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1

Medial calcaneal nerve entrapment as a cause for chronic heel pain.  

PubMed

Clinicians often have difficulty correctly identifying the etiology of heel pain. The purpose of the case report was to demonstrate differential diagnosis and possible interventions for heel pain. The article describes the diagnosis and management of a 36-year-old female patient with an 8-year history of heel pain. After all mechanical etiologies were ruled out, it was determined that her heel pain was the result of entrapment of the medical calcaneal branch of the tibial nerve. Correct diagnosis led to an intervention that resulted in complete symptom relief. The case presents an example for how careful differential diagnosis of heel pain is essential for achieving the desired intervention outcomes. PMID:18574754

Diers, David J

2008-01-01

2

Heel pain  

MedlinePLUS

Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

3

Diagnosis of heel pain.  

PubMed

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

2011-10-15

4

Heel Pain  

MedlinePLUS

... Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may ... Excessive Pronation: Heel pain sometimes results from excessive ...

5

Heel pain and phonophoresis.  

PubMed

A review of 25 cases of heel pain treated conservatively with phonophoresis, using the anti-inflammatory gel containing a combination of flufenamic acid, salicylic acid and mucopolysaccharide polysulphate is being reported here. The purpose of the study was to assess the effectiveness of a noninvasive procedure called phonophoresis in treating hell pain. It involved usage of ultrasound waves to deliver anti-inflammatory drugs to the painful site. The heel pain subsided in all the cases and did not recur for a period of one year till last reviewed indicating the definite role of phonophoresis in heel pain. PMID:21121387

Deshpande, Milind M; Patil, C B

2010-06-01

6

Role of the calcaneal heel pad and polymeric shock absorbers in attenuation of heel strike impact.  

PubMed

The capacity of the calcaneal heel pad, with and without augmentation by a polymeric shock absorbing material (Sorbothane 0050), to attenuate heel strike impulses has been studied using five fresh human cadaveric lower leg specimens. The specimens, instrumented with an accelerometer, were suspended and impacted with a hammer; a steel rod was similarly suspended and impacted. The calcaneal heel pad attenuated the peak accelerations by 80%. Attenuations of up to 93% were achieved by the shock absorbing material when tested against the steel rod; however, when tested in series with the calcaneal heel pad, the reduction in peak acceleration due to the shock absorbing material dropped to 18%. Any evaluation of the effectiveness of shock absorbing shoe materials must take into account their mechanical interaction with the body. PMID:8419676

Noe, D A; Voto, S J; Hoffmann, M S; Askew, M J; Gradisar, I A

1993-01-01

7

Plantar and medial heel pain: diagnosis and management.  

PubMed

Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution. PMID:24860133

Lareau, Craig R; Sawyer, Gregory A; Wang, Joanne H; DiGiovanni, Christopher W

2014-06-01

8

Plantar heel pain.  

PubMed

Plantar heel pain is a common complaint encountered by orthopedic surgeons, internists, and family practitioners. Although it is most often caused by plantar fasciitis, this is a diagnosis of exclusion. Other mechanical, rheumatologic, and neurologic causes must be considered first. The history and physical examination are typically all that is needed to make the proper diagnosis, but diagnostic adjuncts are available to assist the clinician. When plantar fasciitis is diagnosed, conservative modalities must be tried first. Corticosteroid injections and extracorporeal shock-wave therapy may also be used. After 6 months of failed conservative treatments, surgical intervention should be considered. PMID:24559879

Rosenbaum, Andrew J; DiPreta, John A; Misener, David

2014-03-01

9

Clinical Characteristics of the Causes of Plantar Heel Pain  

PubMed Central

Objective The objectives of this study were to investigate the causes of plantar heel pain and find differences in the clinical features of plantar fasciitis (PF) and fat pad atrophy (FPA), which are common causes of plantar heel pain, for use in differential diagnosis. Method This retrospective study analyzed the medical records of 250 patients with plantar heel pain at the Foot Clinic of Rehabilitation Medicine at Bundang Jesaeng General Hospital from January to September, 2008. Results The subjects used in this study were 114 men and 136 women patients with a mean age of 43.8 years and mean heel pain duration of 13.3 months. Causes of plantar heel pain were PF (53.2%), FPA (14.8%), pes cavus (10.4%), PF with FPA (9.2%), pes planus (4.8%), plantar fibromatosis (4.4%), plantar fascia rupture (1.6%), neuropathy (0.8%), and small shoe syndrome (0.8%). PF and FPA were most frequently diagnosed. First-step pain in the morning, and tenderness on medial calcaneal tuberosity correlated with PF. FPA mainly involved bilateral pain, pain at night, and pain that was aggravated by standing. Heel cord tightness was the most common biomechanical abnormality of the foot. Heel spur was frequently seen in X-rays of patients with PF. Conclusion Plantar heel pain can be provoked by PF, FPA, and other causes. Patients with PF or FPA typically show different characteristics in clinical features. Plantar heel pain requires differential diagnosis for appropriate treatment. PMID:22506166

Yi, Tae Im; Seo, In Seok; Huh, Won Seok; Yoon, Tae Hee; Kim, Bo Ra

2011-01-01

10

Imaging study of the painful heel syndrome  

SciTech Connect

A total of 45 patients with the painful heel syndrome without evidence of an associated inflammatory arthritis, seven of whom had pain in both heels, were studied using technetium-99 isotope bone scans and lateral and 45 degrees medial oblique radiographs of both feet. Of the 52 painful heels 31 (59.6%) showed increased uptake of tracer at the calcaneum. Patients with scans showing increased uptake tended to have more severe heel pain and responded more frequently to a local hydrocortisone injection. On plain x-ray, 39 of 52 painful heels (75%) and 24 of the 38 opposite nonpainful heels (63%) showed plantar spurs, compared with five of 63 (7.9%) heels in 59 age- and sex-matched controls. No evidence of stress fractures was seen.

Williams, P.L.; Smibert, J.G.; Cox, R.; Mitchell, R.; Klenerman, L.

1987-06-01

11

The medial and inferior calcaneal nerves: an anatomic study.  

PubMed

The existence of chronic heel pain induced by the compression of nerves prompted us to conduct an anatomic study of the innervation of the heel. Fifteen cadaver feet were dissected to investigate the origin, course and branches of the medial calcaneal nerve (MCN) and the inferior calcaneal nerve (ICN). Despite a variable origin (tibial n. (TN) or lateral plantar n. (LPN)), the medial calcaneal nerve branches which lay superficial to the abductor hallucis muscle (AH) were quite constant. The medial calcaneal nerve gave branches to the abductor hallucis muscle and innervated the posterior part of the medial face of the heel. It terminated in the superficial heel pad at the inferior part of the heel. In our study, the inferior calcaneal nerve always originated from the lateral plantar nerve. Its relationship to the deep fascia of the abductor hallucis muscle and anterior tubercle of calcaneus may explain the entrapment syndrome of the inferior calcaneal nerve. PMID:10431329

Louisia, S; Masquelet, A C

1999-01-01

12

Neuromas of the calcaneal nerves.  

PubMed

A neuroma of a calcaneal nerve has never been reported. A series of 15 patients with heel pain due to a neuroma of a calcaneal nerve are reviewed. These patients previously had either a plantar fasciotomy (n = 4), calcaneal spur removal (n = 2), ankle fusion (n = 2), or tarsal tunnel decompression (n = 7). Neuromas occurred on calcaneal branches that arose from either the posterior tibial nerve (n = 1), lateral plantar nerve (n = 1), the medial plantar nerve (n = 9), or more than one of these nerves (n = 4). Operative approach was through an extended tarsal tunnel incision to permit identification of all calcaneal nerves. The neuroma was resected and implanted into the flexor hallucis longus muscle. Excellent relief of pain occurred in 60%, and good relief in 33%. One patient (17%) had no improvement and required resection of the lateral plantar nerve. Awareness that the heel may be innervated by multiple calcaneal branches suggests that surgery for heel pain of neural origin employ a surgical approach that permits identification of all possible calcaneal branches. PMID:11722141

Kim, J; Dellon, A L

2001-11-01

13

Simultaneous use of lateral calcaneal ostectomy and subtalar arthroscopic debridement for residual pain after a calcaneal fracture.  

PubMed

Inadequate primary treatment of calcaneal fractures frequently results in persistent, residual pain. This can be caused by subtalar arthritis, an increased calcaneal width, and/or calcaneal fibular impingement of the peroneal tendons. Many patients experience multiple disorders simultaneously, requiring a combination of procedures to treat the injury. The purpose of the present study was to evaluate the clinical outcomes of arthroscopic debridement with lateral calcaneal ostectomy for residual pain after a calcaneal fracture. Four feet (4 patients) were treated with arthroscopic debridement and lateral calcaneal ostectomy. The patients were 3 males and 1 female, with a mean age of 55.3 ± 14.1 years. The mean follow-up duration was 33.5 ± 10.5 months postoperatively. Three patients received worker's compensation as a result of their condition. The patients were examined for improvement in pain levels using the numeric pain intensity scale and healing was assessed using the Japanese Society of Surgery of the Foot score. The mean Japanese Society of Surgery of the Foot score improved from 64.5 ± 13.8 preoperatively to 82.5 ± 7.1 postoperatively. The mean postoperative numeric pain intensity scale score was 2.3 ± 1.9. No complications, such as deep infection or problems with wound healing, were observed in any of the patients. The simultaneous use of arthroscopic subtalar debridement and lateral calcaneal ostectomy is a valuable intervention for the treatment of residual pain after a calcaneal fracture in patients who present with increased calcaneal width and mild or no degenerative changes in the subtalar joint. PMID:25459094

Yoshimura, Ichiro; Ichimura, Ryuji; Kanazawa, Kazuki; Ida, Takahiro; Hagio, Tomonobu; Karashima, Hirotaka; Naito, Masatoshi

2015-01-01

14

Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality  

PubMed Central

Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF. PMID:24963184

Thapa, Deepak; Ahuja, Vanita

2014-01-01

15

Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis.  

PubMed

We describe the design of a new cost-effective, comfortable orthotic designed to treat heel pain associated with plantar fasciitis. The heel pad is fabricated from a 4 degrees Sorbothane medial wedge with a customized insertion of low-density Plastazote. The orthotic is medium-density Plastazote reinforced with cork in the medial longitudinal arch. One pair of orthotics takes less than 1 hour to make. Pilot data were collected retrospectively to evaluate the efficacy of the orthotic for reducing pain. Ten clients at a hand and foot orthotic clinic with a mean age of 71+/-9.1 years and with unilateral or bilateral heel pain associated with plantar fasciitis were provided with customized heel pads and soft, molded orthotics at their initial visit. Pain levels were recorded with verbal and Likert-type scales. After 5 weeks of heel pad and orthotic use, all patients showed a reduction in pain, with the overall reduction being highly significant (Pheel pads and soft molded orthotics are an effective first-line treatment for the heel pain and loss of function associated with plantar fasciitis. PMID:14586928

Seligman, Deborah A; Dawson, Deirdre R

2003-10-01

16

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 PMID:7272653

Maclellan, G. E.; Vyvyan, Barbara

1981-01-01

17

Gaenslen's split-heel incision for calcaneal osteomyelitis—Case report  

Microsoft Academic Search

BackgroundThe purpose of the report was to present a 45-year-old lady who had a chronic osteomyelitis right calcaneum with a large non-healing ulcer and discharging sinus, treated by split-heel incision of Gaenslen.

J. Terrence Jose Jerome; Simon Thomas

2008-01-01

18

Don't Ignore Your Kid's Heel Pain  

MedlinePLUS

... if it is done quickly. “Put in a little time to address the problem early because if you wait, you might be in a cast or boot later for a long time,” Dr. Collins says. Kids undergoing growth spurts are especially susceptible to heel pain starting at age 8 until around age 13 for girls and ...

19

Neonatal pain response to heel stick vs venepuncture for routine blood sampling  

Microsoft Academic Search

Neonatal pain response and adverse effects and maternal anxiety were assessed in 27 infants who were randomly allocated to venepuncture or heel stick. Pain was assessed by nurses using the Neonatal Infant Pain Scale (NIPS) and a three point scale for the mothers. NIPS scores were higher in the heel stick group compared with the venepuncture group. Maternal anxiety was

Vibhuti S Shah; Anna Taddio; Sian Bennett; Brian D Speidel

1997-01-01

20

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

2000-01-01

21

Effect of Monophasic Pulsed Current on Heel Pain and Functional Activities caused by Plantar Fasciitis  

PubMed Central

Background Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. Material/Methods Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). Results Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P<0.001). Heel tenderness improved significantly in both groups compared with baseline PA scores (P<0.001). Functional activity level improved significantly in both groups compared with baseline (ADL/FAAM) scores (P<0.001). However, no significant differences existed between the 2 treatment groups in all post-intervention outcome measures. Conclusions This trial showed that MPC is useful in treating inferior heel symptoms caused by PF. PMID:25791231

Alotaibi, Abdullah K.; Petrofsky, Jerrold S.; Daher, Noha S.; Lohman, Everett; Laymon, Michael; Syed, Hasan M.

2015-01-01

22

Effect of Monophasic Pulsed Current on Heel Pain and Functional Activities caused by Plantar Fasciitis.  

PubMed

Background Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. Material and Methods Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). Results Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P<0.001). Heel tenderness improved significantly in both groups compared with baseline PA scores (P<0.001). Functional activity level improved significantly in both groups compared with baseline (ADL/FAAM) scores (P<0.001). However, no significant differences existed between the 2 treatment groups in all post-intervention outcome measures. Conclusions This trial showed that MPC is useful in treating inferior heel symptoms caused by PF. PMID:25791231

Alotaibi, Abdullah K; Petrofsky, Jerrold S; Daher, Noha S; Lohman, Everett; Laymon, Michael; Syed, Hasan M

2015-01-01

23

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

Microsoft Academic Search

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

Matthew P Cotchett; Karl B Landorf; Shannon E Munteanu; Anita Raspovic

2011-01-01

24

Surgical treatment for calcaneal intraosseous lipomas.  

PubMed

Intraosseous lipoma is among rare benign tumors of the bone. The aim of the present study was to evaluate the long-term surgical results of calcaneal lipomas, representing a relatively rare localization for this type of tumors. The present study included 21 calcaneal lipoma cases (22 feet) referred to our podiatry clinic between 1991 and 2001 with complaints of foot and heel pain resistant to conservative treatment for the last 3-6 months. In all cases, the diagnosis of calcaneal intraosseous lipoma was first confirmed radiologically, then histologically. The mean age was 39 years (range 16-62), 15 were females (71%) and 6 were males (29%). One patient had bilateral disease, whereas 11 and 9 patients had right and left calcaneal involvement, respectively. None of the patients have a palpable mass in their foot. For pre-operative differential diagnosis, 3 patients had computerized tomography examination (CT scan) and 8 patients underwent magnetic resonance imaging (MRI). All lesions were totally curetted out with angled curettes. The defect was filled with cancellous autografts taken from the ipsilateral iliac crest. In only four patients, the amount of autograft was not sufficient, so a combination of cancellous allograft and autograft was used. No drain was used. An elastic bandage was wrapped around the foot and ankle, and cold packs were applied to the surgical site. The mean duration of follow up was 94 (45-143) months. Pain improved in 17 feet at 4 months, in an additional 4 feet at 8 months and in the remaining one foot at 12 months. The mean time to the graft consolidation was 5 months (range 3-7 months). There were no recurrences or pathological fractures during the follow up. No wound infection or necrosis was seen at the surgical sites. There were no neurovascular complications. Five cases experienced pain in the iliac bone for 1 month, due to grafting procedures. Although calcaneal intraosseous lipoma accounts for a small portion of cases in the huge differential diagnosis chart for foot pain, it should be kept in mind as a possible diagnosis in unresolved cases. Most of the patients would benefit from non-surgical treatments. But if this is not the case, surgical treatment is indicated. In conclusion, curettage and autogenous bone grafting is an easy and effective method for the surgical treatment of calcaneal intraosseous lipomas. PMID:20307456

Ulucay, Cagatay; Altintas, Faik; Ozkan, Namik K; Inan, Muharrem; Ugutmen, Ender

2009-06-01

25

An Atypical Calcaneal Fracture in a Child: A Literature Review Concerning the Treatment  

PubMed Central

Calcaneal fractures are considered uncommon accounting for 0.005-0.41% of all children fractures. Few reports concerning treatment are available. Most of these fractures are non-displaced/minimally displaced and are associated with a fall of less than 1 m. The aim of this case report was to discuss the diagnosis and treatment of a child calcaneal fracture, an atypical presentation despite the high energy mechanism of trauma. A 7-year-old child fell from a 5-m ladder with all his weight on his right heel. Significantly hind-foot reduced range of motion associated with a lateral/plantar calcaneal swelling and pain was found. Neurovascular examination and other parts of the body were normal. Radiograph showed an undisplaced calcaneal body fracture and computed tomography confirmed no subtalar joint involvement. A splint followed by plaster was applied. Weight bearing and deambulation were not allowed. After 4 weeks, no pain and limping was reported by the child’s parents. Plaster was removed and radiograph showed fracture consolidation. Patient had no complaints of pain, no restrictions in range of motion and normal walking. Limping in children is a difficult complaint to assess. Differential diagnoses of a calcaneal fractures should be performed, even without a history of trauma or a history of trivial trauma. PMID:25368703

Guterres, Leonardo Waihrich; Ribeiro, Deryck Aguiar; Ribeiro, Tiango Aguiar

2015-01-01

26

An atypical calcaneal fracture in a child: a literature review concerning the treatment.  

PubMed

Calcaneal fractures are considered uncommon accounting for 0.005-0.41% of all children fractures. Few reports concerning treatment are available. Most of these fractures are non-displaced/minimally displaced and are associated with a fall of less than 1 m. The aim of this case report was to discuss the diagnosis and treatment of a child calcaneal fracture, an atypical presentation despite the high energy mechanism of trauma. A 7-year-old child fell from a 5-m ladder with all his weight on his right heel. Significantly hind-foot reduced range of motion associated with a lateral/plantar calcaneal swelling and pain was found. Neurovascular examination and other parts of the body were normal. Radiograph showed an undisplaced calcaneal body fracture and computed tomography confirmed no subtalar joint involvement. A splint followed by plaster was applied. Weight bearing and deambulation were not allowed. After 4 weeks, no pain and limping was reported by the child's parents. Plaster was removed and radiograph showed fracture consolidation. Patient had no complaints of pain, no restrictions in range of motion and normal walking. Limping in children is a difficult complaint to assess. Differential diagnoses of a calcaneal fractures should be performed, even without a history of trauma or a history of trivial trauma. PMID:25368703

Guterres, Leonardo Waihrich; Ribeiro, Deryck Aguiar; Ribeiro, Tiango Aguiar

2015-01-01

27

[To reduce the pain of heel prick in the newborn: comparison of six types of lancets].  

PubMed

Heel prick is an usual method performed to get a blood sample for newborn screening. Its wide use justifies the effort in reducing the pain as much as possible and some simple steps, including the use of spring heelsticks, are recommended by national and international guide-lines. But not all the heelsticks cause the same pain and allow to get enough blood for the screening. The aim of this work was to test six automatic heelstick devices with regard to the pain in heel prick measured with NIPS scale and, at the same time, to value their effectiveness in getting a blood sample suitable for filter paper for newborn screening. The following devices were assessed: Amnes Minilet Lancets, Wuxi Xinda Ltd, Exxe Safe Blade, Lifescan Stik Johnson & Johnson, One Touch Ultra Soft, Accu-Chek Safe T Pro Plus. The device Exxe Safe Blade statistically differs from all others: it is the least painful and it doesn't need any prick repetition. PMID:23173410

Ballardini, G; Spruzzola, A; Boneschi, L; Visentin, R; Boscardini, L; Barbaglia, M; Guala, L A

2012-01-01

28

Clinical Presentation and Self-Reported Patterns of Pain and Function in Patients with Plantar Heel Pain  

PubMed Central

Background Plantar heel pain is a common disorder of the foot for which patients seek medical treatment. The purpose of this study is to explore the relationship between duration of symptoms in plantar fasciitis patients and demographic factors, the intensity and location of pain, extent of previous treatment and self reported pain and function. Methods The charts of patients presenting with plantar heel pain between June 2008 and October 2010 were reviewed retrospectively and 182 patients with a primary diagnosis of plantar fasciitis were identified. Patients with symptoms less than 6 months were identified as acute and patients with symptoms greater than or equal to six months were defined as having chronic symptoms. Comparisons based on duration of symptoms were performed for age, gender, BMI, comorbidities, pain location and intensity, and a functional score measured by the Foot and Ankle Ability Measure (FAAM). Results The two groups were similar in age, BMI, gender, and comorbidities. Pain severity, as measured by a VAS, was not statistically significant between the two groups (6.6 and 6.2). The acute and chronic groups of patients reported similar levels of function on both the activity of daily living (62 and 65) and sports (47 and 45) subscales of the FAAM. Patients in the chronic group were more likely to have seen more providers and tried more treatment options for this condition. Conclusion As plantar fasciitis symptoms extend beyond 6 months, patients do not experience increasing pain intensity or functional limitation. No specific risk factors have been identified to indicate a risk of developing chronic symptoms. PMID:22995253

Klein, Sandra E.; Dale, Ann Marie; Hayes, Marcie Harris; Johnson, Jeffrey E.; McCormick, Jeremy J.; Racette, Brad A.

