, a long ventilated history, complete physical and pelvic examination, and pelvic ultrasonograpy if necessary. Laparoscopy normally shows pelvic adhesions in one third of these patients, minimal endometriosis in one third, and a normal pelvis in the final third. The family physician should specifically reassure patients with normal results that they do not have cancer. The ideal therapy combines both stimulation-produced analgesia and treatment of the psychological, emotional, sociological, and environmental aspects of the disease.