2014-01-01

29

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

PubMed Central

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 associated with plantar heel pain. Methods We searched specific electronic databases (MEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus and AMI) in April 2010 to identify randomised and non-randomised trials. We included trials where participants diagnosed with plantar heel pain were treated with dry needling and/or injections (local anaesthetics, steroids, Botulinum toxin A and saline) alone or in combination with acupuncture. Outcome measures that focussed on pain and function were extracted from the data. Trials were assessed for quality using the Quality Index tool. Results Three quasi-experimental trials matched the inclusion criteria: two trials found a reduction in pain for the use of trigger point dry needling when combined with acupuncture and the third found a reduction in pain using 1% lidocaine injections when combined with physical therapy. However, the methodological quality of the three trials was poor, with Quality Index scores ranging form 7 to 12 out of a possible score of 27. A meta-analysis was not conducted because substantial heterogeneity was present between trials. Conclusions There is limited evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain. However, the poor quality and heterogeneous nature of the included studies precludes definitive conclusions being made. Importantly, this review highlights the need for future trials to use rigorous randomised controlled methodology with measures such as blinding to reduce bias. We also recommend that such trials adhere to the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) to ensure transparency. PMID:20807448

2010-01-01

30

A comparison of the effectiveness of extracorporeal shock wave and ultrasound therapy in the management of heel pain  

NASA Astrophysics Data System (ADS)

The aim of this study was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and ultrasound therapy (US) for managing heel pain. Thirty-seven subjects received either: ESWT (once a week), US (three times a week), or CONTROL (no treatment) for 3 consecutive weeks and were followed-up for 3 more weeks. A visual analogue scale (VAS), the maximum tolerable duration for prolonged walking or standing, and the Mayo clinical scoring system (MCSS) were evaluated. Mixed models treating baseline measures as covariates were adopted for statistical analysis. By week 3, intensity of heel pain on palpation was reduced by 37% (VAS score from 7.5 to 4.6) in the ESWT group, 24% (from 5.3 to 4.2) in the US group, and increased by 3% (5.6-5.7) in the control group; this difference was significant after adjusting for baseline VAS scores ( p = 0.022). The improvements in the maximum tolerable duration of prolonged walking or standing was only significant in the ESWT group (157% increase, p = 0.043) but not the other two groups. Both active treatment groups maintained the treatment effect at the three-week follow-up. We conclude that ESWT is potentially more effective in reducing heel pain than ultrasound therapy but additional evidence is needed due to the various limitations of the study.

Cheing, G. L. Y.; Chang, H.; Lo, S. K.

2007-11-01

31

The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis  

PubMed Central

Background There is considerable controversy regarding the effectiveness of extracorporeal shock wave therapy in the management of plantar heel pain. Our aim was to conduct a systematic review of randomised controlled trials to investigate the effectiveness of extracorporeal shock wave therapy and to produce a precise estimate of the likely benefits of this therapy. Methods We conducted a systematic review of all randomised controlled trials (RCTs) identified from the Cochrane Controlled trials register, MEDLINE, EMBASE and CINAHL from 1966 until September 2004. We included randomised trials which evaluated extracorporeal shock wave therapy used to treat plantar heel pain. Trials comparing extra corporeal shock wave therapy with placebo or different doses of extra corporeal shock wave therapy were considered for inclusion in the review. We independently applied the inclusion and exclusion criteria to each identified randomised controlled trial, extracted data and assessed the methodological quality of each trial. Results Six RCTs (n = 897) permitted a pooled estimate of effectiveness based on pain scores collected using 10 cm visual analogue scales for morning pain. The estimated weighted mean difference was 0.42 (95% confidence interval 0.02 to 0.83) representing less than 0.5 cm on a visual analogue scale. There was no evidence of heterogeneity and a fixed effects model was used. Conclusion A meta-analysis of data from six randomised-controlled trials that included a total of 897 patients was statistically significant in favour of extracorporeal shock wave therapy for the treatment of plantar heel pain but the effect size was very small. A sensitivity analysis including only high quality trials did not detect a statistically significant effect. PMID:15847689

Thomson, Colin E; Crawford, Fay; Murray, Gordon D

2005-01-01

32

Medial displacement calcaneal osteotomy with posterior tibial tendon reconstruction for the flexible flatfoot with symptomatic accessory navicular.  

PubMed

We investigated the clinical outcomes after medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular, in patients with flexible flatfoot with accessory navicular symptoms. From December 2008 to July 2011, 16 patients (21 feet) with a flexible flatfoot, symptomatic accessory navicular, and obvious heel valgus underwent medial displacement calcaneal osteotomy and reconstruction with posterior tibial tendon insertion on the navicular bone. The patients were evaluated preoperatively, 6 weeks and 3, 6, and 12 months postoperatively, and every 6 months thereafter. The clinical examination was undertaken using the American Orthopaedic Foot and Ankle Society ankle and midfoot scores. The radiologic assessments included the arch height, calcaneus inclination angle, talocalcaneal angle, and talar first metatarsal angle on the lateral weightbearing radiograph. The talocalcaneal angle and talar first metatarsal angle was assessed on the anteroposterior view of the weightbearing foot. Heel valgus alignment was assessed on the axial hindfoot radiographs. The mean follow-up duration was 28.5 months (range 18 to 48). All patients were satisfied with the clinical results and were pain free 6 months postoperatively. No cases of wound infection or nerve injury developed. The mean American Orthopaedic Foot and Ankle Society score improved from 53.3 ± 6.5 to 90.8 ± 1.4 at the last follow-up visit (p < .01). The improvements in all radiographic parameters were statistically significant between the preoperative and last follow-up examinations (p < .01). The heel valgus of all patients was corrected. Our results have shown that medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular bone is an effective treatment of flexible flatfoot with symptomatic accessory navicular, associated with excellent clinical outcomes and correction of the deformity. PMID:24856662

Cao, Hong-Hui; Tang, Kang-Lai; Lu, Wei-Zhong; Xu, Jian-Zhong

2014-01-01

33

Bilateral Heel Numbness due to External Compression during Obstetric Epidural Analgesia  

PubMed Central

We describe the case of a 32-year-old woman who developed bilateral heel numbness after obstetric epidural analgesia. We diagnosed her with bilateral neuropathy of the medial calcaneal nerve, most likely due to longstanding pressure on both heels. Risk factors for the development of this neuropathy were prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy. Padded footrests decrease pressure and can possibly prevent this neuropathy. PMID:25802500

Kamphuis, Vivian P.; Zegers, Marie P.A.; Koppen, Hille

2015-01-01

34

Quantitative scintigraphy in diagnosis and management of plantar fasciitis (Calcaneal periostitis): concise communication  

SciTech Connect

We have found that Tc-99m methylene diphosphonate imaging of the heel is of diagnostic value in the painful heel syndrome, permitting positive identification of the site of inflammation in cases where radiography is unhelpful. With this technique, tracer uptake in the heel is susceptible to quantification, allowing a serial and objective assessment of response to therapy.

Sewell, J.R.; Black, C.M.; Chapman, A.H.; Statham, J.; Hughes, G.R.V.; Lavender, J.P.

1980-07-01

35

Biomechanical Tolerance of Calcaneal Fractures  

PubMed Central

Biomechanical studies have been conducted in the past to understand the mechanisms of injury to the foot-ankle complex. However, statistically based tolerance criteria for calcaneal complex injuries are lacking. Consequently, this research was designed to derive a probability distribution that represents human calcaneal tolerance under impact loading such as those encountered in vehicular collisions. Information for deriving the distribution was obtained by experiments on unembalmed human cadaver lower extremities. Briefly, the protocol included the following. The knee joint was disarticulated such that the entire lower extremity distal to the knee joint remained intact. The proximal tibia was fixed in polymethylmethacrylate. The specimens were aligned and impact loading was applied using mini-sled pendulum equipment. The pendulum impactor dynamically loaded the plantar aspect of the foot once. Following the test, specimens were palpated and radiographs in multiple planes were obtained. Injuries were classified into no fracture, and extra-and intra-articular fractures of the calcaneus. There were 14 cases of no injury and 12 cases of calcaneal fracture. The fracture forces (mean: 7802 N) were significantly different (p<0.01) from the forces in the no injury (mean: 4144 N) group. The probability of calcaneal fracture determined using logistic regression indicated that a force of 6.2 kN corresponds to 50 percent probability of calcaneal fracture. The derived probability distribution is useful in the design of dummies and vehicular surfaces.

Yoganandan, Narayan; Pintar, Frank A.; Gennarelli, Thomas A.; Seipel, Robert; Marks, Richard

1999-01-01

36

Bursitis of the heel  

MedlinePLUS

... heel is swelling of the fluid-filled sac (bursa) at the back of the heel bone under ... A bursa acts as a cushion and lubricant between tendons or muscles sliding over bone. There are bursas around ...

37

Clinical performance of a highly portable, scanning calcaneal ultrasonometer.  

PubMed

The aim of this study was to establish a normative database, assess precision, and evaluate the ability to identify women with low bone mass and to discriminate women with fracture from those without for a highly portable, scanning calcaneal ultrasonometer: the QUS-2. Fourteen hundred and one Caucasian women were recruited for the study. Among them were 794 healthy women 25-84 years of age evenly distributed per 10-year period to establish a normative database. Of these, 171 aged 25-34 years were defined as the young normal group for the purpose of T-score determination. Precision was assessed within 1 day (short-term) and over a 16-week period (long-term) in 79 women aged 25-84 years. Five hundred twenty-eight women ranging from 50 to 84 years of age with or without prevalent fractures of the spine, hip or forearm were measured to compare the QUS-2 with bone mineral density (BMD) of the hip and spine. Mean calcaneal broadband ultrasound attenuation (BUA) was constant in healthy women from 25 to 54 years of age and decreased with increasing age thereafter. Short-term precision, with and without repositioning of the heel, and long-term precision yielded comparable results (BUA SDs of 2.1-2.4 dB/MHz, coefficients of variations (CVs) of 2.5-2.9%). Calcaneal BUA was significantly correlated with BMD of the total hip (TH), femoral neck (FN) and lumbar spine (LS) in 698 women (r = 0.6-0.7, all p < 0.0001). A similar relationship was observed for LS BMD compared with either TH or FN BMD (r = 0.7, p < 0.0001). Prevalence of osteoporosis in our population (WHO criteria) was 20%, 17%, 21%, and 24% for BUA, BMD of the TH, FN and LS, respectively. Age-adjusted values for a 1 SD reduction in calcaneal BUA and TH and FN BMD predicted prevalent fractures of the spine, forearm, and hip with significant (p < 0.05) odds ratios of 2.3, 2.0 and 2.1, respectively. Areas under the receiver operating characteristic curves for age-adjusted bone mass values predicting prevalent fracture were 0.62 for BUA, 0.59 for TH BMD, 0.60 for FN BMD, and 0.57 for LS BMD; all statistically equivalent. We conclude that the QUS-2 calcaneal ultrasonometer exhibits reproducible clinical performance that is similar to BMD of the spine and hip in identifying women with low bone mass and discriminating women with fracture from those without. PMID:11444088

Greenspan, S L; Cheng, S; Miller, P D; Orwoll, E S

2001-01-01

38

Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial  

PubMed Central

Background A significant number of individuals suffer from plantar heel pain (PHP) and many go on to have chronic symptoms and continued disability. Persistence of symptoms adds to the economic burden of PHP and cost-effective solutions are needed. Currently, there is a wide variation in treatment, cost, and outcomes of care for PHP with limited information on the cost-effectiveness and comparisons of common treatment approaches. Two practice guidelines and recent evidence of effective physical therapy intervention are available to direct treatment but the timing and influence of physical therapy intervention in the multidisciplinary management of PHP is unclear. The purpose of this investigation is to compare the outcomes and costs associated with early physical therapy intervention (ePT) following initial presentation to podiatry versus usual podiatric care (uPOD) in individuals with PHP. Methods A parallel-group, block-randomized clinical trial will compare ePT and uPOD. Both groups will be seen initially by a podiatrist before allocation to a group that will receive physical therapy intervention consisting primarily of manual therapy, exercise, and modalities, or podiatric care consisting primarily of a stretching handout, medication, injections, and orthotics. Treatment in each group will be directed by practice guidelines and a procedural manual, yet the specific intervention for each participant will be selected by the treating provider. Between-group differences in the Foot and Ankle Ability Measure 6 months following the initial visit will be the primary outcome collected by an independent investigator. In addition, differences in the European Quality of Life – Five Dimensions, Numeric Pain Rating Scale, Global Rating of Change (GROC), health-related costs, and cost-effectiveness at 6 weeks, 6 months, and 1 year will be compared between groups. The association between successful outcomes based on GROC score and participant expectations of recovery generally, and specific to physical therapy and podiatry treatment, will also be analyzed. Discussion This study will be the first pragmatic trial to investigate the clinical outcomes and cost-effectiveness of ePT and uPOD in individuals with PHP. The results will serve to inform clinical practice decisions and management guidelines of multiple disciplines. Trial registration ClinicalTrials.gov: NCT01865734 PMID:24299257

2013-01-01

39

Randomized, Multicenter Trial on the Effect of Radiation Therapy on Plantar Fasciitis (Painful Heel Spur) Comparing a Standard Dose With a Very Low Dose: Mature Results After 12 Months' Follow-Up  

SciTech Connect

Purpose: To conduct a randomized trial of radiation therapy for painful heel spur, comparing a standard dose with a very low dose. Methods and Materials: Sixty-six patients were randomized to receive radiation therapy either with a total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy twice weekly (standard dose) or with a total dose of 0.6 Gy applied in 6 fractions of 0.1 Gy twice weekly (low dose). In all patients lateral opposing 4- to 6-MV photon beams were used. The results were measured using a visual analogue scale, the Calcaneodynia score, and the SF12 health survey. The fundamental phase of the study ended after 3 months, and the follow-up was continued up to 1 year. Patients with insufficient pain relief after 3 months were offered reirradiation with the standard dosage at any time afterward. Results: Of 66 patients, 4 were excluded because of withdrawal of consent or screening failures. After 3 months the results in the standard arm were highly significantly superior compared with those in the low-dose arm (visual analogue scale, P=.001; Calcaneodynia score, P=.027; SF12, P=.045). The accrual of patients was stopped at this point. Further evaluation after 12 months' follow-up showed the following results: (1) highly significant fewer patients were reirradiated in the standard arm compared with the low-dose arm (P<.001); (2) the results of patients in the low-dose arm who were reirradiated were identical to those in the standard arm not reirradiated (reirradiation as a salvage therapy if the lower dose was ineffective); (3) patients experiencing a favorable result after 3 months showed this even after 12 months, and some results even improved further between 3 and 12 months. Conclusions: This study confirms the superior analgesic effect of radiation therapy with 6-Gy doses on painful heel spur even for a longer time period of at least 1 year.

Niewald, Marcus, E-mail: marcus.niewald@uks.eu [Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar (Germany)] [Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar (Germany); Seegenschmiedt, M. Heinrich [Radiotherapy Center, Hamburg (Germany)] [Radiotherapy Center, Hamburg (Germany); Micke, Oliver [Franziskus Hospital, Bielefeld (Germany)] [Franziskus Hospital, Bielefeld (Germany); Graeber, Stefan [Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar (Germany)] [Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar (Germany); Muecke, Ralf [Lippe Hospital, Lemgo (Germany)] [Lippe Hospital, Lemgo (Germany); Schaefer, Vera; Scheid, Christine; Fleckenstein, Jochen; Licht, Norbert; Ruebe, Christian [Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar (Germany)] [Department of Radiation Oncology, Saarland University Medical Center, Homburg/Saar (Germany)

2012-11-15

40

De-epithelialized fasciocutaneous turnover flap for recurrent calcaneal wound with osteomyelitis.  

PubMed

Recurrent ulcerations of the foot and ankle almost always present a challenge to lower extremity surgeons. Recalcitrant heel ulcerations with osteomyelitis are especially difficult to treat because of the lack of soft tissue coverage. The turnover flap is a simple, fast, and effective treatment method for lower extremity wounds. It is a de-epithelialized fasciocutaneous flap harvested from the adjacent area of the wound. We believe it is an underused technique for advanced wound closure in the lower extremity. It offers several advantages compared with traditional, more difficult to perform, flaps. We have seen an excellent result 18 months after using the turnover flap in a patient with recurrent posterior heel ulceration with calcaneal osteomyelitis. PMID:23910737

Panagakos, Panagiotis; McDonald, Patrick; Norem, Nathan; Shapiro, Howard; Boc, Steven F; Mitra, Amit

2014-01-01

41

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.

2003-06-01

42

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

43

Muscle activation of paraspinal muscles in different types of high heels during standing.  

PubMed

[Purpose] This study researched the effects of different types of high heels on the muscles surrounding the cervical spine, the thoracic spine, and the lumbar spine by analyzing muscle activation of the paraspinal muscles during standing while wearing high heels. The high heels were all of the same height: 8?cm. [Subjects and Methods] The 28 subjects in this experiment were females in their 20s with a foot size of 225-230?mm and a normal gait pattern. To measure the muscle activation of the paraspinal muscles, EMG electrodes were attached on the paraspinal muscles around C6, T7, and L5. The muscle activation during standing while wearing 8-cm-high wedge heels, setback heels, and French heels was then measured. The measurements were performed 3 times each, and the mean value was used for analysis. [Results] The levels of muscle activation of the paraspinal muscles induced by standing on wedge heels, setback heels, and French heels in the cervical and lumbar areas were significantly higher than those induced by standing on bare feet. But there was no significant difference according to the heel types. [Conclusion] The height of the heels presented a greater variable than the width of the heels on the muscle activation of paraspinal muscles. Therefore, wearing high heels is not recommended for those who have pain or functional problems in the cervical and/or lumbar spine. PMID:25642040

Han, Dongwook

2015-01-01

44

Muscle activation of paraspinal muscles in different types of high heels during standing  

PubMed Central

[Purpose] This study researched the effects of different types of high heels on the muscles surrounding the cervical spine, the thoracic spine, and the lumbar spine by analyzing muscle activation of the paraspinal muscles during standing while wearing high heels. The high heels were all of the same height: 8?cm. [Subjects and Methods] The 28 subjects in this experiment were females in their 20s with a foot size of 225–230?mm and a normal gait pattern. To measure the muscle activation of the paraspinal muscles, EMG electrodes were attached on the paraspinal muscles around C6, T7, and L5. The muscle activation during standing while wearing 8-cm-high wedge heels, setback heels, and French heels was then measured. The measurements were performed 3 times each, and the mean value was used for analysis. [Results] The levels of muscle activation of the paraspinal muscles induced by standing on wedge heels, setback heels, and French heels in the cervical and lumbar areas were significantly higher than those induced by standing on bare feet. But there was no significant difference according to the heel types. [Conclusion] The height of the heels presented a greater variable than the width of the heels on the muscle activation of paraspinal muscles. Therefore, wearing high heels is not recommended for those who have pain or functional problems in the cervical and/or lumbar spine. PMID:25642040

Han, Dongwook

2015-01-01

45

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. PMID:23819090

Faroug, Radwane; Stirling, Paul; Ali, Farhan

2013-01-01

46

[Hindfoot pain].  

PubMed

The hindfoot is the part of the foot which is proximal to the midtarsal joint. The obvious causes of pain are not considered (post-traumatic etiologies, sprains and fractures but also cutaneous lesions). The main etiologies on the subject are successively exposed by following the localization of the pain. Diffuse pains (ankle arthritis tarsal osteoarthritis, algodystrophy, calcaneo-navicular synostosis but also bone diseases like stress fractures, Paget disease or tumors). Plantar talalgia (Sever's disease, plantar fasciitis and entrapment neuropathies such as (esions of the medial calcaneal nerve, of the first branch of the plantar lateral nerve, medial plantar nerve and lateral plantar nerve). Posterior pains: calcaneal tendinopathy including peritendinitis, tendinosis, retro-calcaneal bursitis and pathology of the postero-lateral talar tuberosity. Medial pains: tendinopathies of the posterior tibial tendon and tendinopathy of the flexor hallucis longus tendon and tarsal tunnel syndrome. Lateral pains: fibularis tendinopathies including split lesions of the fibularis brevis tendon, displacement of the fibularis iongus tendon, sinus tarsi syndrome and finally thickenings of capsules and ligaments and ossifications localized under the tibial malleoli. Anterior pains: antero-inferior tibio-fibular ligament, anterior tibial tendinopathy and anterior impingment syndrome. PMID:20402125

Damiano, Joël; Bouysset, Maurice

2010-03-20

47

The Pathomechanics Of Calcaneal Gait  

NASA Astrophysics Data System (ADS)

The data acquisition system employed in our laboratory includes optical, electronic and computer subsystems. Three movie camera freeze the motion for analysis. The film is displayed on a motion analyzer, and the body segment positions are recorded in a three dimensional coordinate system with Graf/pen sonic digitizer. The angular rotations are calculated by computer and automatically plotted. The force plate provides measurements of vertical force, foreaft shear, medial-lateral shear, torque, and center of pressure. Electromyograms are superimposed upon gait movies to permit measurement of muscle phasic activity. The Hycam movie camera si-multaneously films (through separate lens) the subject and oscilloscope. Movement measurements, electromyograms, and floor reaction forces provide the data base for analysis. From a study of the gait changes in five normal subjects following tibial nerve block, and from additional studies of patients with paralysis of the ankle plantar flexors, the pathomechanics of calcaneal gait can be described. Inability to transfer weight to the forward part of the foot produces ankle instability and reduction of contralateral step length. Excessive drop of the center of mass necessitates com-pensatory increased lift energy output through the sound limb to restore the height of the center of mass. Excessive stance phase ankle dorsiflexion produces knee instability requiring prolonged quadriceps muscle phasic activity.

Sutherland, David H.; Cooper, Les

1980-07-01

48

Explicit finite element modelling of heel pad mechanics in running: inclusion of body dynamics and application of physiological impact loads.  

PubMed

Many heel pathologies including plantar heel pain may result from micro tears/trauma in the subcutaneous tissues, in which internal tissue deformation/stresses within the heel pad play an important role. Previously, many finite element models have been proposed to evaluate stresses inside the heel pad, but the majority of these models only focus on static loading boundary conditions. This study explored a dynamics modelling approach to the heel pad subjected to realistic impact loads during running. In this model, the inertial property and action of the body are described by a lumped parameter model, while the heel/shoe interactions are modelled using a viscoelastic heel pad model with contact properties. The impact force pattern, dynamic heel pad deformation and stress states predicted by the model were compared with published experimental data. Further parametrical studies revealed the model responses, in terms of internal stresses in the skin and fatty tissue, change nonlinearly when body dynamics changes. A reduction in foot's touchdown velocity resulted in a less severe impact landing and stress relief inside the heel pad, for example peak von-Mises stress in fatty tissue, was reduced by 11.3%. Applications of the model may be extendable to perform iterative analyses to further understand the complex relationships between body dynamics and stress distributions in the soft tissue of heel pad during running. This may open new opportunities to study the mechanical aetiology of plantar heel pain in runners. PMID:24980181

Chen, Wen-Ming; Lee, Peter Vee-Sin

2015-01-01

49

Medial ankle and heel: ultrasound evaluation and sonographic appearances of conditions causing symptoms.  

PubMed

The complex anatomy of the medial ankle and hindfoot can make clinical assessment of medial ankle and heel pain challenging. Ultrasound is an accessible, relatively inexpensive modality, and modern high-resolution probes allow eloquent demonstration of the main structures that are implicated as potential causes of medial ankle pain. In this work we review highlights the clinically relevant anatomy and normal sonographic appearances of structures around the medial ankle and heel and discuss key techniques to allow optimal ultrasound assessment. The conditions that cause medial-sided ankle and heel symptoms are discussed with their characteristic sonographic appearances. PMID:21414548

Kotnis, Nikhil; Harish, Srinivasan; Popowich, Terry

2011-04-01

50

Calcaneal loading during walking and running  

NASA Technical Reports Server (NTRS)

PURPOSE: This study of the foot uses experimentally measured kinematic and kinetic data with a numerical model to evaluate in vivo calcaneal stresses during walking and running. METHODS: External ground reaction forces (GRF) and kinematic data were measured during walking and running using cineradiography and force plate measurements. A contact-coupled finite element model of the foot was developed to assess the forces acting on the calcaneus during gait. RESULTS: We found that the calculated force-time profiles of the joint contact, ligament, and Achilles tendon forces varied with the time-history curve of the moment about the ankle joint. The model predicted peak talocalcaneal and calcaneocuboid joint loads of 5.4 and 4.2 body weights (BW) during walking and 11.1 and 7.9 BW during running. The maximum predicted Achilles tendon forces were 3.9 and 7.7 BW for walking and running. CONCLUSIONS: Large magnitude forces and calcaneal stresses are generated late in the stance phase, with maximum loads occurring at approximately 70% of the stance phase during walking and at approximately 60% of the stance phase during running, for the gait velocities analyzed. The trajectories of the principal stresses, during both walking and running, corresponded to each other and qualitatively to the calcaneal trabecular architecture.

Giddings, V. L.; Beaupre, G. S.; Whalen, R. T.; Carter, D. R.

2000-01-01

51

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. PMID:22470803

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

2011-01-01

52

A new ankle spanning fixator construct for distal tibia fractures: optimizing visualization, minimizing pin problems, and protecting the heel.  

PubMed

Pilon and ankle fractures and ligamentous injuries about the ankle often require external fixation to allow for soft tissue stabilization before definitive surgery. Often used external fixator constructs can cause obscuring of the site of injury on radiographs, pin tract infections, loosening of calcaenal pin fixation, and heel ulcerations. A novel and simple technique of placing the calcaneal pins posteriorly and using a U-shaped bar allows for a construct that reduces or eliminates many of these drawbacks during the time it takes for soft tissue swelling to permit definitive fixation. PMID:22648040

Ziran, Bruce H; Morrison, Troy; Little, Jill; Hileman, Barbara

2013-02-01

53

Optimized preoperative planning of calcaneal fractures using spiral computed tomography  

Microsoft Academic Search

.   The aim of this study was the evaluation of spiral-CT examinations in preoperative planning of calcaneal fractures supported\\u000a by 3D reconstructions after electronic disarticulation. We examined 45 patients with 47 calcaneal fractures with diagnostic\\u000a spiral-CT examinations in a prospective study. In addition to the conventional axial slices and sagittal reconstructions,\\u000a 3D reconstructions prior to and after electronic disarticulation were

M. Freund; M. Thomsen; B. Hohendorf; W. Zenker; M. Heller

1999-01-01

54

Pain  

MedlinePLUS

... Active Medical Research Studies on Pain (ClinicalTrials.gov) Multimedia NCCAM Intramural Pain Research Program Safety Information Remoufan ... News Press Releases Alerts & Advisories Events Highlighted Information Multimedia (Video, Images, and Audio) NCCIH Clinical Digest A ...

55

Pain  

MedlinePLUS

... women. For instance, after puberty, when sex hormone levels rise, girls start to have more migraines than boys. But other painful conditions, such as joint pain, don’t become more common in women until after menopause, when sex hormone levels drop. It’s not clear yet which hormones affect ...

56

Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts’ review  

Microsoft Academic Search

Introduction  A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment\\u000a modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares\\u000a the different percutaneous distractional approaches for intra-articular calcaneal fractures. The history, technique, anatomical\\u000a and fracture considerations, limitations and the results of different distractional approaches reported

T. Schepers; P. Patka

2009-01-01

57

Effect of heel height on in-shoe localized triaxial stresses.  

PubMed

Abnormal and excessive plantar pressure and shear are potential risk factors for high-heeled related foot problems, such as forefoot pain, hallux valgus deformity and calluses. Plantar shear stresses could be of particular importance with an inclined supporting surface of high-heeled shoe. This study aimed to investigate the contact pressures and shear stresses simultaneously between plantar foot and high-heeled shoe over five major weightbearing regions: hallux, heel, first, second and fourth metatarsal heads, using in-shoe triaxial force transducers. During both standing and walking, peak pressure and shear stress shifted from the lateral to the medial forefoot as the heel height increased from 30 to 70mm. Heel height elevation had a greater influence on peak shear than peak pressure. The increase in peak shear was up to 119% during walking, which was about five times that of peak pressure. With increasing heel height, peak posterolateral shear over the hallux at midstance increased, whereas peak pressure at push-off decreased. The increased posterolateral shear could be a contributing factor to hallux deformity. It was found that there were differences in the location and time of occurrence between in-shoe peak pressure and peak shear. In addition, there were significant differences in time of occurrence for the double-peak loading pattern between the resultant horizontal ground reaction force peaks and in-shoe localized peak shears. The abnormal and drastic increase of in-shoe shear stresses might be a critical risk factor for shoe-related foot disorders. In-shoe triaxial stresses should therefore be considered to help in designing proper footwear. PMID:21705002

Cong, Yan; Cheung, Jason Tak-Man; Leung, Aaron K L; Zhang, Ming

2011-08-11

58

Shock absorbency of factors in the shoe/heel interaction--with special focus on role of the heel pad.  

PubMed

The heel pad acts as a shock absorber in walking and in heel-strike running. In some patients, a reduction of its shock-absorbing capacity has been connected to the development of overuse injuries. In this article, the shock absorption of the heel pad as well as external shock absorbers are studied. Individual variation and the effect of trauma and confinement on the heel pad were specifically investigated. Drop tests, imitating heel impacts, were performed on a force plate. The test specimens were cadaver heel pads (n = 10); the shoe sole component consisted of ethyl vinyl acetate (EVA) foam and Sorbothane inserts. The shock absorption was significantly greater in the heel pad than in the external shock absorbers. The mean heel pad shock absorption was 1.1 times for EVA foam and 2.1 times for Sorbothane. The shock absorption varied by as much as 100% between heel pads. Trauma caused a decrease in the heel pad shock absorbency (24%), whereas heel pad confinement increased the shock absorbency (49% in traumatized heel pads and 29.5% in nontraumatized heel pads). These findings provide a biomechanical rationale for the clinical observations of a correlation between heel pad shock absorbency loss and heel strike-dependent overuse injuries. To increase shock absorbency, confinement of the heel pad should be attempted in vivo. PMID:2744671

Jørgensen, U; Bojsen-Møller, F

1989-06-01

59

Surgical treatment of calcaneal fractures of sanders type II and III by a minimally invasive technique using a locking plate.  

PubMed

The aim of the present study was to investigate the outcomes of surgical treatment of calcaneal fractures of Sanders type II and III using a minimally invasive technique and a locking plate. We reviewed 33 feet in 33 consecutive patients with Sanders type II and III calcaneal fractures who had undergone a minimally invasive technique using percutaneous reduction and locking plates. All operations were performed by the same surgeons. The postoperative evaluation included radiographs, determination of restoration of Böhler's angle and Gissane's angle, and administration of the American Orthopaedic Foot and Ankle Society ankle-hind foot scale, Maryland Foot Score, and visual analog scale of pain. The mean visual analog scale score was 1.6 ± 1.4 when radiographic fracture healing was observed. The median functional score of the 33 patients (33 feet) reached 82 (interquartile range 80 to 99) at the last follow-up evaluation according to the American Orthopaedic Foot and Ankle Society ankle-hind foot scale and 89 (interquartile range 80 to 99) according to Maryland Foot Score. All cases achieved restoration of a normal Böhler's angle and Gissane's angle. Postoperative superficial infections occurred in 2 patients, subtalar arthritis developed in 2, and no soft tissue necrosis was observed. For Sanders type II and III fractures of the calcaneus bone, treatment with a minimally invasive technique combining percutaneous reduction and locking plate fixation provided satisfactory clinical results, with a lower incidence of complications. However, longer term studies with a larger sample size and more randomized controlled trials are required to define the superiority of our minimally invasive technique compared with conventional surgical treatment of calcaneal fractures. PMID:25441282

Cao, Liehu; Weng, Weizong; Song, Shaojun; Mao, Ningfang; Li, Haihang; Cai, Yuanqi; Zhou, Qirong; Su, Jiacan

2015-01-01

60

Report on a clinical evaluation of the KerraPro Heel silicone heel pad.  

PubMed

Heels are at increased risk of injury due to the posterior prominence and lack of padding over the calcaneus. Pressure injuries, once established, are extremely costly, both in terms of the detrimental effect on psychosocial wellbeing and threat to life, as well as financially due to length of hospital stay and resources used to heal the wounds. A new and inexpensive silicone heel pad has been designed to simplify the necessary decisions and to address the problems associated with pressure injuries to the heels. This article will describe an observational evaluation of the product. KerraPro Heel pads were evaluated in two separate cohorts of 17 participants over a 4-week period with the primary aim to evaluate the efficacy of the product in preventing and alleviating pressure injuries on the heels. All participants had been reported as 'at risk' or 'at high risk' of pressure injury to the heels and had a history of developing such lesions. The KerraPro heel pads were compared with the participant's standard protocol. The outcome of the evaluation demonstrated the effectiveness of the KerraPro Heel pads in the prevention and treatment of heel pressure injuries. PMID:24225600

Knowles, A; Young, S; Collins, F; Hampton, S

2013-11-01

61

Effect of non-sucrose sweet tasting solution on neonatal heel prick responses.  

PubMed

A substance commercially described as 'sugar free,' used as a sweetener for paracetamol suspension, was evaluated on measures of neonatal pain. Sixty infants were randomly allocated to receive one of four solutions before heel stab blood sampling: sterile water (placebo); 25 or 50% sucrose (weight/volume); and the commercial sweet-tasting solution. There was a significant reduction in crying time and pain score 3 minutes after the painful stimulus in all groups compared with the controls. It is concluded that this sweet-tasting solution has analgesic effects as potent as those of concentrated sucrose solutions. PMID:8777661

Ramenghi, L A; Griffith, G C; Wood, C M; Levene, M I

1996-03-01

62

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

PubMed Central

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 "Hospital with no pain". Practices such as skin to skin contact, or breastfeeding, in healthy newborn, may represent an alternative to the use of analgesic drugs. The aim of our work is to evaluate the analgesic effect of breastfeeding during heel puncture in full term healthy newborn. Methods We studied 200 healthy full term newborns (100 cases and 100 controls), proposing the puncture to mothers during breastfeeding, and explaining to them all the advantages of this practice. Pain assessment was evaluated by DAN scale (Douleur Aigue Nouveau ne scale). Results The difference in score of pain according to the DAN scale was significant in the two groups of patients (p = 0.000); the medium score was 5.15 for controls and 2.65 for cases (newborns sampled during breastfeeding). Conclusion Our results confirmed the evidence of analgesic effect of breastfeeding during heel puncture. This procedure could easily be adopted routinely in maternity wards. PMID:19490654

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

2008-01-01

63

Evolution and Allometry of Calcaneal Elongation in Living and Extinct Primates  

PubMed Central

Specialized acrobatic leaping has been recognized as a key adaptive trait tied to the origin and subsequent radiation of euprimates based on its observed frequency in extant primates and inferred frequency in extinct early euprimates. Hypothesized skeletal correlates include elongated tarsal elements, which would be expected to aid leaping by allowing for increased rates and durations of propulsive acceleration at takeoff. Alternatively, authors of a recent study argued that pronounced distal calcaneal elongation of euprimates (compared to other mammalian taxa) was related primarily to specialized pedal grasping. Testing for correlations between calcaneal elongation and leaping versus grasping is complicated by body size differences and associated allometric affects. We re-assess allometric constraints on, and the functional significance of, calcaneal elongation using phylogenetic comparative methods, and present an evolutionary hypothesis for the evolution of calcaneal elongation in primates using a Bayesian approach to ancestral state reconstruction (ASR). Results show that among all primates, logged ratios of distal calcaneal length to total calcaneal length are inversely correlated with logged body mass proxies derived from the area of the calcaneal facet for the cuboid. Results from phylogenetic ANOVA on residuals from this allometric line suggest that deviations are explained by degree of leaping specialization in prosimians, but not anthropoids. Results from ASR suggest that non-allometric increases in calcaneal elongation began in the primate stem lineage and continued independently in haplorhines and strepsirrhines. Anthropoid and lorisid lineages show stasis and decreasing elongation, respectively. Initial increases in calcaneal elongation in primate evolution may be related to either development of hallucal-grasping or a combination of grasping and more specialized leaping behaviors. As has been previously suggested, subsequent increases in calcaneal elongation are likely adaptations for more effective acrobatic leaping, highlighting the importance of this behavior in early euprimate evolution. PMID:23844094

Boyer, Doug M.; Seiffert, Erik R.; Gladman, Justin T.; Bloch, Jonathan I.

2013-01-01

64

On high heels and short muscles: a multiscale model for sarcomere loss in the gastrocnemius muscle.  

PubMed

High heels are a major source of chronic lower limb pain. Yet, more than one third of all women compromise health for looks and wear high heels on a daily basis. Changing from flat footwear to high heels induces chronic muscle shortening associated with discomfort, fatigue, reduced shock absorption, and increased injury risk. However, the long-term effects of high-heeled footwear on the musculoskeletal kinematics of the lower extremities remain poorly understood. Here we create a multiscale computational model for chronic muscle adaptation to characterize the acute and chronic effects of global muscle shortening on local sarcomere lengths. We perform a case study of a healthy female subject and show that raising the heel by 13cm shortens the gastrocnemius muscle by 5% while the Achilles tendon remains virtually unaffected. Our computational simulation indicates that muscle shortening displays significant regional variations with extreme values of 22% in the central gastrocnemius. Our model suggests that the muscle gradually adjusts to its new functional length by a chronic loss of sarcomeres in series. Sarcomere loss varies significantly across the muscle with an average loss of 9%, virtually no loss at the proximal and distal ends, and a maximum loss of 39% in the central region. These changes reposition the remaining sarcomeres back into their optimal operating regime. Computational modeling of chronic muscle shortening provides a valuable tool to shape our understanding of the underlying mechanisms of muscle adaptation. Our study could open new avenues in orthopedic surgery and enhance treatment for patients with muscle contracture caused by other conditions than high heel wear such as paralysis, muscular atrophy, and muscular dystrophy. PMID:25451524

Zöllner, Alexander M; Pok, Jacquelynn M; McWalter, Emily J; Gold, Garry E; Kuhl, Ellen

2015-01-21

65

An exploration of emergency department presentations related to high heel footwear in Victoria, Australia, 2006–2010  

PubMed Central

Background Many women are warned against the dangers of wearing high heel footwear however there is limited empirical evidence demonstrating an association between wearing high heel with injury. Gait laboratory testing has found a higher heel height placed the foot in a position that increases the risk of ankle sprain. Women have also been surveyed about wearing high heels and approximately half of those reported inconvenience and pain after wearing a high heel shoe. This study aims to explore emergency department presentations of injuries and the estimated costs that have been directly attributed to wearing high heeled footwear within Victoria, Australia during 2006–2010. Methods The Victorian Emergency Minimum Dataset (VEMD) was searched for all injuries attributed to wearing high heel footwear presenting to emergency departments in Victoria Australia, between the years of 2006–2010. The VEMD produced a report detailing sex, age at presentation, month of presentation, time of day of presentation, day of presentation, location that injury occurred and type of injury for presentation. Monash Health in Victoria Australia, provided emergency department estimates for injury types to calculate an estimated cost of an acute injury related to wearing high heel footwear. Results There were 240 injuries presenting to Victorian emergency departments directly attributed to wearing high heeled footwear. The majority of people injured were women (n?=?236) and all were less than 55 years of age. More injuries presented on a Sunday (n?=?83) and more in the 8 am-12 pm time bracket (n?=?64). There were also more injuries presenting in the months of November, December and January (n?=?80). The most commonly injured body part was the ankle (n?=?123). The emergency department estimate of the cost of these injuries over this time-frame was almost $72,000 (mean of $316.72 per presentation). Conclusions People who wear high heel footwear on weekends appear to be at higher risk for injury that leads to emergency department presentation. However, there was not a large cost associated with emergency department presentations attributable to wearing high heel footwear over a 5 year period. PMID:24456691

2014-01-01

66

Diabetic Heel Ulcer in the Sudan: Determinants of Outcome  

Microsoft Academic Search

Heel ulceration, on average, costs 1.5 times more than metatarsal ulceration. The aim of this study was to analyze the determinant factors of healing in diabetic patients with heel ulcers and the late outcomes at Jabir Abu Eliz Diabetic Centre Khartoum, Khartoum, Sudan. Data were collected prospectively for 96 of 100 diabetic patients presenting with heel ulcers at the Jabir Abu

Haseeb E. Bakheit; Mohamed F. Mohamed; Seif ElDin I. Mahadi; Abu Bakr H. Widatalla; Mohamed A. Shawer; Amar H. Khamis; Mohamed E. Ahmed

67

Clinical Allograft of a Calcaneal Tendon in a Rhesus Macaque (Macaca mulatta)  

PubMed Central

A 5.5-y-old male rhesus monkey (Macaca mulatta) housed in an outdoor field cage presented for severe trauma involving the left calcaneal tendon. Part of the management of this wound included an allograft of the calcaneal tendon from an animal that was euthanized for medical reasons. This case report describes the successful medical and surgical management of a macaque with a significant void of the calcaneal tendon. To our knowledge, this report is the first description of a successful tendon allograft in a rhesus macaque for clinical purposes. PMID:25255076

Lemoy, Marie-Josee; Summers, Laura; Colagross-Schouten, Angela

2014-01-01

68

Improved method for determining tank heel volumes  

SciTech Connect

As part of the tank calibration process, the instrument heel is that part of the tank that cannot be measured by the liquid level instrumentation. if the tank being calibrated is not a bottom drain tank, some volume of fluid will be present in the bottom of the tank after draining as much as possible. The amount of fluid remaining in the tank at the start of each run can be estimated by measuring a concentration change of an added spiking material. With the great improvement of liquid level measuring instruments, the total error associated with the instrument heel determination can be greatly affected by the laboratory method used to measure the concentration difference. At the Savannah River Site, the laboratory method used has historically been Direct Current Plasma Emission Spectroscopy, which yielded very marginal results at best. In the most recent tank calibrations, the laboratory method was changed to Absorption Spectrophotometry, which reduces the total error on the instrument heel measurement by a factor of 2.5 times. This paper describes the method used to determine tank instrument heels and the improvements made to this process.

Holt, S.H.; Livingston, R.R.; Nave, S.E.

1994-07-01

69

Measurement of lumbar lordosis in static standing posture with and without high-heeled shoes  

PubMed Central

Objective Some doctors and therapists believe that wearing high-heeled shoes causes increased lumbar lordosis and that this may be a cause of low back pain. The purpose of this study was to evaluate whether high-heeled shoes increase lumbar lordosis and to do so with more reliable methods and a larger sample size than used in previous studies. Methods Fifty participants from a chiropractic university were included in a test group (32 female and 18 male) and 9 in a control group (3 female and 6 male). A Spinal Mouse was used to measure lumbar lordosis in test participants barefoot and then again with 3- or 4-in high-heeled shoes after a 10-minute adaptation period of walking and sitting and standing while wearing the shoes. Reliability of the testing conditions was evaluated with 9 barefoot control participants before and after an identical adaptation period, and intra- and interexaminer reliability of Spinal Mouse measurements was tested by use of a wooden model built to mimic the proportions of a human spine. Results Both groups showed non-significant decreases in lordosis between the first and second scans (high heels: 23.4° to 22.8°, P = .17; control: 18.8° to 17.6°, P = .16). Scans of the wooden spine model were highly reliable (intra- and interexaminer intraclass correlation coefficients > .999). Conclusions Consistent with most previous studies, high-heeled shoes did not affect lumbar lordosis in most people while standing. Future research could investigate the effect of shoes during dynamic conditions or identify affected subgroups. PMID:23449540

Russell, Brent S.; Muhlenkamp, Kimberly A.; Hoiriis, Kathryn T.; DeSimone, Carolyn M.

2012-01-01

70

The role of computed tomography in the diagnosis and treatment of calcaneal fractures  

PubMed Central

The intra articular fractures represent a challenge for the orthopaedic surgeons. Because of the three-articulary surfaces, the calcaneus represents a permanent subject of discussion about the investigation and treatment opportunities. In a retrospective audit of patients hospitalized in our clinic, I tried to identify the opportunity of the CT scan as a preoperative investigation protocol in calcaneal fractures, the results showing that the CT scan represents a mandatory standard in calcaneal fractures.

Bica, F

2014-01-01

71

Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction.  

PubMed

Flexor digitorum longus transfer and medial displacement calcaneal osteotomy is a well-recognised form of treatment for stage II posterior tibial tendon dysfunction. Although excellent short- and medium-term results have been reported, the long-term outcome is unknown. We reviewed the clinical outcome of 31 patients with a symptomatic flexible flat-foot deformity who underwent this procedure between 1994 and 1996. There were 21 women and ten men with a mean age of 54.3 years (42 to 70). The mean follow-up was 15.2 years (11.4 to 16.5). All scores improved significantly (p < 0.001). The mean American Orthopedic Foot and Ankle Society (AOFAS) score improved from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up. The mean pain component improved from 12.3 to 35.2 (20 to 40). The mean function score improved from 35.2 to 45.6 (30 to 50). The mean visual analogue score for pain improved from 7.3 to 1.3 (0 to 6). The mean Short Form-36 physical component score was 40.6 (sd 8.9), and this showed a significant correlation with the mean AOFAS score (r = 0.68, p = 0.005). A total of 27 patients (87%) were pain free and functioning well at the final follow-up. We believe that flexor digitorum longus transfer and calcaneal osteotomy provides long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction. Cite this article: Bone Joint J 2015;97-B:346-52. PMID:25737518

Chadwick, C; Whitehouse, S L; Saxby, T S

2015-03-01

72

Effect of calcaneal osteotomy and plantar fasciotomy on arch configuration in a flatfoot model.  

PubMed

Seven fresh-frozen cadaver specimens had a calcaneal osteotomy performed obliquely through the posterior portion of the calcaneus. Angular relationships between the first metatarsal and talus were recorded with the use of a motion-analysis system in the transverse, sagittal, and coronal planes. The specimen was mounted in a testing machine and loaded via an intramedullary rod to 150, 350, and 550 N. A flatfoot model was created, and repeat measurements were obtained. The calcaneal osteotomy was then displaced 1 cm medially, and repeat measurements were made at each of the three load levels. The calcaneal osteotomy was then returned to its original position, the plantar fascia was divided, and the new angular measurements were obtained. The calcaneal osteotomy was again displaced 1 cm, and repeat angular measurements were obtained. A mild consistent flatfoot deformity was created in all three axes before the plantar fascia was cut. A statistically significant increase in deformity was noted after cutting the plantar fascia. A correction of the flatfoot deformity in all three planes occurred with the medial displacement of the calcaneal osteotomy, which was greater at the lower load levels. We noted that a medial displacement calcaneal osteotomy partially corrected a flatfoot deformity in all three planes. The correction occurred with or without an intact plantar fascia and, therefore, is independent of the structure. We also noted an increased deformity after dividing the plantar fascia. This study provides some biomechanical insight as to the corrective effect of a medial displacement calcaneal osteotomy in correcting a flatfoot deformity. PMID:9677080

Thordarson, D B; Hedman, T; Lundquist, D; Reisch, R

1998-06-01

73

Use of Allograft in Skeletally Immature Patients for Calcaneal Neck Lengthening Osteotomy  

PubMed Central

Purpose To date, there have been no studies evaluating the usefulness of allograft as a substitute for autograft in calcaneal neck lengthening osteotomy. This retrospective study examined the results of calcaneal neck lengthening osteotomy using allograft for pathologic flatfoot deformity in children and adolescents with various neuromuscular diseases. Materials and Methods 118 feet in 79 children treated surgically between Mar 2000 and July 2005 were reviewed. The mean age at the time of the operation was 9 + 3 years (range, 3 - 17 years) and follow-up averaged 15.4 months (range, 13 - 21 months) postoperatively. Talo-1st metatarsal angle, talo-calcaneal angle, calcaneal pitch were measured before and after operation and bony union was estimated. Results Bony union was noted at the latest follow-up and there were no postoperative complications such as reduction loss, infection, nonunion, delayed union or graft loss during the follow-up period in all but one foot. All radiographic indices were improved postoperatively in all cases. Conclusion Our results indicate that use of allograft in calcaneal neck lengthening osteotomy is a useful option for correction of the planovalgus deformity in skeletally immature patients whose enough autobone can not be obtained. PMID:18306473

Kwak, Yoon Hae; Park, Kun Bo; Park, Hui Wan

2008-01-01

74

Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.  

PubMed

Reconstruction of weight-bearing surfaces at the foot and ankle is controversial. Free tissue transfer and local fasciocutaneous perforator flaps are preferred for plantar reconstruction, but high rates of flap breakdown and ulceration have caused unsatisfactory functional outcomes. We present a modified "sural fasciomyocutaneous perforator flap" and its functional outcome. Between January 2007 and September 2010, 19 patients were treated for soft-tissue defects in the weight-bearing area with sural fasciomyocutaneous perforator flaps. The gastrocnemius, preserved in the base of the flap, was applied as padding under the calcaneus. In follow-up from 9 to 25 months (mean 13.8 months), each patient's pain score, defect size, ulcer formation, protective sensation recovery, and normal footwear were analyzed. The majority of the flaps survived with satisfactory aesthetic and functional results. One case of partial flap loss and one case of delayed ulceration were noted. With partial weight bearing at 4 weeks, satisfactory gait recovery was obtained at 5 to 8 months (in conjunction with protective sensation recovery). Sural fasciomyocutaneous perforator flap is a reliable modality in heel construction, showing advantages of low ulceration rate, durability, and good protective sensation recovery compared with conventional free tissue transfer and local fasciocutaneous perforator flap. PMID:24163225

Lu, Shengdi; Chai, Yimin; Wang, Chunyang; Wen, Gen

2014-02-01

75

Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis?  

PubMed

Calcaneal quantitative ultrasound (QUS) is attractive as a prescreening tool for osteoporosis, alternative to dual-energy X-ray absorptiometry. We investigated the literature of the usability of calcaneal QUS. We found large heterogeneity between studies and uncertainty about cutoff, device, and measured variable. Despite osteoporosis-related fractures being a major health issue, osteoporosis remains underdiagnosed. Dual-energy X-ray absorptiometry (DXA) of the hip or spine is currently the preferred method for diagnosis of osteoporosis, but the method is limited by low accessibility. QUS is a method for assessing bone alternative to DXA. The aim of this systematic review was to explore the usability of QUS as a prescreen stratification tool for assessment of osteoporosis. Studies that evaluated calcaneal QUS with DXA of the hip or spine as the gold standard was included. We extracted data from included studies to calculate number of DXAs saved and misclassification rates at cutoffs equal to high sensitivity and/or specificity. The number of DXAs saved and percentage of persons misclassified were measures of usability. We included 31 studies. Studies were heterogeneous regarding study characteristics. Analyses showed a wide spectrum of percentage of DXAs saved (2.7-68.8 %) and misclassification rates (0-12.4 %) depending on prescreen strategy and study characteristics, device, measured variable, and cutoff. Calcaneal QUS is potentially useful as a prescreen tool for assessment of osteoporosis. However, there is no consensus of device, variable, and cutoff. Overall, there is no sufficient evidence to recommend a specific cutoff for calcaneal QUS that provides a certainty level high enough to rule in or out osteoporosis. Calcaneal QUS in a prescreen or stratification algorithm must be based on device-specific cutoffs that are validated in the populations for which they are intended to be used. PMID:25634771

Thomsen, K; Jepsen, D B; Matzen, L; Hermann, A P; Masud, T; Ryg, J

2015-05-01

76

Safety of Noninvasive Electrical Stimulation of Acupuncture Points During a Routine Neonatal Heel Stick  

PubMed Central

Abstract Background Hospitalized infants may undergo frequent painful procedures with inadequate pain relief. Alternative pain relief interventions are needed. Objective The aim of this research was to determine the safety of noninvasive electrical stimulation of acupuncture points (NESAP) in neonates who were receiving routine heel sticks. Design This was a descriptive study performed to assess the safety of using a transcutaneous electrical nerve stimulation (TENS) unit to deliver NESAP to neonates. Setting/Subjects The subjects were healthy newborn infants<3 days old before hospital discharge. Intervention The intervention was NESAP delivered via a TENS unit, administered before, during, and after heel stick. The electrodes of the TENS unit were applied at four acupuncture points. Settings were gradually increased: 6 infants received 1.0 mA, 2 Hz; the second 6 infants received 2.0 mA, 10 Hz; and the last 18 infants received 3.5 mA, 10?Hz. Main Outcome Measures Three main measures were used: (1) skin assessment (2) vital signs; (3) pain scores using the Premature Infant Pain Profile (PIPP). Results There were no significant changes in vital signs during and after NESAP. There were no changes in PIPP scores in the first 12 infants after initiation of NESAP. A slight but nonsignificant increase in PIPP scores (from 2.65 to 3.5 on a scale of 0–18) occurred in the last 18 infants. There were no adverse events during or after NESAP. Conclusions NESAP is safe for infants with low settings on a TENS unit. PMID:24761178

Mitchell, Anita J.; Lowe, Leah M.; Lee, Amy; Hall, Richard W.

2013-01-01

77

Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures  

PubMed Central

Background: In surgeries of closed calcaneal fractures, the lateral L-shaped incision is usually adopted. Undesirable post-operative healing of the incision is a common complication. In this retrospective study, controllable risk factors of incision complications after closed calcaneal fracture surgery through a lateral L-shaped incision are discussed and the effectiveness of clinical intervention is assessed. Materials and Methods: A review of medical records was conducted of 209 patients (239 calcaneal fractures) surgically treated from June 2005 to October 2012. Univariate analyses were performed of seven controllable factors that might influence complications associated with the surgical incision. Binomial multiple logistic regression analysis was performed to determine factors of statistical significance. Results: Twenty-one fractures (8.79%) involved surgical incision complications, including 8 (3.35%) cases of wound dehiscence, 7 (2.93%) of flap margin necrosis, 5 (2.09%) of hematoma, and 1 (0.42%) of osteomyelitis. Five factors were statistically significant : The time from injury to surgery, operative duration, post-operative drainage, retraction of skin flap, bone grafting, and patients’ smoking habits. The results of multivariate analyses showed that surgeries performed within 7 days after fracture, operative time > 1.5 h, no drainage after surgery, static skin distraction, and patient smoking were risk factors for calcaneal incision complications. The post-operative duration of antibiotics and bone grafting made no significant difference. Conclusion: Complications after calcaneal surgeries may be reduced by postponing the surgery at least 7 days after fracture, shortening the time in surgery, implementing post-operative drainage, retracting skin flaps gently and for as short a time as possible, and prohibiting smoking. PMID:25197289

Wu, Kai; Wang, Chuanshun; Wang, Qiugen; Li, Haoqing

2014-01-01

78

The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: A finite element analysis  

PubMed Central

Objective: In the surgery of calcaneal fracture, whether the sustentaculum tali screw should always be placed is widely controversial. The aim of this study was to explore the necessity and function of the sustentaculum tali screw placement for the treatment of Sanders type II calcaneal fracture. Methods: The finite element analysis was used in this study. After the establishment of the finite element model of Sanders type II calcaneal fracture, the two internal fixation simulations were designed. In one model, the AO calcaneal plate was simulated on the lateral side of the calcanues with 7 screws being fixated at different position of the plate. In the other model, the calcaneus was fixated with the same AO calcaneal plate together with an additional screw being infiltrated into the sustentaculum tali. The two models were simulated under the same loading and the displacement of the fracture line and the stress distribution in the two models were calculated respectively. Results: The maximum principal stress focused on the cortical bone of sustentaculum tali in both the models under the same loading. The displacement of the fracture line, the maximum principal stress of calcaneus and internal fixation system in the model with sustentaculum screw fixation were smaller than that in the model without sustentaculum screw fixation. The stress in the model with sustentaculum screw fixation was more dispersed. Conclusions: The placement of sustentaculum tali screw is essential for fixation of type II calcaneal fracture to achieve the biomechanical stability. PMID:25225534

Pang, Qing-Jiang; Yu, Xiao; Guo, Zong-Hui

2014-01-01

79

Randomized crossover trial of kangaroo care to reduce biobehavioral pain responses in preterm infants: a pilot study.  

PubMed

Kangaroo care (KC), skin-to-skin contact between mother and infant, is a promising method for blunting pain responses. This crossover pilot tested KC effects on biobehavioral responses to heel stick in preterm infants (30-32 weeks' gestational age, 2-9 days old) measured by Premature Infant Pain Profile (PIPP) and salivary and serum cortisol. Mother-infant dyads were randomly assigned to KC heel stick (KCH) first or incubator heel stick (IH) first. Study 1 (80-min study, N = 18) tested the effect of 80 min of KC before and throughout the heel stick procedure versus incubator care. Study 2 (30-min study, N = 10) tested 30 min of KC before and throughout the heel stick versus incubator care. KCH and IH began during a premeasurement phase and continued through four data collection phases: baseline, heel warming, heel stick, and recovery. PIPP responses were measured every 30 s during data collection; salivary cortisol was measured at the end of baseline and recovery; and serum cortisol was measured during heel stick. Study 1 showed no differences between KCH and IH. Study 2 showed lower PIPP scores at four time points during recovery (p < .05 to p < .001), lower salivary cortisol at the end of recovery (p < .05), and lower serum cortisol during heel stick for the KCH condition (p < .05) as well as clinically lower PIPP scores in the KCH condition during heel stick. Thirty minutes of KC before and throughout the heel stick reduced biobehavioral responses to pain in preterm infants. PMID:21196428

Cong, Xiaomei; Ludington-Hoe, Susan M; Walsh, Stephen

2011-04-01

80

Nerve Injury and Pain after Operative Repair of Calcaneal Fractures: A Literature Review  

PubMed Central

Peripheral nerve injury is a common problem in foot and ankle surgery. We look at evidence of nerve injury as it relates to different operative approaches to the fractured calcaneus. The direct lateral, extended lateral, smile, sinus tarsi, and percutaneous approaches are discussed and the reported incidence of nerve injury in each is identified. We expect to identify divergent rates of injury between approaches and stimulate further investigation into prevention and treatment. PMID:24027484

Haugsdal, Jaclyn; Dawson, Jeremiah; Phisitkul, Phinit

2013-01-01

81

An in vivo analysis of the effectiveness of the osteoarthritic knee brace during heel strike and midstance of gait.  

PubMed

Presently, there are multiple nonoperative techniques a surgeon can use to alleviate the pain of an osteoarthritic joint including: oral medications, physical therapy, injections and off-loading knee braces. The objective of this study was to analyze subjects under in vivo, dynamic conditions using fluoroscopy to determine if off-loading knee braces actually separate the femoral condyle from the tibial plateau during the mid-stance and heel-strike phases of gait. Forty subjects with substantial unicompartmental osteoarthritis were studied under fluoroscopic surveillance in the frontal plane while performing normal gait on a treadmill. The subjects were patients of one surgeon and were all clinically diagnosed to have marked unicompartimental degenerative joint space narrowing. Initially, each subject was asked to perform normal gait on a treadmill under fluoroscopic surveillance in the frontal plane. An offloading osteoarthritic knee brace was then fixated on the osteoarthritic knee joint. The subjects were then asked to walk on level ground while wearing the brace to rate the effectiveness of the brace in alleviating pain. The subjects were then asked to perform normal gait on a treadmill while wearing the brace. Successive fluoroscopic images of each patient at mid-stance and heel-strike (with and without a brace) were downloaded to a workstation computer. The captured fluoroscopic images were then analyzed using digitization. Thirty-four of forty subjects (85%) judged the osteoarthritic knee brace effective in reducing knee pain. Six of the subjects (15%) were not able to detect a change in knee pain. All of these subjects were overweight resulting in suboptimal brace fixation. Thirty-one of forty subjects (78%) demonstrated articular separation of the degenerative knee compartment at heel-strike and 28/40 (70%) at midstance. Thirty-one of forty subjects (78%) experienced an angular change at heel-strike, while 37/40 experienced an angular change at mid-stance. The average amount of change in condylar separation (A) was 1.7 mm (0.0-6.4) at heel-strike and 1.9 mm (0.0-7.9) at mid-stance. The average amount of change in angle ?S was 2.0 degrees (0.0-4.8 degrees) at heel-strike and 1.6 degrees (0.0-5.1) at mid-stance. Previous biomechanical studies have documented excessive loads in degenerative compartments of patients with unicompartmental arthrosis and associated angular deformities. Offloading braces have been developed to attempt to lessen loads in the degenerative compartment with subsequent reductions in knee pain. This present study demonstrates in vivo articular separation of degenerative knee compartments can be achieved with offloading braces with subsequent subjective relief of knee pain. These braces may have limited effectiveness in obese patients. Key words: osteoarthritis of the knee, a knee brace, conservative treatment. PMID:20478172

Dennis, A D; Komistek, R D

1999-01-01

82

The mineralized collagen for the reconstruction of intra-articular calcaneal fractures with trabecular defects  

PubMed Central

Background: In cases of severe subversion of the morphology of calcaneal fractures with trabecular defects, bone graft is often necessary to provide a mechanical buttress. The mineralized collagen (MC) is a novel bone substitute that is developed by biomimetic synthesis strategy that mimics the extracellular matrix (ECM) of natural bone in structure and chemical composition. It can avoid donor site morbidity and complications associated with harvesting autologous bone graft. Objective: In this study, we conducted a retrospective matched-pair analysis to assess the clinical and radiological performances of MC as a bone graft substitute in intra-articular calcaneal fractures with trabecular defects. Methods: 24 pairs of intra-articular calcaneal fractures with trabecular defects were treated with open reduction, internal fixation, and grafting either with MC or autograft. Patient demographics, medical history, and CT fracture classification were matched. Fractures were monitored 6 weeks, 12 weeks, 6 months, and 1 year postoperatively for healing and postoperative complications and results were analyzed. Results: All patients had follow-up at a minimum of 12 months after surgery with a mean follow-up time of 17 months. All fractures were healed; there were no significant differences in the meantime to union and clinical between the two groups. The radiographic evaluation confirmed that a significant improvement in the mean Böhler’s angle, Gissane’s angle and the calcaneus height was observed in all patients in both treatment groups. A total of 29% (7/24) of patients suffered from harvest-site morbidity at 12 months in the autograft group. In contrast, all patients were free from postoperative local complications in the iliac region and no patient developed adverse reactions attributable to MC in the MC group. Conclusion: These results justify and favor the use of MC as a good autograft alternative in displaced intra-articular calcaneal fractures with trabecular defects. PMID:24270815

Lian, Kai; Lu, Hong; Guo, Xiaodong; Cui, Fuzhai; Qiu, Zhiye; Xu, Shuyun

2013-01-01

83

Comparison of Six Calcaneal Quantitative Ultrasound Devices: Precision and Hip Fracture Discrimination  

Microsoft Academic Search

:   Quantitative ultrasound (QUS) is now accepted as a useful tool in the management of osteoporosis. There are a variety of\\u000a QUS devices clinically available with a number of differences among them, including their coupling methods, parameter calculation\\u000a algorithms and sites of measurement. This study evaluated the abilities of six calcaneal QUS devices to discriminate between\\u000a normal and hip-fractured subjects

C. F. Njeh; D. Hans; J. Li; B. Fan; T. Fuerst; Y. Q. He; E. Tsuda-Futami; Y. Lu; C. Y. Wu; H. K. Genant

2000-01-01

84

[Anatomical variants of the medial calcaneal nerve and the Baxter nerve in the tarsal tunnel].  

PubMed

The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel. PMID:24701749

Martín-Oliva, X; Elgueta-Grillo, J; Veliz-Ayta, P; Orosco-Villaseñor, S; Elgueta-Grillo, M; Viladot-Perice, R

2013-01-01

85

Branching Patterns of Medial and Inferior Calcaneal Nerves Around the Tarsal Tunnel  

PubMed Central

Objective To demonstrate the bifurcation pattern of the tibial nerve and its branches. Methods Eleven legs of seven fresh cadavers were dissected. The reference line for the bifurcation point of tibial nerve branches was an imaginary horizontal line passing the tip of the medial malleolus. The distances between the reference line and the bifurcation points were measured. The bifurcation branching patterns were categorized as type I, the pattern in which the medial calcaneal nerve (MCN) branched most proximally; type II, the pattern in which the three branches occurred at the same point; and type III, in which MCN branched most distally. Results There were seven cases (64%) of type I, three cases (27%) of type III, and one case (9%) of type II. The median MCN branching point was 0.2 cm (range, -1 to 3 cm). The median bifurcation points of the lateral plantar nerves and inferior calcaneal nerves was -0.6 cm (range, -1.5 to 1 cm) and -2.5 cm (range, -3.5 to -1 cm), respectively. Conclusion MCN originated from the tibial nerve in most cases, and plantar nerves were bifurcated below the medial malleolus. In all cases, inferior calcaneal nerves originated from the lateral plantar nerve. These anatomical findings could be useful for performing procedures, such as nerve block or electrophysiologic studies.

Kim, Beom Suk; Choung, Phil Woo; Kwon, Soon Wook; Rhyu, Im Joo

2015-01-01

86

The biomechanical efficacy of dressings in preventing heel ulcers.  

PubMed

The heels are the most common site for facility-acquired pressure ulcers (PUs), and are also the most susceptible location for deep tissue injuries. The use of multilayer prophylactic dressings to prevent heel PUs is a relatively new prevention concept, generally aimed at minimizing the risk for heel ulcers (HUs) through mechanical cushioning and reduction of friction at the dressing-support interface. We used 9 finite element model variants of the posterior heel in order to evaluate the biomechanical performance of a multilayer dressing in prevention of HUs during supine lying. We compared volumetric exposures of the loaded soft tissues to effective and maximal shear strains, as well as peak stresses in the Achilles tendon, without any dressing and with a single-layer or a multilayer dressing (Mepilex(®) Border Heel-type), on supports with different stiffnesses. The use of the multilayer dressing consistently and considerably reduced soft tissue exposures to elevated strains at the posterior heel, on all of the tested support surfaces and when loaded with either pure compression or combined compression and shear. The aforementioned multilayer design showed (i) clear benefit over a single-layer dressing in terms of dissipating tissue strains, by promoting internal shear in the dressing which diverts loads from tissues; (ii) a protective effect that was consistent on supports with different stiffnesses. Recent randomized controlled trials confirmed the efficacy of the simulated multilayer dressing, and so, taken together with this modeling work, the use of a prophylactic multilayer dressing indicates a great promise in taking this route for prevention. PMID:25639600

Levy, Ayelet; Frank, Mor Ben-Or; Gefen, Amit

2015-02-01

87

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

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...

2013-10-01

88

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

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...

2010-10-01

89

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

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...

2012-10-01

90

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

Code of Federal Regulations, 2014 CFR

...2014-10-01 2014-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...

2014-10-01

91

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

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Calculation of wind heeling moment (Hm). 174.055 Section...Drilling Units § 174.055 Calculation of wind heeling moment (Hm). (a) The wind heeling moment (Hm) of a unit in a given...

2011-10-01

92

Nuclear mitochondrial DNA: an Achilles' heel of molecular systematics, phylogenetics,  

E-print Network

Nuclear mitochondrial DNA: an Achilles' heel of molecular systematics, phylogenetics. In studies of animal species, most researchers prefer to use mitochondrial DNA (mtDNA) because of certain-transcribed DNA regions which were trans- ferred from the mitochondrial to nuclear genome (numts), (Lopez et al

93

Heel Lifts and the Stance Phase of Gait in Subjects With Limited Ankle Dorsiflexion  

PubMed Central

Context: Heel lifts are often prescribed as part of the treatment program for patients with overuse injuries associated with limited ankle dorsiflexion. However, little is known about how joint kinematics and temporal variables are affected by heel lifts. Objective: To determine the effects of heel lifts on selected lower extremity kinematic and temporal variables during the stance phase of gait in subjects with limited ankle dorsiflexion. Design: Two-way, fully repeated-measures design. The 2 factors were side (right or left) and walking condition (shoes alone, 6-mm heel lifts in shoes, 9-mm heel lifts in shoes). Setting: University biomechanics laboratory. Patients or Other Participants: Twenty-six volunteers (21 females, 5 males) with no more than 5° of ankle joint dorsiflexion. Intervention(s): Subjects were tested in shoes alone and in shoes with 6-mm and 9-mm heel lifts. Main Outcome Measure(s): We used the Qualisys Motion Analysis System to measure ankle dorsiflexion excursion, maximal knee extension, and time to heel off during the stance phase of gait under the 3 walking conditions. Results: On the right side, ankle dorsiflexion excursion increased significantly with the 6-mm and 9-mm heel lifts compared with shoes alone ( P < .05). On the left side, ankle dorsiflexion increased significantly with the 9-mm heels lifts over shoes alone and with the 9-mm heel lifts compared with the 6-mm heel lifts ( P < .05). Time to heel off increased significantly for walking with the 9-mm heel lifts compared with shoes alone ( P < .05). No differences were noted for maximal knee extension ( P > .05). Conclusions: Clinicians may consider prescribing heel lifts for patients with limited dorsiflexion range of motion if increasing ankle dorsiflexion excursion and time to heel off during the stance phase of gait may be beneficial. PMID:16791300

Johanson, Marie A; Cooksey, Alanna; Hillier, Caroline; Kobbeman, Heather; Stambaugh, Amy

2006-01-01

94

Intra-articular neuropathic fracture of the calcaneal body treated by open reduction and subtalar arthrodesis.  

PubMed

A novel pattern of neuropathic intra-articular calcaneal fracture in a diabetic patient is described. This fracture combined proximal retraction of the tuberosity and body along with hindfoot collapse and plantar ulceration. Following control of the acute Charcot process with total contact casting, surgical reduction and subtalar arthrodesis was performed to stabilize the hindfoot and decrease the risk of recurrent ulceration. After healing, the patient successfully resumed ambulation and presently uses extra-depth shoes for daily activities. Despite the risks of surgical treatment, this difficult fracture may be treated operatively to maintain plantigrade alignment and offer limb salvage for the neuropathic patient. PMID:11428765

Campbell, J T

2001-05-01

95

A case of acute tarsal tunnel syndrome following lateralizing calcaneal osteotomy.  

PubMed

Surgical correction of hindfoot varus is frequently performed with a lateral displacement calcaneal osteotomy. It has rarely been associated with iatrogenic tarsal tunnel syndrome in patients with pre-existing neurological disease. We report the first case of acute postoperative tarsal tunnel syndrome in a neurologically intact patient with post-traumatic hindfoot varus. Early diagnosis and emergent operative release afforded an excellent clinical outcome. Imaging studies can help outrule a compressive hematoma and assess for possible nerve transection; however it is paramount that a high index of suspicion is utilized with judicious operative intervention to minimize long-term sequelae. PMID:25682414

Walls, Raymond J; Chan, Jeremy Y; Ellis, Scott J

2015-03-01

96

Heel and toe driving on fuel cell vehicle  

DOEpatents

A system and method for providing nearly instantaneous power in a fuel cell vehicle. The method includes monitoring the brake pedal angle and the accelerator pedal angle of the vehicle, and if the vehicle driver is pressing both the brake pedal and the accelerator pedal at the same time and the vehicle is in a drive gear, activating a heel and toe mode. When the heel and toe mode is activated, the speed of a cathode compressor is increased to a predetermined speed set-point, which is higher than the normal compressor speed for the pedal position. Thus, when the vehicle brake is removed, the compressor speed is high enough to provide enough air to the cathode, so that the stack can generate nearly immediate power.

Choi, Tayoung; Chen, Dongmei

2012-12-11

97

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

PubMed

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

2006-01-01

98

Discriminative Capacity of Calcaneal Quantitative Ultrasound and of Osteoporosis and Fracture Risk Factors in Postmenopausal Women with Osteoporotic Fractures  

Microsoft Academic Search

Bone fragility fractures constitute the principal complication of osteoporosis. The identification of individuals at high risk of sustaining osteoporotic fractures is important for implementing preventive measures. The purpose of this study is to analyze the discriminative capacity of a series of osteoporosis and fracture risk factors, and of calcaneal quantitative ultrasound (QUS), in a population of postmenopausal women with a

J. L. Hernández; F. Marin; J. González-Macías; A. Díez-Pérez; J. Vila; S. Giménez; B. Galán; M. S. Arenas; F. Suárez; L. Gayola; G. Guillén; T. Sagredo; R. Belenguer; A. Moron; E. Arriaza

2004-01-01

99

Calcaneal ultrasound predicts early postmenopausal fractures as well as axial BMD. A prospective study of 422 women  

Microsoft Academic Search

Low calcaneal ultrasound measurement (quantitative ultrasound, QUS) has been shown to predict fractures in elderly women. However, only a few studies have examined its ability to predict perimenopausal and early postmenopausal fractures. We conducted a prospective population-based cohort study to assess the capability of QUS as compared to axial BMD measurement to predict early postmenopausal fractures at that age. Four

J. Huopio; H. Kröger; R. Honkanen; J. Jurvelin; S. Saarikoski; E. Alhava

2004-01-01

100

Neurotized distally based sural flap for heel reconstruction.  

PubMed

The use of local flaps for the reconstruction of leg has lost their popularity with the more often performed flaps on the basis of perforators and microsurgical technique. Like the head and neck reconstruction, in the lower extremity there are limited units of tissue to base the flaps because of the lack of vascularity and arc of mobilization. The distally based sural flap represents an ideal flap for the reconstruction of heel, and with the inclusion of the sural nerve, we can neurotize the flap to give the stability of a weight-bearing area and provide the necessary sensibility to avoid ulcerations of the reconstructed heel. We present a case of a 32-year-old woman with a traumatic loss of the tissue covering the heel, with a diagnosis of a pseudoepithelial hyperplasia treated in previous occasions with skin grafts that led to chronic ulcerations. A distally based sural flap was planned for a definitive coverage, planning a perineural neurorrhaphy, to the intermediate dorsal cutaneous branch of the superficial peroneal nerve to give sensibility to the flap. PMID:23757153

Mendieta, Mauricio J; Roblero, Carlos; Vega, Juan C

2013-10-01

101

Modification of high-heeled shoes to decrease pronation during gait.  

PubMed

One of the reasons that high heels may contribute to the formation of halux valgus is that the wearers pronate during propulsion. This pilot study was performed to determine whether relocation of the heel under the counter of a fashion high-heeled pump could change the degree of pronation of the foot during the gait cycle. The authors report that more foot stability was experienced by the subjects when the center of the heel was offset between 2 and 4 mm medial to the center of the heel counter. This study is designed to promote further research into whether the shoe industry should change the design parameters of high-heeled fashion shoes in order to improve foot function. PMID:1875295

Phillips, R D; Reczek, D M; Fountain, D; Renner, J; Park, D B

1991-04-01

102

Validation of a neonatal pain scale adapted to the new practices in caring for preterm newborns  

Microsoft Academic Search

BackgroundNeonatal pain assessment generally requires access to facial expression. Improved neonatology practices, such as greater protection against bright lights and non-invasive mask ventilation, have made facial observation more difficult.ObjectiveTo validate a ‘faceless’ acute neonatal pain scale (FANS), which does not depend on facial expression.MethodsIn a prospective, multicentre study, 24–40-week-old neonates were videotaped during a painful procedure (heel prick). Three investigators

Christophe Milesi; Gilles Cambonie; Aurelien Jacquot; Eric Barbotte; Renaud Mesnage; Florence Masson; Odile Pidoux; Felicie Ferragu; Pierre Thevenot; Jean-Bernard Mariette; Jean-Charles Picaud

2010-01-01

103

A comparison of two pressure-relieving devices on the prevention of heel pressure ulcers.  

PubMed

The effectiveness of hospital pillows versus a commercial heel elevation device (the Foot Waffle [EHOB incorporated]) in preventing heel pressure ulcers was examined using an experimental balanced factorial design with repeated measures on 52 patients (ages 27 to 90) in randomized groups. Heel interface pressures were taken with patients in supine and right lateral tilt positions. Logistic regression demonstrated a statistically significant difference between interface pressures on left and right heels (p = .004) and a trend toward significance between the pillow and Foot Waffle (p = .069). The Generalized Estimating Equations (GEE) method revealed the Foot Waffle was four times more likely not to suspend the heel off the bed than the pillow, and the left heel was four-and-a-half times more likely to have higher interface pressures than the right. There was no significant difference between groups in incidence of lower-extremity pressure ulcers, but patients using the Foot Waffle developed pressure ulcers significantly sooner (10 days versus 13 days for the pillow). Heels require additional protection beyond the use of specially beds and mattress overlays. In order to provide continuous heel suspension, clinicians must consider proper fit, turning schedules, patient position, patient activity, and presence of additional equipment when selecting heel protection products. This study illustrates how difficult it is to control for all these factors when doing clinical research. Note: This study was done with a Foot Waffle model that has since been redesigned. No research is available on the new model. PMID:9204803

Tymec, A C; Pieper, B; Vollman, K

1997-01-01

104

Groin pain  

MedlinePLUS

Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... The health care provider will do an exam of the groin area and ask questions about your medical history and symptoms, such as: Have you had an injury recently? Has there ...

105

Abdominal pain  

MedlinePLUS

Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is does not always reflect the seriousness ...

106

Flank pain  

MedlinePLUS

Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. However, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

107

Factors in Daily Physical Activity Related to Calcaneal Mineral Density in Men  

NASA Technical Reports Server (NTRS)

To determine the factors in daily physical activity that influence the mineral density of the calcaneus, we recorded walking steps and the type and duration of exercise in 43 healthy 26-to 51-yr-old men. Areal (g/sq cm) calcaneal bone mineral density (CBMD) was measured by single energy x-ray densitometry. Subjects walked a mean (+/- SD) of 7902(+/-2534) steps per day or approximately 3.9(+/-1.2) miles daily. Eight subjects reported no exercise activities. The remaining 35 subjects spent 143(2-772) (median and range) min/wk exercising. Twenty-eight men engaged in exercise activities that generate single leg peak vertical ground reaction forces (GRF(sub z)) of 2 or more body weights (high loaders, HL), and 15 reported exercise or daily activities that typically generate GRF(sub z) less than 1.5 body weights (low loaders, LL). CBMD was 12% higher in HL than LL (0.668 +/- 0.074 g/sq cm vs 0.597 +/- 0.062 g/sq cm, P less than 0.004). In the HL group, CBMD correlated to reported minutes of high load exercise (r = 0.41, P less than 0.03). CBMD was not related to the number of daily walking steps (N = 43, r = 0.03, NS). The results of this study support the concept that the dominant factor in daily physical activity relating to bone mineral density is the participation in site specific high loading activities, i.e., for the calcaneus, high calcaneal loads.

Hutchinson, Teresa M.; Whalen, Robert T.; Cleek, Tammy M.; Vogel, John M.; Arnaud, Sara B.

1995-01-01

108

Does osteoporosis classification using heel BMD agree across manufacturers?  

PubMed

The lack of standardization in bone mineral density (BMD) measurements is known. Several studies have been carried out to cross-calibrate the axial dual X-ray absorptiometry (DXA) devices. Recently, a number of peripheral DXA (pDXA) densitometers have been introduced. In this study we evaluated the agreement between two heel DXA devices on BMD and T-scores. A total of 99 females aged 21-78 years (ca. 16 per decade) had their non-dominant heel BMD measured using the PIXI (Lunar Inc.) and the Apollo (Norland Medical) pDXA scanners. The mean BMD values were 0.492 and 0.607 g/cm(2) and the mean T-scores using manufacturers' specified reference data were -0.07 and -0.25 for the PIXI and Apollo, respectively. Both the BMD and T-score intermachine relationships were highly correlated but showed significant nonidentity slopes and non-zero offsets. The diagnostic comparison on T-scores resulted in 86% agreement between the instruments (weighted kappa score of 0.550). Normalizing the reference peaks and SDs using this study's young adult population BMD results removed the systematic T-score disagreement. We found that PIXI and Apollo are highly correlated. Differences in BMD values are mainly due to different region of interest (ROI) definitions and additional T-score disagreement reflects the difference in normative databases. PMID:12181618

Grigorian, M; Shepherd, J A; Cheng, X G; Njeh, C F; Toschke, J O; Genant, H K

2002-08-01

109

Mid-Term Follow Up Results of Subtalar Distraction Arthrodesis Using a Double Bone-Block for Calcaneal Malunion  

PubMed Central

Purpose This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. Materials and Methods From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. Results The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8° in talocalcaneal angle, 5.1° in talar declination angle and 5.3° in talo-first metatarsal angle. Conclusion Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis. PMID:24954341

Chung, Hyung-Jin; Choo, Ji-Woong

2014-01-01

110

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

2006-01-01

111

Treatment of calcaneal fractures with closed reduction and the endobutton-assisted technique short-term analysis.  

PubMed

Background : Closed reduction and percutaneous pinning, open reduction and internal fixation, and primary arthrodesis are procedures used in the surgical treatment of calcaneal fractures. This study presents short-term clinical and radiologic results of patients with calcaneal fractures treated by closed indirect reduction with Endobutton-assisted minimally invasive osteosynthesis. Methods : Twenty-one feet of 18 patients (four women and 14 men) with calcaneal fractures were retrospectively analyzed. Böhler and Gissane angles were measured from the preoperative, postoperative, and latest follow-up lateral radiographs of the feet. American Orthopaedic Foot and Ankle Society (AOFAS) scores were used for the 6-month and latest follow-up clinical assessments. Results : The mean preoperative Böhler angle of 17.1° was corrected to a mean of 20.4° postoperatively. The mean value of this angle measured at the time of latest follow-up was 21.3°. The mean preoperative and postoperative Gissane angles were 116° and 117.8°, respectively. The mean value of this angle measured at the time of latest follow-up was 117.4°. The mean 6-month postoperative AOFAS score was 59.8 points. The mean AOFAS score at the time of latest follow-up (79.1 points) was significantly higher than the mean score 6 months postoperatively (P < .001). Regarding the latest follow-up AOFAS scores, four were poor, four were moderate, ten were good, and three were excellent. Conclusions : With a low learning curve and satisfactory clinical outcomes, this technique can be used in acute, edematous cases with soft-tissue injuries to avoid calcaneal enlargement, infection, and soft-tissue problems. PMID:25675224

Atmaca, Halil; Memisoglu, Kaya; Baran, Tuncay; Kesemenli, Cumhur Cevdet

2015-01-01

112

Surgical treatment of intra-articular calcaneal fractures: description of a technique using an adjustable uniplanar external fixator.  

PubMed

Several surgical techniques are available for the treatment of intra-articular calcaneal fractures. The use of a uniplanar external fixator is an option for the treatment of fractures classified as Sanders types 2 and 3. Satisfactory reduction and stabilisation of the fracture are achieved by means of mini-incisions and fixator adjustment. The advantages of this technique include less soft-tissue damage, avoidance of internal implants and early weight-bearing with the potential to improve postoperative recovery. PMID:25540120

Ramos, Randal Rudge; de Castro Filho, Carlos Daniel Candido; Ramos, Roger Rudge; Bittar, Cíntia Kelly; de Cillo, Mario Sérgio Paulilo; de Mattos, Carlos Augusto; Zabeu, José Luís Amim; Mazzuia, Antenor Rafael

2014-11-01

113

Influence of the calcaneus shape on the risk of posterior heel ulcer using 3D patient-specific biomechanical modeling  

E-print Network

1 Influence of the calcaneus shape on the risk of posterior heel ulcer using 3D patient: Biomechanical model for heel ulcer prevention *Corresponding author: Yohan Payan Equipe GMCAO - Laboratoire TIMC in Annals of Biomedical Engineering #12;2 Abstract Most posterior heel ulcers are the consequence

Payan, Yohan

114

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

PubMed

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

2010-03-01

115

Cancer pain  

SciTech Connect

This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

Swerdlow, M.; Ventafridda, V.

1987-01-01

116

Radiation levels on empty cylinders containing heel material  

SciTech Connect

Empty UF{sub 6} cylinders containing heel material were found to emit radiation levels in excess of 200 mr/hr, the maximum amount stated in ORO-651. The radiation levels were as high as 335 mr/hr for thick wall (48X and 48Y) cylinders and 1050 mr/hr for thin wall (48G and 48H) cylinders. The high readings were found only on the bottom of the cylinders. These radiation levels exceeded the maximum levels established in DOT 49 CFR, Part 173.441 for shipment of cylinders. Holding periods of four weeks for thick-wall cylinders and ten weeks for thin-wall cylinders were established to allow the radiation levels to decay prior to shipment.

Shockley, C.W. [Martin Marietta Energy Systems, Inc., Paducah, KY (United States)

1991-12-31

117

Backwards in High Heels: Getting Women Elected, 1842-1990  

NSDL National Science Digital Library

Incorporated as the capital of the Republic of Texas in 1839, Austin didnâ??t elect its first female council woman until the middle of the 20th century. The first female legislators didnâ??t find their way into office until the 1970s, and it wasnâ??t until 1990 that Texas elected a female governor. This exhibit by Austinâ??s Public Library tells the story of women in the cityâ??s politics through photographs, essays, and old newspaper clippings. Categories include Womenâ??s Work, Political Pioneers, and A Foot in the Door, among many others. Of particular interest, the biography of Ann Richards, the former governor of Texas, contextualizes her famous quote: â??Ginger Rogers did everything that Fred Astaire did. She just did it backwards and in high heels.â?

2014-02-25

118

Foetal pain?  

PubMed

The majority of commentary on foetal pain has looked at the maturation of neural pathways to decide a lower age limit for foetal pain. This approach is sensible because there must be a minimal necessary neural development that makes pain possible. Very broadly, it is generally agreed that the minimal necessary neural pathways for pain are in place by 24 weeks gestation. Arguments remain, however, as to the possibility of foetal pain before or after 24 weeks. Some argue that the foetus can feel pain earlier than 24 weeks because pain can be supported by subcortical structures. Others argue that the foetus cannot feel pain at any stage because it is maintained in a state of sedation in the womb and lacks further neural and conceptual development necessary for pain. Much of this argument rests on the definition of terms such as 'wakefulness' and 'pain'. If a behavioural and neural reaction to a noxious stimulus is considered sufficient for pain, then pain is possible from 24 weeks and probably much earlier. If a conceptual subjectivity is considered necessary for pain, however, then pain is not possible at any gestational age. Regardless of how pain is defined, it is clear that pain for conceptual beings is qualitatively different than pain for non-conceptual beings. It is therefore a mistake to draw an equivalence between foetal pain and pain in the older infant or adult. PMID:20356798

Derbyshire, Stuart W G

2010-10-01

119

Pain (PDQ)  

MedlinePLUS

... cancer treatment ends. Pain control can improve your quality of life. Pain can be controlled in most patients with ... in most patients. Pain control can improve your quality of life all through your cancer treatment and after it ...

120

Belly Pain  

MedlinePLUS

... tract infection or a blocked intestine. Infection by bacteria or a parasite, heartburn , irritable bowel disease , or ... to have abdominal pain, the pain in your gut may really be a pain in your brain. ...

121

Elbow pain  

MedlinePLUS

Pain - elbow ... Elbow pain can be caused by a variety of problems. A common cause in adults is tendinitis , an inflammation ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

122

Neck Pain  

MedlinePLUS

... Pregnancy and Rheumatic Disease Sex and Arthritis Neck Pain PRINT Download PDF Description Saying, “It’s a pain ... requires expensive or uncomfortable tests. What is neck pain? Acute strain may occur after sleeping in an ...

123

Wrist pain  

MedlinePLUS

... back. Over-the-counter pain medications, such as ibuprofen or naproxen, can relieve pain and swelling. Various, ... Take over-the-counter pain medication, such as ibuprofen or acetaminophen. Wear a splint for several days. ...

124

Pain Relievers  

MedlinePLUS

Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

125

Radiographic Texture Analysis of Densitometric Calcaneal Images: Relationship to Clinical Characteristics and to Bone Fragility  

PubMed Central

Osteoporotic fractures are related not only to bone mineral density (BMD) but also to bone structure or microarchitecture, which is not assessed routinely with currently available methods. We have developed radiographic texture analysis (RTA) for calcaneal images from a peripheral densitometer as an easy, noninvasive method for assessing bone structure. We conducted a cross-sectional study of the relationship between RTA and prevalent vertebral fractures (n = 148) among 900 subjects (ages 19 to 99 years, 94 males) referred for bone densitometry as part of their routine medical care. RTA features were derived from Fourier-based image analysis of the radiographic texture pattern (including root mean square, first moment, and power spectral analyses). RTA features were associated with age, weight, gender, and race, as well as glucocorticoid use. When controlling for clinical risk factors and BMD (or a summary measure calculated using FRAX algorithms), RTA features were significantly different for subjects with and without prevalent vertebral fractures [adjusted odds ratio (OR) = 1.5 per 1 standard deviation (SD) decrease in RTA feature beta, 95% confidence interval (CI) 1.2–1.8, p = .001]. Gender and use of pharmacologic therapy for osteoporosis did not significantly affect this association, suggesting that RTA can be applied to a wide range of densitometry patients. We conclude that RTA obtained using a portable instrument has a potential as a noninvasive method to enhance identification of patients at increased risk of osteoporotic fractures. Copyright © 2010 American Society for Bone and Mineral Research PMID:19594292

Vokes, Tamara; Lauderdale, Diane; Ma, Siu-Ling; Chinander, Mike; Childs, Keona; Giger, Maryellen

2010-01-01

126

Strength evaluation of lateral calcaneal wall with circular external fixation application in cadaveric specimens.  

PubMed

Circular external fixation is a useful treatment option for the correction of complex trauma, extremity deformity, osteomyelitis, and reconstruction of the foot and ankle. The goal of the present study was to determine the degrees of bolt rotation required to create enough wire tension to cause structural failure of the lateral calcaneal wall when stressed with both olive and smooth wires in a cadaveric model. Ten fresh, thawed, below-the-knee specimens were tested at the San Diego Cadaveric Academic Research Symposium. The mean bolt rotation required to pull an olive wire through the lateral wall of the calcaneus was 79.8° ± 32.81°, and the mean bolt rotation required to "walk" a skinny wire (narrow diameter) and create 1 mm of cortical bone failure was 50.5° ± 30.91°. The results of the present investigation further define and elucidate the appropriate "Russian tensioning" technique applicable for external fixation of the calcaneus using olive or skinny wires in the case of fracture repair or compression arthrodesis. PMID:23253879

Bussewitz, Bradly W; Scott, Ryan T; Hyer, Christopher F; Philbin, Terrence M

2013-01-01

127

Pelvic Pain  

MedlinePLUS

Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

128

Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing  

Microsoft Academic Search

Objective: The objective of this study was to determine the effectiveness of treatment of nonhealing heel ulcers and gangrene and to define those variables that are associated with success.Methods: A multi-institutional review was undertaken at four university or university-affiliated hospitals of all patients with wounds of the heel and arterial insufficiency, which was defined as absent pedal pulses and a

Gerald S Treiman; Gustavo S. C Oderich; Amir Ashrafi; Peter A Schneider

2000-01-01

129

Heel ulcer and blood flow: the importance of the angiosome concept.  

PubMed

A young female diabetic patient is reported, who presented with a double foot lesion. She presented with a first metatarsal head exposure concomitant with a heel wet gangrene. Magnetic resonance demonstrated osteomyelitis of the rear portion of the calcaneus. Transmetatarsal amputation was performed and a wide debridement was required to remove all gangrenous tissue from the heel wound. The pedal artery was palpable; the posterior tibial pulse was present, but weak.Transcutaneous oximetry (TcPO2) at the dorsum of the foot was TcPO2 = 56 mmHg despite significant oedema. Nevertheless, TcPO2 on the perilesional area of the heel ulcer (TcPO2 = 24mmHg) was suggestive for critical chronic ischemia. At angiographic examination, anterior tibial and peroneal arteries were patent, but the posterior tibial artery that showed severe stenosis then percutaneous angioplasty (PTA) was performed. Just the day after PTA, values of TcPO2 at the perilesional area of the heel ulcer increased to 41 mmHg. Heel osteomyelitis was subsequently treated by partial calcanectomy. The patient was discharged after a 21-day hospital stay. In the treatment of heel ulcers, it is clinically useful to use the angiosomic concept. The majority of the blood supply to the heel is provided by the posterior tibial artery, and only to a small extent by the posterior branch of peroneal artery. If the decrease in blood flow to this region is not detected, and direct flow based on the angiosome concept is not obtained, the healing of a heel ulcer may be delayed or impaired. PMID:24043681

Faglia, Ezio; Clerici, Giacomo; Caminiti, Maurizio; Vincenzo, Curci; Cetta, Francesco

2013-09-01

130

Association of quantitative heel ultrasound with history of osteoporotic fractures in elderly men: The ESOPO study  

Microsoft Academic Search

In order to evaluate the usefulness of calcaneal quantitative ultrasound (QUS) in the assessment of male osteoporosis, a cross-sectional, population-based study was performed. A cohort of 4,832 men, randomly selected, community-dwelling, aged 60–80 years and representative of the general older male Italian population was recruited. QUS measurements were assessed in 83 centers distributed all over Italy and equipped with an Achilles

M. Varenna; L. Sinigaglia; S. Adami; S. Giannini; G. Isaia; S. Maggi; P. Filipponi; O. Di Munno; D. Maugeri; D. de Feo; G. Crepaldi

2005-01-01

131

Thinking while walking: experienced high-heel walkers flexibly adjust their gait.  

PubMed

Theories of motor-skill acquisition postulate that attentional demands of motor execution decrease with practice. Hence, motor experts should experience less attentional resource conflict when performing a motor task in their domain of expertise concurrently with a demanding cognitive task. We assessed cognitive and motor performance in high-heel experts and novices who were performing a working memory task while walking in gym shoes or high heels on a treadmill. Surprisingly, neither group showed lower working memory performance when walking than when sitting, irrespective of shoe type. However, high-heel experts adapted walking regularity more flexibly to shoe type and cognitive load than novices, by reducing the variability of time spent in the single-support phase of the gait cycle in high heels when cognitively challenged. We conclude that high-heel expertise is associated with more flexible adjustments of movement patterns. Future research should investigate whether a more demanding walking task (e.g., wearing high heels on uneven surfaces and during gait perturbations) results in expertise-related differences in the simultaneous execution of a cognitive task. PMID:23760158

Schaefer, Sabine; Lindenberger, Ulman

2013-01-01

132

Even routine painful procedures can be harmful for the newborn.  

PubMed

Stressful events can damage neonatal brain through a complexity of events including free radical (FR) generation. We examined whether pain provoked by a routine heel prick can generate an increase in potentially harmful FR in neonatal blood. To this aim, advanced oxidation protein products (AOPP) and total hydroperoxide (TH) concentrations were measured at the beginning (sample A) and at the end (sample B) of each sampling in 64 babies (corrected age: 37.2+/-2.7 weeks) who underwent heel prick for routine blood tests. We scored pain of every procedure in all newborns. No differences were detected between AOPP and TH blood concentrations at the beginning and at the end of heel prick sampling, considering the whole cohort of babies. Conversely, a significant increase was observed between AOPP and TH blood concentrations considering only those babies who showed the highest pain intensity. When babies' pain was high (ABC score >or=4), mean AOPP and TH blood levels increased significantly; in this case, mean AOPP values increased from 53.5microm/l (SD=41.6) to 63.2microm/l (SD=44.3) and TH values from 218.3UCarr (SD=89.2) to 228.7UCarr (SD=93.3), with a significant p value of 0.02 and 0.036, respectively. A significant correlation was also found between AOPP blood levels ratio (sample B/sample A) in each baby, and the correspondent level of pain. These data show that even common routine procedures can be potentially harmful for the newborn if they provoke a high level of pain. PMID:19786323

Bellieni, C V; Iantorno, L; Perrone, S; Rodriguez, A; Longini, M; Capitani, S; Buonocore, G

2009-12-15

133

Heel effect adaptive flat field correction of digital x-ray detectors  

SciTech Connect

Purpose: Anode heel effect renders large-scale background nonuniformities in digital radiographs. Conventional offset/gain calibration is performed at mono source-to-image distance (SID), and disregards the SID-dependent characteristic of heel effect. It results in a residual nonuniform background in the corrected radiographs when the SID settings for calibration and correction differ. In this work, the authors develop a robust and efficient computational method for digital x-ray detector gain correction adapted to SID-variant heel effect, without resorting to physical filters, phantoms, complicated heel effect models, or multiple-SID calibration and interpolation.Methods: The authors present the Duo-SID projection correction method. In our approach, conventional offset/gain calibrations are performed only twice, at the minimum and maximum SIDs of the system in typical clinical use. A fast iterative separation algorithm is devised to extract the detector gain and basis heel patterns from the min/max SID calibrations. The resultant detector gain is independent of SID, while the basis heel patterns are parameterized by the min- and max-SID. The heel pattern at any SID is obtained from the min-SID basis heel pattern via projection imaging principles. The system gain desired at a specific acquisition SID is then constructed using the projected heel pattern and detector gain map.Results: The method was evaluated for flat field and anatomical phantom image corrections. It demonstrated promising improvements over interpolation and conventional gain calibration/correction methods, lowering their correction errors by approximately 70% and 80%, respectively. The separation algorithm was able to extract the detector gain and heel patterns with less than 2% error, and the Duo-SID corrected images showed perceptually appealing uniform background across the detector.Conclusions: The Duo-SID correction method has substantially improved on conventional offset/gain corrections for digital x-ray imaging in an SID-variant environment. The technique is relatively simple, and can be easily incorporated into multiple-point gain calibration/correction techniques. It offers a potentially valuable tool for preprocessing digital x-ray images to boost image quality of mammography, chest and cardiac radiography, as well as automated computer aided diagnostic radiology.

Yu, Yongjian [X-ray Products, Varian Medical Systems Inc., Liverpool, New York 13088 (United States)] [X-ray Products, Varian Medical Systems Inc., Liverpool, New York 13088 (United States); Wang, Jue [Department of Mathematics, Union College, Schenectady, New York 12308 (United States)] [Department of Mathematics, Union College, Schenectady, New York 12308 (United States)

2013-08-15

134

Functional Outcome and Patient Satisfaction after Displaced Intra-articular Calcaneal Fractures: A Comparison Among Open, Percutaneous, and Nonoperative Treatment.  

PubMed

The aim of the present study was to compare the outcomes of patients with a displaced calcaneal fracture treated by open reduction and internal fixation (ORIF), percutaneous treatment, or nonoperative methods. A retrospective cohort study was conducted at a level I trauma center of patients with a displaced intra-articular calcaneal fracture treated from January 1, 2002 to December 31, 2011. The patient-reported outcome measures included the Foot Function Index, American Orthopaedic Foot and Ankle Society hindfoot scale, Short Form-36, the EQ-5D from the EuroQol Group, and a 10-point visual analog scale. Clinical data were collected from 169 patients, and questionnaires were obtained from 78 patients (18 nonoperatively, 27 ORIF, and 33 percutaneously). The late intervention rate was significantly greater in the percutaneous group (n = 18; 30%) than in the ORIF group (n = 6; 12%) or the nonoperative group (n = 8; 13%; p = .030). Significantly more disability was reported in the nonoperative group (median Foot Function Index score, 40 points) than in the ORIF group (median, 16 points; p = .010) or in the percutaneous group (median, 21 points; p = .034). In conclusion, the operatively treated patients (ORIF and percutaneous treatment) reported better functional outcome scores (Foot Function Index and American Orthopaedic Foot and Ankle Society hindfoot scale) than did the nonoperatively treated patients. PMID:24891090

De Boer, A Siebe; Van Lieshout, Esther M M; Den Hartog, Dennis; Weerts, Bas; Verhofstad, Michael H J; Schepers, Tim

2014-05-30

135

Pain Assessment  

MedlinePLUS

... as a result of the pain, and the nature of other medical and psychiatric problems, should be ... information helps the health care provider understand the nature of the pain or the potential benefits of ...

136

Finger pain  

MedlinePLUS

Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

137

Orofacial Pain  

MedlinePLUS

... 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 ...

138

Knee pain  

MedlinePLUS

... avoid activities that aggravate your pain, especially weight bearing activities. Apply ice. First, apply it every hour ... knee You have severe pain, even when not bearing weight Your knee buckles, clicks, or locks Your ...

139

Painful swallowing  

MedlinePLUS

... ulcers Something stuck in the throat (for example, fish or chicken bones) Tooth infection or abscess ... with the painful swallowing, including: Abdominal pain Chills Cough Fever Heartburn Nausea or vomiting Sour taste in ...

140

Neck Pain  

MedlinePLUS

... 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 ...

141

Back Pain  

MedlinePLUS

... my aching back!", you are not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

142

Chronic Pain  

MedlinePLUS

... 2002. Reflex Sympathetic Dystrophy/ Complex Regional Pain Syndromes (CRPS): State-of-the-Science A workshop on Reflex Sympathetic Dystrophy/ Complex Regional Pain Syndromes (CRPS): State-of-the-Science, December 15, 2001. Publicaciones ...

143

Chronic pain.  

PubMed

Essential facts Chronic pain is pain that persists or recurs for more than three months. It may be related to a condition, or may be pain from an injury or operation that continues after healing would usually take place. According to guidance from the Scottish Intercollegiate Guidelines Network (SIGN), around 18 per cent of Europe's population are currently affected by moderate to severe chronic pain. It has a considerable effect on quality of life, and can cause significant suffering and disability. PMID:25783253

2015-03-18

144

Chronic Pain  

Microsoft Academic Search

The primary purposes of acute pain and the reason it is noxious are to interrupt ongoing activity in order to warn the sufferer of tissue damage, to discourage movement that might exacerbate injury or prevent healing, and to teach the organism to avoid the pain-producing circumstances. Therefore, it is no wonder that when pain persists to become chronic, many sufferers

Malcolm H. Johnson

145

Face pain  

MedlinePLUS

Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or ... Pain that starts in the face may be caused by a nerve problem, ... Face pain may also begin other places in the body. Abscessed ...

146

A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates  

PubMed Central

BACKGROUND: Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized. OBJECTIVE: To establish the efficacy of nonsucrose sweet-tasting solutions for pain relief during painful procedures in neonates. METHOD: The present article is a systematic review and meta-analyses of the literature. Standard methods of the Cochrane Neonatal Collaborative Review Group were used. Literature searches were reviewed for randomized controlled trials investigating the use of sweet solutions, except sucrose, for procedural pain management in neonates. Outcomes assessed included validated pain measures and behavioural and physiological indicators. RESULTS: Thirty-eight studies (3785 neonates) were included, 35 of which investigated glucose. Heel lancing was performed in 21/38 studies and venipuncture in 11/38 studies. A 3.6-point reduction in Premature Infant Pain Profile scores during heel lances was observed in studies comparing 20% to 30% glucose with no intervention (two studies, 124 neonates; mean difference ?3.6 [95% CI ?4.6 to ?2.6]; P<0.001; I2=54%). A significant reduction in the incidence of cry after venipuncture for infants receiving 25% to 30% glucose versus water or no intervention was observed (three studies, 130 infants; risk difference ?0.18 [95% CI ?0.31 to ?0.05]; P=0.008, number needed to treat = 6 [95% CI 3 to 20]; I2=63%). CONCLUSIONS: The present systematic review and meta-analyses demonstrate that glucose reduces pain scores and crying during single heel lances and venipunctures. Results indicate that 20% to 30% glucose solutions have analgesic effects and can be recommended as an alternative to sucrose for procedural pain reduction in healthy term and preterm neonates. PMID:23748256

Bueno, Mariana; Yamada, Janet; Harrison, Denise; Khan, Sobia; Ohlsson, Arne; Adams-Webber, Thomasin; Beyene, Joseph; Stevens, Bonnie

2013-01-01

147

Effect of Different Forefoot and Heel Support Surfaces on the Activities of the RF and HAM Muscles during the Sit-to-stand Task while Wearing High-heel Shoes  

PubMed Central

[Purpose] The purpose of this study was to show the effect of different forefoot and heel support surfaces on the activities of the rectus femoris and medial hamstring muscles during the sit-to-stand task while wearing high-heel shoes. [Subjects] Fifteen female subjects were recruited. [Methods] The muscle activities of the rectus femoris and hamstring muscles were recorded using an MP150 system during the sit-to-stand task while wearing various high-heeled shoes. [Results] The activities of the rectus femoris and medial hamstring muscles significantly decreased when subjects wore condition 1 shoes compared with when they wore condition 2, 3 or 4 high-heeled shoes. The activities of the rectus femoris and medial hamstring muscles significantly decreased when subjects wore condition 2 high-heeled shoes compared with condition 3 or 4 high-heeled shoes. [Conclusion] The results can be interpreted as indicating that the size of the forefoot supporting surface can influence the lower extremity muscles of women wearing high-heeled shoes more than the size of the heel supporting surface. PMID:25364105

Yoo, Won-gyu

2014-01-01

148

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. PMID:22448049

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

2012-01-01

149

The Effects of Wearing High Heels while Pressing a Car Accelerator Pedal on Lower Extremity Muscle Activation  

PubMed Central

[Purpose] The purpose of this study was to determine the effects of wearing high heels while driving on lower extremity muscle activation. [Subjects] The subjects of this experimental study were 14 healthy women in their 20s who normally wear shoes with high heels. [Methods] The subjects were asked to place their shoes on an accelerator pedal with the heel touching the floor and then asked to press the pedal with as much pressure as possible for 3 seconds before removing their feet from the pedal. A total of 3 measurements were taken for each heel height (flat, 5?cm, 7?cm), and the heel height was randomly selected. [Results] The levels of muscle activity, indicated as the percentage of reference voluntary contraction, for gastrocnemius muscle in the flat, 5?cm, and 7?cm shoes were 180.8±61.8%, 285.4±122.3%, and 366.2±193.7%, respectively, and there were significant differences between groups. Those for the soleus muscle were 477.3±209.2%, 718.8±380.5%, and 882.4±509.9%, and there were significant differences between groups. [Conclusion] To summarize the results of this study, it was found that female drivers require greater lower extremity muscle activation when wearing high heels than when wearing low heels. Furthermore, instability and muscle fatigue of the ankle joint, which results from wearing high heels on a daily basis, could also occur while driving. PMID:25435684

Jung, Jaemin; Lee, Sang-yeol

2014-01-01

150

Combining bone resorption markers and heel quantitative ultrasound to discriminate between fracture cases and controls  

Microsoft Academic Search

Summary  This nested case-control analysis of a Swiss ambulatory cohort of elderly women assessed the discriminatory power of urinary\\u000a markers of bone resorption and heel quantitative ultrasound for non-vertebral fractures. The tests all discriminated between\\u000a cases and controls, but combining the two strategies yielded no additional relevant information.\\u000a \\u000a \\u000a \\u000a Introduction  Data are limited regarding the combination of bone resorption markers and heel quantitative

D. Nanchen; J. Cornuz; C. Ruffieux; W. Riesen; P. Burckhardt; M. A. Krieg

2009-01-01

151

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. PMID:19400724

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

2009-01-01

152

Early minimally invasive percutaneous fixation of displaced intra-articular calcaneal fractures with a percutaneous angle stable device.  

PubMed

The Minimally Invasive Reduction and Osteosynthesis System(®) (MIROS) is a percutaneous angle stable device for the treatment of fractures. The aim of the present study was to evaluate the clinical and radiographic results of an early minimally invasive osteosynthesis with the MIROS device. A total of 40 consecutive patients were treated for an intra-articular fracture of the calcaneus. We evaluated the clinical and radiographic outcomes after treatment of intra-articular calcaneal fractures with the MIROS hardware. Soft tissue damage was noted. The patients completed the American Orthopaedic Foot and Ankle Society survey at 12 and 24 months and underwent radiologic evaluations. A statistically significant association between the American Orthopaedic Foot and Ankle Society score and type of soft tissue lesion. A Sanders type II, III, and IV fracture was found in 15, 20, and 15 of 50 fractures, respectively. Postoperatively, restoration of the posterior facet was reached in 13 of 15, 18 of 20, and 11 of 15 with a type II, III, and IV fracture, respectively. The American Orthopaedic Foot and Ankle Society scale mean score was 85 at the final follow-up visit. No significant association was found between the score and the preoperative variables (p > .09), although patients with bilateral fractures had a significantly lower score. The MIROS device for early treatment of intra-articular calcaneus fractures resulted in excellent clinic and radiologic results. The standardized technique we have reported, with the elastic wires acting as a girder for the fractured and displace subtalar joint and the collapsed lateral calcaneal wall, has permitted early weightbearing with positive stimuli for the bone healing. The drainage effect of the percutaneous wires likely prevented compartment syndrome when applied within the first hours after the trauma. PMID:25441275

Battaglia, Alberto; Catania, Pompeo; Gumina, Stefano; Carbone, Stefano

2015-01-01

153

PAIN SCALES (ATTACHMENT A)  

E-print Network

PAIN SCALES (ATTACHMENT A) 0-10 NUMERIC PAIN INTENSITY SCALE 0 1 2 3 4 5 6 7 8 9 10 NO PAIN MODERATE WORST PAIN PAIN #12;PAIN SCALES (ATTACHMENT A) FLACC PAIN SCALE The FLACC is a behavioral pain assessment scale for use in non-verbal patients unable to provide numeric reports of pain. SCORING Categories

Oliver, Douglas L.

154

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.

1998-04-17

155

Screening Rural and Urban Indian Population for Osteoporosis Using Heel Ultrasound Bone Densitometer  

Microsoft Academic Search

Osteoporosis is more common in India. It predominantly affects postmenopausal women, and elderly of both sexes. The mal-nutrition, and smoking, consumption of liquor and tobacco may have an effect on bone mineral density (BMD). The aim of this study was to screen the rural as well as urban population for osteoporosis using a portable ultrasound heel bone densitometer; A total

Samar; Dev Maletia; Kribakaran Venkatesan; Savita Rana; M. Anburajan

2011-01-01

156

Effects of Different Cyclic Pressurization and Relief Patterns on Heel Skin Blood Perfusion  

Microsoft Academic Search

OBJECTIVE: It was hypothesized that a device or support surface providing inter- mittent cycles of pressurization and pressure relief might minimize the impact of blood flow deficits in the heels resulting from the application of pressure. Because this possibility depends on whether pressure-relief hyperemia can adequately compensate for blood flow deficits, the main objective was to determine how dif- ferent

Harvey N. Mayrovitz; Nancy Sims

2002-01-01

157

Hypoglycemia:The Achilles Heel of the Treatment of Children With Type 1 Diabetes  

Microsoft Academic Search

Hypoglycemia is the Achilles heel of the treatment of all indi- viduals with diabetes, and children and adolescents in partic- ular. In the Diabetes Control and Complications Trial (DCCT), the relative risk of severe hypoglycemia due to intensive diabetes management was similar in adolescent and adult subjects; however, rates of severe hypoglycemia were almost doubled in adolescents compared to adults.

Danièle Pacaud

158

Author's personal copy The most temperature-adapted corals have an Achilles' Heel  

E-print Network

time, similarly adapt to survive even in an impover- ished form, under conditions of acidification is mediated by oceanic currents and the heat-adapted trait can be imparted to reefs further afield throughAuthor's personal copy The most temperature-adapted corals have an Achilles' Heel S.J. Purkis , D

Purkis, Sam

159

Normal anatomy of the heel entheses: anatomical and ultrasonographic study of their blood supply  

Microsoft Academic Search

The purpose of this study was first to determine the normal blood supply of the heel entheses with cadaver injection, and second, to identify by means of ultrasound (US) this blood supply in healthy volunteers before and after the intravenous injection of a US contrast agent (SonoVue). Twenty cadaver lower limbs were cut into sagittal, coronal, or axial sections after

M. Morel; N. Boutry; X. Demondion; I. Legroux-Gerot; H. Cotten; A. Cotten

2005-01-01

160

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.

2010-01-01

161

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. PMID:20142270

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

2010-01-01

162

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

2008-01-01

163

Pain frequency moderates the relationship between pain catastrophizing and pain  

PubMed Central

Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

2014-01-01

164

Spinal pain.  

PubMed

The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic pain, much more difficult to treat. The clinical assessment of pain source can be a challenge because of the complex anatomy and function of the spine; the advanced imaging methods are often not sufficient for a definitive diagnosis because similar findings could be present in either asymptomatic and symptomatic subjects: a clinical correlation is always mandatory and the therapy cannot rely uniquely upon any imaging abnormalities. Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. Special attention will be done to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. PMID:25824642

Izzo, R; Popolizio, T; D'Aprile, P; Muto, M

2015-05-01

165

Reproducibility of pain measurement and pain perception  

Microsoft Academic Search

The reproducibility of both the conscious experience of pain and the reproducibility of psychophysical assessments of pain remain critical, yet poorly characterized factors in pain research and treatment. To assess the reproducibility of both the pain experience and two methods of pain assessment, 15 subjects evaluated experimental heat pain during four weekly sessions. In each session, both brief (5s) and

Elisa M. Rosier; Michael J. Iadarola; Robert C. Coghill

2002-01-01

166

Chronic pain - resources  

MedlinePLUS

Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association - www.theacpa.org National Fibromyalgia and Chronic Pain Association - www.fmcpaware.org ...

167

Eye pain  

MedlinePLUS

... may be caused by the wrong eyeglass or contact lens prescription. Sometimes they are due to a problem ... that can cause eye pain are: Infections Inflammation Contact lens problems Dry eye Acute glaucoma Sinus problems Neuropathy ...

168

Neuropathic Pain  

MedlinePLUS

... nerve pain, you know that it can erode quality of life. Communication Tools View All Everyday Tools During Your ... each of them. Ability Chart - Arthritis version (PDF) Quality of Life Scale The Quality of Life scale is provided ...

169

Chest pain  

MedlinePLUS

... carries food from the mouth to the stomach) Gallstones cause pain that gets worse after a meal ( ... EM, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST- ...

170

Breast pain  

MedlinePLUS

... breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some amount ... unless a woman is taking hormone replacement therapy) Menstruation and premenstrual syndrome (PMS) Pregnancy -- breast tenderness tends ...

171

Shoulder pain  

MedlinePLUS

... therapist can help you do this safely. Taking ibuprofen or acetaminophen (such as Tylenol) may help reduce ... have had shoulder pain before, use ice and ibuprofen after exercising. Learn exercises to stretch and strengthen ...

172

Chest Pain  

MedlinePLUS

Having a pain in your chest can be scary. It does not always mean that you are having a heart attack. ... can be many other causes, including Other heart problems, such as angina Panic attacks Digestive problems, such ...

173

EM-31 RETRIEVAL KNOWLEDGE CENTER MEETING REPORT: MOBILIZE AND DISLODGE TANK WASTE HEELS  

SciTech Connect

The Retrieval Knowledge Center sponsored a meeting in June 2009 to review challenges and gaps to retrieval of tank waste heels. The facilitated meeting was held at the Savannah River Research Campus with personnel broadly representing tank waste retrieval knowledge at Hanford, Savannah River, Idaho, and Oak Ridge. This document captures the results of this meeting. In summary, it was agreed that the challenges to retrieval of tank waste heels fell into two broad categories: (1) mechanical heel waste retrieval methodologies and equipment and (2) understanding and manipulating the heel waste (physical, radiological, and chemical characteristics) to support retrieval options and subsequent processing. Recent successes and lessons from deployments of the Sand and Salt Mantis vehicles as well as retrieval of C-Area tanks at Hanford were reviewed. Suggestions to address existing retrieval approaches that utilize a limited set of tools and techniques are included in this report. The meeting found that there had been very little effort to improve or integrate the multiple proven or new techniques and tools available into a menu of available methods for rapid insertion into baselines. It is recommended that focused developmental efforts continue in the two areas underway (low-level mixing evaluation and pumping slurries with large solid materials) and that projects to demonstrate new/improved tools be launched to outfit tank farm operators with the needed tools to complete tank heel retrievals effectively and efficiently. This document describes the results of a meeting held on June 3, 2009 at the Savannah River Site in South Carolina to identify technology gaps and potential technology solutions to retrieving high-level waste (HLW) heels from waste tanks within the complex of sites run by the U. S. Department of Energy (DOE). The meeting brought together personnel with extensive tank waste retrieval knowledge from DOE's four major waste sites - Hanford, Savannah River, Idaho, and Oak Ridge. The meeting was arranged by the Retrieval Knowledge Center (RKC), which is a technology development project sponsored by the Office of Technology Innovation & Development - formerly the Office of Engineering and Technology - within the DOE Office of Environmental Management (EM).

Fellinger, A.

2010-02-16

174

Anorectal Pain  

Microsoft Academic Search

Anorectal pain is distressing for the patient and challenging for the physician. The vague and inconsistent use of terms such\\u000a as proctalgia fugax, levator ani syndrome, spastic pelvic floor, coccygodynia, chronic idiopathic anorectal pain, and pelvic\\u000a floor dyssynergia make it difficult to identify a cause and an effective therapy. Many conditions, some of which may be potentially\\u000a fatal, must be

Jill C. Genua; Dana R. Sands

175

Neonatal pain  

PubMed Central

Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

Walker, Suellen M

2014-01-01

176

Cyclic impacts on heel strike: A possible biomechanical factor in the etiology of degenerative disease of the human locomotor system  

Microsoft Academic Search

The cyclic impacts induced by heel strike when walking were studied using both a high-resonance-frequency force plate and a low-mass skin-mounted accelerometer. The data were computer analyzed. The results showed that during normal human walking, the locomotor system is subjected to repetitive impact loads at heel strike, lasting about 5 ms and consisting of frequency spectra up to and above

Yoram Folman; Joseph Wosk; Arkady Voloshin; Shimon Liberty

1986-01-01

177

Influence of in-shoe heel lifts on plantar pressure and center of pressure in the medial-lateral direction during walking.  

PubMed

The aim of this study was to investigate how the height and material of in-shoe heel lifts affect plantar pressure and center of pressure (COP) trajectory in the medial-lateral direction during walking. Seventeen healthy young male adults were asked to walk along an 8m walkway while wearing a high-cut flat shoe and 5 different heel lifts. Peak pressure (PP), pressure-time integral (PTI) and contact area (CA) were measured by Pedar insole system for three foot regions: forefoot, midfoot and heel. Range and velocity of medial-lateral (ML) COP during forefoot contact phase (FFCP) and foot flat phase (FFP) were collected using Footscan pressure plate. Forefoot pressure and ML-COP parameters increased as the heel was elevated. Statistically significant attenuation of heel peak plantar pressure was provided by all heel lifts except for the hard lift. Post hoc tests suggest that material had a greater influence on the range and velocity of ML-COP during FFCP than heel height, while during FFP, heel height seemed to affect these parameters more. The findings from this study suggest that thick heel lifts should be used with caution, and that a heel lift made of materials with good support and elastic properties might be more appropriate to improve footwear comfort and medial-lateral motion control. PMID:24440428

Zhang, Xianyi; Li, Bo

2014-04-01

178

The Effects of Lower Extremity Angle According to Heel-height Changes in Young Ladies in Their 20s during Gait  

PubMed Central

[Purpose] The purpose of this study was to compare the effects of heel-height changes on the low joint angles of the lower extremities of women in their 20s during gait. [Subjects and Methods] Qualisys Track Manager Software ver. 2.8 (Qualisys, Sweden) was used to perform measurements on 14 female university students in their 20s. To measure movements, the subjects were asked to walk while wearing high-heeled shoes and reflective stickers on their hip joints, knee joints, and ankle joints, the changes in joint angles were measured at heel strike, foot flat, and toe off. [Results] Analysis of the amount of change according to heel height changes during gait showed that the angle of the hip joints was reduced with an increase in heel-height. Although the changes were not significant, the angle of the knee joints was reduced during heel strike, foot flat, and midstance, and it was increased during toe off. In contrast, the angle of the ankle joints was increased by a significant amount during heel strike, foot flat, midstance, and toe off. [Conclusions] During gait with high heels, the movements of the lower extremities of women in their 20s were reduced significantly with an increase in heel height. Therefore, it is concluded that the restrictions on gait can only be reduced by wearing low-heeled shoes. PMID:25140096

Lee, ChangRyeol

2014-01-01

179

Heel-ball (HB) index: sexual dimorphism of a new index from foot dimensions.  

PubMed

The present research is aimed to introduce Heel-ball (HB) index from foot dimensions and determine whether this index exhibits sexual dimorphism. The study was conducted on a sample of 303 North Indian individuals (154 men, and 149 women) aged between 13 and 18 years. The stature, body weight, foot breadth at the ball (BBAL), and foot breadth at heel (BHEL) were measured. The HB index was derived by the formula BHEL × 100/BBAL. Although the mean HB index was larger in women in both feet it showed statistically significant sex differences in the right foot only. The study shows that while the foot dimensions show a positive correlation with stature and weight, the HB index is independent of the stature and weight of an individual. This novel index (HB index) may be utilized in sex determination when a part of the foot is brought for medico-legal investigation. PMID:22074354

Krishan, Kewal; Kanchan, Tanuj; Passi, Neelam; DiMaggio, John A

2012-01-01

180

Feasibility of quantitative ultrasound measurement of the heel bone in people with intellectual disabilities  

Microsoft Academic Search

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 status that can be used outside the hospital.

S. Mergler; B. Löbker; H. M. Evenhuis; C. Penning

2010-01-01

181

Power-Efficient AND-EXOR-INV Based Realization of Achilles' heel Logic Functions  

Microsoft Academic Search

This paper deals with a power-conscious AND- EXOR-Inverter type logic implementation for a complex class of Boolean functions, namely Achilles' heel functions. Different variants of the above function class have been considered viz. positive, negative and pure horn for analysis and simulation purposes. The proposed realization is compared with the decomposed implementation corresponding to an existing standard AND-EXOR logic minimizer;

Padmanabhan Balasubramanian; R. Chinnadurai

182

[Forefoot pain].  

PubMed

Forefoot chronic pain is a frequent problem in daily clinical practice. Mechanical pathology of the forefoot, usually called static metatarsalgia, represents the most frequent reason for consultation in pathology of the foot. The cause is a functionnal disorder or anatomic derangement of the forefoot architecture. Metatarsalgia can originate from a wide range of affections. Etiologies of chronic pain are described from medial to lateral with first ray pathologies (hallux valgus, hallux rigidus and sesamoid pathology) and first ray insufficiency, pathologies of the second, third and fourth ray and intermetatarsal spaces (second ray syndrome, Freiberg's disease, Morton neuroma, stress or bone insufficiency metatarsal fractures, intermetatarsal bursitis) and fifth ray pathology (lateral bursitis, quintus varus). Sometimes forefoot pain could also be caused by chronic inflammatory rheumatic diseases (rheumatoid and psoriatic arthritis) with a risk of structural metatarsophalangeal joints alteration. The pathology of the toes can, more rarely, explain a forefoot pain. So, several pathologic conditions can produce forefoot pain and the diagnostic approach must always be based on the anamnesis and clinical examination. In a second time if the cause is difficult to establish based solely on clinical findings, radiography and ultrasonography are today the most usefull auxiliary investigations. PMID:20402124

Damiano, Joël

2010-03-20

183

Feasibility of quantitative ultrasound measurement of the heel bone in people with intellectual disabilities.  

PubMed

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 status that can be used outside the hospital. QUS might be used for screening purposes to identify people with intellectual disability with poor bone status, who are in need of supplementary examination and treatment. To investigate feasibility of QUS in this group, QUS of the heel bone was performed on-site in 151 people with ID living in residential care. Measurements were successfully performed in at least one foot in 94.7%, were interpretable (resulting in a stiffness index) in 91.6%, and induced barely or no stress in 90.4% of the study population. Measurements generally took less than 10 min. In 93 persons bone status of both feet had been measured. The "mean percentage of the absolute difference" between outcomes of both feet was 15.5% (±15.3% SD, range 0-76.5%). Ultrasound measurement of the heel bone is a feasible and non-stressful method for measuring bone status in people with ID. Since the mean difference between outcomes of the left and right foot were large, measurement of both feet is recommended to prevent inaccurate interpretation. PMID:20800437

Mergler, S; Löbker, B; Evenhuis, H M; Penning, C

2010-01-01

184

Work- and travel-related physical activity and alcohol consumption: relationship with bone mineral density and calcaneal quantitative ultrasonometry.  

PubMed

A number of healthy workers rarely exercise because of a lack of time or resources. Physical activity related to work and everyday travel may be more feasible, but evidence of its beneficial effect on bone health is scarce. We assessed if this form of physical activity was associated with higher bone mineral density (BMD) and stiffness index (SI) when adjusted for recreational physical activity, age, body mass index, smoking, alcohol consumption, education, and serum level of 25-hydroxyvitamin D. Healthy workers, aged 25-54 yr, of the Electricity Generating Authority of Thailand were surveyed. The outcomes were BMD (lumbar spine, femoral neck, and total hip) and calcaneal SI. Physical activity was estimated using the global physical activity questionnaire and considered active when >600 metabolic equivalent tasks (min). Of 2268 subjects, 74% were men. Active male subjects had significantly higher BMD at the femoral neck and total hip (p<0.005). However, the association was not significant with male lumbar spine BMD, male SI, or any bone parameters in women (p>0.05). In men, work and travel physical activity seems beneficial to male bone health; hence, it should be encouraged. Furthermore, smoking appeared harmful while moderate alcohol consumption was beneficial. PMID:24878331

Sritara, Chanika; Thakkinstian, Ammarin; Ongphiphadhanakul, Boonsong; Pornsuriyasak, Prapaporn; Warodomwichit, Daruneewan; Akrawichien, Tawatchai; Vathesatogkit, Prin; Sritara, Piyamitr

2015-01-01

185

Intra-articular calcaneal fractures: effect of open reduction and internal fixation on the contact characteristics of the subtalar joint.  

PubMed

Intra-articular calcaneal fractures are associated with significant long-term morbidity, and considerable controversy exists regarding the optimum method of treating them. The contact characteristics in the intact subtalar joint were determined at known loads and for different positions of the ankle and subtalar joint, using pressure-sensitive film (Super Low; Fuji, Itochu Canada Ltd, Montreal, Quebec). We measured the contact area to joint area ratio (pressure > 5 kg force/cm2 [kgf/cm2]) which normalizes for differences in joint size and the ratio of high pressure zone (>20 kgf/cm2) as a reflection of overall increase in joint pressure. Three simulated fracture patterns were then created and stabilized with either 1 or 2 mm of articular incongruity. Eight specimens were prepared with a primary fracture line through the posterior facet, eight with a joint depression-type fracture, and six with a central joint depression fracture. A measure of 1 to 2 mm of incongruity in the posterior facet for all three fracture patterns produced significant unloading of the depressed fragment, with a redistribution of the overall pattern of pressure distribution to parts of the facet that were previously unloaded. PMID:9872472

Mulcahy, D M; McCormack, D M; Stephens, M M

1998-12-01

186

Back Pain  

NSDL National Science Digital Library

This patient education program reviews the anatomy of the back, the most common causes of back pain, and measures to prevent back pain. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

Patient Education Institute

187

Ankle and subtalar synovitis in a ball-and-socket ankle joint causing posterolateral painful coarse crepitus: a case report.  

PubMed

A 17-year-old girl with bilateral ball-and-socket ankles reported left medial heel pain. Her left heel had gone into a varus position on tiptoeing, and a painful clunk had occurred when returning to normal standing. The clunk persisted after physiotherapy and treatment with an orthosis. Subtalar arthroscopy and peroneal tendoscopy showed mild diffuse synovitis of the ankle joint, especially over the posterior capsule, and a patch of inflamed and fibrotic synovium at the posterolateral corner of the subtalar joint. The clunk subsided immediately after arthroscopic synovectomy and had not recurred during 5 years of follow-up. We found no other reported cases of ankle and subtalar synovitis occurring in patients with a ball-and-socket ankle joint. PMID:25179452

Fan, Ka Yuk; Lui, Tun Hing

2014-01-01

188

Inflammatory Back Pain vs. Mechanical Back Pain  

MedlinePLUS Videos and Cool Tools

... cause. Specifically, is the back pain inflammatory in nature or mechanical? INFLAMMATORY VS MECHANICAL BACK PAIN VIDEO: ... determing if the back pain is inflammatory in nature and related to a disease such as ankylosing ...

189

Leg pain  

MedlinePLUS

... bone tumors ( osteosarcoma , Ewing sarcoma) Legg-Calve-Perthes disease -- poor blood flow to the hip that may stop or slow the normal growth of the leg Noncancerous (benign) tumors or cysts of the femur or tibia (osteoid osteoma) Sciatic nerve pain (radiating ...

190

Central Pain Syndrome  

MedlinePLUS

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

191

Somatoform pain disorder  

MedlinePLUS

Pain disorder ... thought to be related to emotional stress. The pain was often said to be "all in their head." However, patients with somatoform pain disorder seem to experience painful sensations in a ...

192

Methods for Heel Retrieval for Tanks C-101, C-102, and C-111 at the Hanford Site - 13064  

SciTech Connect

The purpose of this paper is to evaluate the prospects of using bulk waste characteristics to determine the most appropriate heel retrieval technology. If the properties of hard to remove heels can be determined before bulk retrieval, then a heel retrieval technology can be selected before bulk retrieval is complete. This would save substantially on sampling costs and would allow the deployment of the heel retrieval technology immediately after bulk retrieval. The latter would also accelerate the heel removal schedule. A number of C-farm retrievals have been fully or partially completed at the time of this writing. Thus, there is already substantial information on the success of different technologies and the composition of the heels. There is also substantial information on the waste types in each tank based on historical records. Therefore, this study will correlate the performance of technologies used so far and compare them to the known waste types in the tanks. This will be used to estimate the performance of future C Farm heel retrievals. An initial decision tree is developed and employed on tanks C-101, C-102, and C 111. An assumption of this study is that no additional characterization information would be available, before or after retrieval. Note that collecting additional information would substantially increase the probability of success. Deploying some in-situ testing technologies, such as a water lance or an in-situ Raman probe, might substantially increase the probability of successfully selecting the process conditions without having to take samples from the tanks for laboratory analysis. (authors)

Sams, T.L.; Kirch, N.W.; Reynolds, J.H. [Washington River protection Solutions, Richland, WA 99352 (United States)] [Washington River protection Solutions, Richland, WA 99352 (United States)

2013-07-01

193

Methods for heel retrieval for tanks C-101, C-102, and C-111 at the Hanford Site  

SciTech Connect

The purpose of this paper is to evaluate the prospects of using bulk waste characteristics to determine the most appropriate heel retrieval technology. If the properties of hard to remove heels can be determined before bulk retrieval, then a heel retrieval technology can be selected before bulk retrieval is complete. This would save substantially on sampling costs and would allow the deployment of the heel retrieval technology immediately after bulk retrieval. The latter would also accelerate the heel removal schedule. A number of C-farm retrievals have been fully or partially completed at the time of this writing. Thus, there is already substantial information on the success of different technologies and the composition of the heels. There is also substantial information on the waste types in each tank based on historical records. Therefore, this study will correlate the performance of technologies used so far and compare them to the known waste types in the tanks. This will be used to estimate the performance of future C Farm heel retrievals. An initial decision tree is developed and employed on tanks C-101, C-102, and C 111. An assumption of this study is that no additional characterization information would be available, before or after retrieval. Note that collecting additional information would substantially increase the probability of success. Deploying some in-situ testing technologies, such as a water lance or an in-situ Raman probe, might substantially increase the probability of successfully selecting the process conditions without having to take samples from the tanks for laboratory analysis.

Sams, Terry L. [Washington River Protection Solutions, LLC, Richland, WA (United States); Kirch, N. W. [Washington River Protection Solutions, LLC, Richland, WA (United States); Reynolds, Jacob G. [Washington River Protection Solutions, LLC, Richland, WA (United States)

2013-01-11

194

Up-regulation of the chemo-attractive receptor ChemR23 and occurrence of apoptosis in human chondrocytes isolated from fractured calcaneal osteochondral fragments.  

PubMed

To study the expression level of a panel of pro/anti-apoptotic factors and inflammation-related receptors in chondral fragments from patients undergoing surgical treatment for intra-articular calcaneal fractures, cartilage fragments were retrieved from calcaneal fractures of 20 patients subjected to surgical treatment. Primary cultures were performed using chondral fragments from fractured and control patients. Chondrocyte cultures from each patient of the fractured and control groups were subjected to immunofluorescence staining and quantitatively analyzed under confocal microscopy. Proteins extracted from the cultured chondrocytes taken from the fractured and control groups were processed for Western blot experiments and densitometric analysis. The percentage of apoptotic cells was determined using the cleaved PARP-1 antibody. The proportion of labelled cells was 35% for fractured specimens, compared with 7% for control samples. Quantification of caspase-3 active and Bcl-2 proteins in chondrocyte cultures showed a significant increase of the apoptotic process in fractured specimens compared with control ones. Fractured chondrocytes were positively stained for ChemR23 with statistically significant differences with respect to control samples. Densitometric evaluation of the immunoreactive bands confirmed these observations. Human articular chondrocytes obtained from patients with intra-articular calcaneal fractures express higher levels of pivotal pro-apoptotic factors, and of the chemo-attractive receptor ChemR23, compared with control cultures. On the basis of these observations, the authors hypothesize that consistent prolonged chondrocyte death, associated with the persistence of high levels of pro-inflammatory factors, could enhance the deterioration of cartilage tissue with consequent development of post-traumatic arthritis following intra-articular bone fracture. PMID:24689495

Sena, Paola; Manfredini, Giuseppe; Benincasa, Marta; Mariani, Francesco; Smargiassi, Alberto; Catani, Fabio; Palumbo, Carla

2014-06-01

195

Clinical Issues in Pain Management Clinical Issues in Pain Management  

E-print Network

#12;Clinical Issues in Pain Management: Chronic Pain Chronic Pain Typically begins with an acute of chronic pain Chronic benign pain Recurrent acute pain Chronic progressive pain #12;Clinical Issues in Pain Management: Chronic Pain Chronic benign pain Persists more than 6 months Varies in severity

Meagher, Mary

196

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. PMID:19421349

Kobsar, Bradley; Alcantara, Joel

2009-01-01

197

The X-ray attenuation characteristics and density of human calcaneal marrow do not change significantly during adulthood  

NASA Technical Reports Server (NTRS)

Changes in the material characteristics of bone marrow with aging can be a significant source of error in measurements of bone density when using X-ray and ultrasound imaging modalities. In the context of computed tomography, dual-energy computed techniques have been used to correct for changes in marrow composition. However, dual-energy quantitative computed tomography (DE-QCT) protocols, while increasing the accuracy of the measurement, reduce the precision and increase the radiation dose to the patient in comparison to single-energy quantitative computed tomography (SE-QCT) protocols. If the attenuation properties of the marrow for a particular bone can be shown to be relatively constant with age, it should be possible to use single-energy techniques without experiencing errors caused by unknown marrow composition. Marrow was extracted by centrifugation from 10 mm thick frontal sections of 34 adult cadaver calcanei (28 males, 6 females, ages 17-65 years). The density and energy-dependent linear X-ray attenuation coefficient of each marrow sample were determined. For purposes of comparing our results, we then computed an effective CT number at two GE CT/i scan voltages (80 and 120 kVp) for each specimen. The coefficients of variation for the density, CT number at 80 kVp and CT number at 120 kVp were each less than 1%, and the parameters did not change significantly with age (p > 0.2, r2 < 0.02, power > 0.8 where the minimum acceptable r2 = 0.216). We could demonstrate no significant gender-associated differences in these relationships. These data suggest that calcaneal bone marrow X-ray attenuation properties and marrow density are essentially constant from the third through sixth decades of life.

Les, C. M.; Whalen, R. T.; Beaupre, G. S.; Yan, C. H.; Cleek, T. M.; Wills, J. S.

2002-01-01

198

Effect of Aloe vera application on the content and molecular arrangement of glycosaminoglycans during calcaneal tendon healing.  

PubMed

Although several treatments for tendon lesions have been proposed, successful tendon repair remains a great challenge for orthopedics, especially considering the high incidence of re-rupture of injured tendons. Our aim was to evaluate the pharmacological potential of Aloe vera on the content and arrangement of glycosaminoglycans (GAGs) during tendon healing, which was based on the effectiveness of A. vera on collagen organization previously observed by our group. In rats, a partial calcaneal tendon transection was performed with subsequent topical A. vera application at the injury site. The tendons were treated with A. vera ointment for 7 days and excised on the 7(th) , 14(th) , or 21(st) day post-surgery. Control rats received ointment without A. vera. A higher content of GAGs and a lower amount of dermatan sulfate were detected in the A. vera-treated group on the 14(th) day compared with the control. Also at 14 days post-surgery, a lower dichroic ratio in toluidine blue stained sections was observed in A. vera-treated tendons compared with the control. No differences were observed in the chondroitin-6-sulfate and TGF-?1 levels between the groups, and higher amount of non-collagenous proteins was detected in the A. vera-treated group on the 21(st) day, compared with the control group. No differences were observed in the number of fibroblasts, inflammatory cells and blood vessels between the groups. The application of A. vera during tendon healing modified the arrangement of GAGs and increased the content of GAGs and non-collagenous proteins. PMID:25147000

Aro, Andrea Aparecida de; Esquisatto, Marcelo Augusto Marretto; Nishan, Umar; Perez, Mylena Oliveira; Rodrigues, Rodney Alexandre Ferreira; Foglio, Mary Ann; Carvalho, João Ernesto de; Gomes, Laurecir; Vidal, Benedicto De Campos; Pimentel, Edson Rosa

2014-12-01

199

The damping properties of the venous plexus of the heel region of the foot during simulated heelstrike.  

PubMed

The damping mechanisms that are operational in the heel pad during the impact phase of locomotion have the important function to protect the musculo-skeletal system from injuries. How this is achieved is still not fully understood, as is for instance illustrated by the 'heel pad paradox', the observation that in vivo and in vitro experiments yielded widely different results. This paradox could so far only partially be explained. In the light of this paradox, and a previous study by our group, we conjectured that the venous plexus might contribute as a hydraulic shock absorber to the damping properties of the heel pad. To investigate this hypothesis in vivo, heel pads of 11 volunteers were subjected to pendulum impact tests, using velocities of 0.2, 0.4, and 0.6 m/s, and three physiologically different, consecutive conditions: (i) a relatively empty venous plexus, (ii) a congested venous plexus, and (iii) a decongested venous plexus. At congestion, the maximum impact force decreased slightly but significantly by 2.6% at 0.2 m/s and 1.8% at 0.4 m/s. This effect was no longer found at 0.6 m/s. Although these effects are rather small, they confirm the fundamental hypothesis that the venous plexus contributes to the damping properties of the heel pad during walking. It is likely that some underestimation of the effect has occurred. PMID:16214490

Weijers, René E; Kessels, Alphons G H; Kemerink, Gerrit J

2005-12-01

200

Neck pain  

PubMed Central

Introduction Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 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 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy, physical treatments, postural techniques (yoga, pilates, Alexander technique), pulsed electromagnetic field (PEMF) treatment, soft collars and special pillows, spray and stretch, surgery, traction, and transcutaneous electrical nerve stimulation (TENS). PMID:19445809

2008-01-01

201

SLUDGE HEEL REMOVAL BY ALUMINUM DISSOLUTION AT SAVANNAH RIVER SITE 12390  

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.

2012-01-12

202

Pain and the ethics of pain management  

Microsoft Academic Search

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not

Rem B. Edwards

1984-01-01

203

Results of Characterization and Retrieval Testing on Tank 241-C-110 Heel Solids  

SciTech Connect

Nine samples of heel solids from tank 241-C-110 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, the sample solids were primarily white to light-brown with minor dark-colored inclusions. The maximum dimension of the majority of the solids was <2 mm; however, numerous pieces of aggregate, microcrystalline, and crystalline solids with maximum dimensions ranging from 5-70 mm were observed. In general, the larger pieces of aggregate solids were strongly cemented. Natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}?19H{sub 2}O] was the dominant solid phase identified in the heel solids. Results of chemical analyses suggested that 85-87 wt% of the heel solids were the fluoridephosphate double salt. The average bulk density measured for the heel solids was 1.689 g/mL; the reference density of natrophosphate is 1.71 g/mL. Dissolution tests on composite samples indicate that 94 to 97 wt% of the tank 241-C-110 heel solids can be retrieved by dissolution in water. Dissolution and recovery of the soluble components in 1 kg (0.59 L) of the heel solids required the addition of ≈9.5 kg (9.5 L) of water at 15 ?C and ≈4.4 kg (4.45 L) of water at 45 ?C. Calculations performed using the Environmental Simulation Program indicate that dissolution of the ≈0.86 kg of natrophosphate in each kilogram of the tank 241-C-110 heel solids would require ≈9.45 kg of water at 15 ?C and ≈4.25 kg of water at 45 ?C. The slightly larger quantities of water determined to be required to retrieve the soluble components in 1 kg of the heel solids are consistent with that required for the dissolution of solids composed mainly of natrophosphate with a major portion of the balance consisting of highly soluble sodium salts. At least 98% of the structural water, soluble phosphate, sodium, fluoride, nitrate, carbonate, nitrite, sulfate, oxalate, and chloride in the test composites was dissolved and recovered in the dissolution tests. Most of the {sup 99}Tc and {sup 137}Cs present in the initial heel solids composites was removed in the water dissolution tests. The estimated activities/weights of {sup 129}I, {sup 234}U, {sup 235}U, {sup 236}U, and {sup 238}U in the dry residual solids were <25% of the weights/activities in the initial composite solids. Gibbsite and nordstrandite [both Al(OH){sub 3}] were the major solid phases identified in the solids remaining after completion of the dissolution tests. Chemical analysis indicated that the residual solids may have contained up to 62 wt% Al(OH){sub 3}. Significant quantities of unidentified phosphate-, iron-, bismuth-, silicon-, and strontium- bearing species were also present in the residual solids. The reference density of gibbsite (and nordstrandite) is 2.42 g/mL. The measured density of the residual solids, 2.65 g/mL, would be a reasonable value for solids containing gibbsite as the major component with minor quantities of other, higher density solids. Sieve analysis indicated that 22.2 wt% of the residual solids were discrete particles >710 μm in size, and 77.8 wt% were particulates <710 μm in size. Light-scattering measurements suggested that nearly all of the <710-μm particulates with diameters >12 μm were weakly bound aggregates of particles with diameters <2 μm. The <710-μm residual solids settled very slowly when dispersed in reagent water. The physical appearance of a suspension containing ≈0.4 vol% of the solids in pure water changed very little over a period of 46.5 hours. It should be noted that the distribution of particle sizes in the residual solids and the observed settling behavior were both strongly influenced by the procedures followed in the dissolution tests.

Callaway, William S.

2013-09-30

204

[Shewanella algae infection after surgical treatment of Haglund's heel and rupture of the Achilles tendon.  

PubMed

This is a case report of soft tissue infection with the marine bacterium Shewanella algae that is rare in Denmark. The patient was a 43-year-old male and he was treated surgically for Haglund's heel, a bony protrusion at the calcaneus. After clinical healing the patient suffered a rupture of the Achilles tendon, which was treated surgically as well. The post-operative healing process proved to be protracted with a number of surgical wound revisions being necessary. A microbiology culture showed the presence of S. algae and after proper antibiotic treatment the patient recovered quickly. PMID:25353681

Prischl, Clemens; Bendtsen, Michael Melchior; Laursen, Malene

2014-10-20

205

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

PubMed

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

2011-02-01

206

Influence of the calcaneus morphology on the risk of posterior heel ulcer creation Vincent Luboz, Antoine Perrier, Marek Bucki, Bruno Diot, Francis Cannard, Nicolas Vuillerme,  

E-print Network

Influence of the calcaneus morphology on the risk of posterior heel ulcer creation Vincent Luboz percent of the reanimation or geriatric patients develop a pressure ulcer, of which 40 % are posterior heel ulcers. The main suspected causes are the excessive pressure intensity (leading to internal

Payan, Yohan

207

Inherited Pain  

PubMed Central

Inherited erythromelalgia (IEM) causes debilitating episodic neuropathic pain characterized by burning in the extremities. Inherited “paroxysmal extreme pain disorder” (PEPD) differs in its clinical picture and affects proximal body areas like the rectal, ocular, or jaw regions. Both pain syndromes have been linked to mutations in the voltage-gated sodium channel Nav1.7. Electrophysiological characterization shows that IEM-causing mutations generally enhance activation, whereas mutations leading to PEPD alter fast inactivation. Previously, an A1632E mutation of a patient with overlapping symptoms of IEM and PEPD was reported (Estacion, M., Dib-Hajj, S. D., Benke, P. J., Te Morsche, R. H., Eastman, E. M., Macala, L. J., Drenth, J. P., and Waxman, S. G. (2008) NaV1.7 Gain-of-function mutations as a continuum. A1632E displays physiological changes associated with erythromelalgia and paroxysmal extreme pain disorder mutations and produces symptoms of both disorders. J. Neurosci. 28, 11079–11088), displaying a shift of both activation and fast inactivation. Here, we characterize a new mutation of Nav1.7, A1632T, found in a patient suffering from IEM. Although transfection of A1632T in sensory neurons resulted in hyperexcitability and spontaneous firing of dorsal root ganglia (DRG) neurons, whole-cell patch clamp of transfected HEK cells revealed that Nav1.7 activation was unaltered by the A1632T mutation but that steady-state fast inactivation was shifted to more depolarized potentials. This is a characteristic normally attributed to PEPD-causing mutations. In contrast to the IEM/PEPD crossover mutation A1632E, A1632T failed to slow current decay (i.e. open-state inactivation) and did not increase resurgent currents, which have been suggested to contribute to high-frequency firing in physiological and pathological conditions. Reduced fast inactivation without increased resurgent currents induces symptoms of IEM, not PEPD, in the new Nav1.7 mutation, A1632T. Therefore, persistent and resurgent currents are likely to determine whether a mutation in Nav1.7 leads to IEM or PEPD. PMID:24311784

Eberhardt, Mirjam; Nakajima, Julika; Klinger, Alexandra B.; Neacsu, Cristian; Hühne, Kathrin; O'Reilly, Andrias O.; Kist, Andreas M.; Lampe, Anne K.; Fischer, Kerstin; Gibson, Jane; Nau, Carla; Winterpacht, Andreas; Lampert, Angelika

2014-01-01

208

When Sex Is Painful  

MedlinePLUS

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 ...

209

Shoulder Pain COMMON CAUSES  

E-print Network

Shoulder Pain COMMON CAUSES: Shoulder injury or pain may be triggered by a specific event those required in swimming, tennis, baseball, and football can lead to shoulder pain. These OVER USE labor can lead to shoulder pain over time. Long term shoulder problems are more likely when pain

Virginia Tech

210

Effects of weight bearing and non-weight bearing exercises on bone properties using calcaneal quantitative ultrasound  

PubMed Central

Objective: This study was designed to investigate bone properties using heel quantitative ultrasound (QUS) in young adults participating in various sports. Methods: A cross sectional study was performed on Chinese male students (n = 55), aged 18–22 years. Subjects with previous fractures or suffering from any diseases known to affect bone metabolism or taking any medication with such an effect, were not included. The subjects were categorised according to their main sporting activities, including soccer (n = 15) (a high impact, weight bearing exercise), dancing (n = 10) (a low impact, weight bearing exercise), and swimming (n = 15) (non-weight bearing exercise). A sedentary group acted as controls (n = 15). A reproducibility study of the velocity of sound (VOS) and the broadband ultrasound attenuation (BUA) measurement was performed and analysed using the intraclass correlation coefficient (ICC). Results: There was good intra-investigator and inter-investigator agreement (ICC?0.8; p<0.05) in the measurement of BUA and VOS. No significant differences in BUA and VOS (p>0.05) were found between the dominant and non-dominant heel. Soccer players (137±4.3 dB/MHz; 1575±56 m/s; 544.1±48.4) and dancers (134.6±3.7 dB/MHz; 1538±46 m/s; 503.0±37.0) had significantly higher BUA, VOS, and stiffness index (SI) scores (p<0.05), respectively, than swimmers (124.1±5.1 dB/MHz; 1495±42 m/s; 423.3±46.9) and the sedentary control group (119.9±6.1 dB/MHz; 1452±41 m/s; 369.9±46.4). A trend of a significant linear increase with the weight bearing and high impact exercise was revealed in all QUS parameters (p<0.05). Conclusion: This cross sectional study indicated that regular participation in weight bearing exercise in young people might be beneficial for accruing peak bone mass and optimising bone structure. PMID:16046341

Yung, P; Lai, Y; Tung, P; Tsui, H; Wong, C; Hung, V; Qin, L

2005-01-01

211

Control of the motion of the body's center of mass in relation to the center of pressure during high-heeled gait.  

PubMed

High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. Knowledge of the motion of the body's center of mass (COM) with respect to the center of pressure (COP) during high-heeled gait may offer insights into the balance control strategies and provide a basis for approaches that minimize the risk of falling and associated adverse effects. The study aimed to investigate the influence of the base and height of the heels on the COM motion in terms of COM-COP inclination angles (IA) and the rate of change of IA (RCIA). Fifteen females who regularly wear high heels walked barefoot and with narrow-heeled shoes with three heel heights (3.9cm, 6.3cm and 7.3cm) while kinematic and ground reaction force data were measured and used to calculate the COM and COP, as well as the temporal-distance parameters. The reduced base of the heels was found to be the primary factor for the reduced normalized walking speed and the reduced frontal IA throughout the gait cycle. This was achieved mainly through the control of the RCIA during double-leg stance (DLS). The heel heights affected mainly the peak RCIA during DLS, which were not big enough to affect the IA. These results suggest young adults adopt a conservative strategy for balance control during narrow-heeled gait. The results will serve as baseline data for future evaluation of patients and/or older adults during narrow-heeled gait with the aim of reducing the risk of falling. PMID:23337731

Chien, Hui-Lien; Lu, Tung-Wu; Liu, Ming-Wei

2013-07-01

212

Pain drawings in somatoform-functional pain  

PubMed Central

Background Pain drawings are a diagnostic adjunct to history taking, clinical examinations, and biomedical tests in evaluating pain. We hypothesized that somatoform-functional pain, is mirrored in distinctive graphic patterns of pain drawings. Our aim was to identify the most sensitive and specific graphic criteria as a tool to help identifying somatoform-functional pain. Methods We compared 62 patients with somatoform-functional pain with a control group of 49 patients with somatic-nociceptive pain type. All patients were asked to mark their pain on a pre-printed body diagram. An investigator, blinded with regard to the patients’ diagnoses, analyzed the drawings according to a set of numeric or binary criteria. Results We identified 13 drawing criteria pointing with significance to a somatoform-functional pain disorder (all p-values???0.001). The most specific and most sensitive criteria combination for detecting somatoform-functional pain included the total number of marks, the length of the longest mark, and the presence of symmetric patterns. The area under the ROC-curve was 96.3% for this criteria combination. Conclusion Pain drawings are an easy-to-administer supplementary technique which helps to identify somatoform-functional pain in comparison to somatic-nociceptive pain. PMID:23256679

2012-01-01

213

Growing Pains (For Parents)  

MedlinePLUS

... Lessons? Visit KidsHealth in the Classroom What Other Parents Are Reading Measles: What to Know Vaccines: FAQs ... Precautions Checkups: What to Expect Growing Pains KidsHealth > Parents > General Health > Aches, Pains & Injuries > Growing Pains Print ...

214

What Is Chronic Pain?  

MedlinePLUS Videos and Cool Tools

... 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 Surveys September is ...

215

American Pain Society  

MedlinePLUS

... From the APS Newsroom Current research in The Journal of Pain discuss the latest in therapeutic opioids, chronic headaches, chronic neck pain and pain education. Read More » Posted February 16, 2015 Clinical Trial ...

216

Pain syndromes in children  

Microsoft Academic Search

The pediatric rheumatologist cares for children who may have a wide variety of causes of musculoskeletal pain. These include\\u000a such diverse conditions as arthritis, low-back pain, hypermobility, metabolic bone pain, and amplified pain syndromes such\\u000a as complex regional pain syndrome and fibromyalgia. This review examines the recent literature on these and other conditions\\u000a causing musculoskeletal pain in children and adolescents.

David D. Sherry

2000-01-01

217

Results of Characterization and Retrieval Testing on Tank 241-C-109 Heel Solids  

SciTech Connect

Eight samples of heel solids from tank 241-C-109 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, one-half to two-thirds of the solids were off-white to tan solids that, visually, were fairly evenly graded in size from coarse silt (30-60 μm) to medium pebbles (8-16 mm). The remaining solids were mostly strongly cemented aggregates ranging from coarse pebbles (16-32 mm) to fine cobbles (6-15 cm) in size. Solid phase characterization and chemical analysis indicated that the air-dry heel solids contained ≈58 wt% gibbsite [Al(OH){sub 3}] and ≈37 wt% natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}?19H{sub 2}O]. The strongly cemented aggregates were mostly fine-grained gibbsite cemented with additional gibbsite. Dissolution testing was performed on two test samples. One set of tests was performed on large pieces of aggregate solids removed from the heel solids samples. The other set of dissolution tests was performed on a composite sample prepared from well-drained, air-dry heel solids that were crushed to pass a ?-in. sieve. The bulk density of the composite sample was 2.04 g/mL. The dissolution tests included water dissolution followed by caustic dissolution testing. In each step of the three-step water dissolution tests, a volume of water approximately equal to 3 times the initial volume of the test solids was added. In each step, the test samples were gently but thoroughly mixed for approximately 2 days at an average ambient temperature of 25 ?C. The caustic dissolution tests began with the addition of sufficient 49.6 wt% NaOH to the water dissolution residues to provide ≈3.1 moles of OH for each mole of Al estimated to have been present in the starting composite sample and ≈2.6 moles of OH for each mole of Al potentially present in the starting aggregate sample. Metathesis of gibbsite to sodium aluminate was then allowed to proceed over 10 days of gentle mixing of the test samples at temperatures ranging from 26-30 ?C. The metathesized sodium aluminate was then dissolved by addition of volumes of water approximately equal to 1.3 times the volumes of caustic added to the test slurries. Aluminate dissolution was allowed to proceed for 2 days at ambient temperatures of ≈29 ?C. Overall, the sequential water and caustic dissolution tests dissolved and removed 80.0 wt% of the tank 241-C-109 crushed heel solids composite test sample. The 20 wt% of solids remaining after the dissolution tests were 85-88 wt% gibbsite. If the density of the residual solids was approximately equal to that of gibbsite, they represented ≈17 vol% of the initial crushed solids composite test sample. In the water dissolution tests, addition of a volume of water ≈6.9 times the initial volume of the crushed solids composite was sufficient to dissolve and recover essentially all of the natrophosphate present. The ratio of the weight of water required to dissolve the natrophosphate solids to the estimated weight of natrophosphate present was 8.51. The Environmental Simulation Program (OLI Systems, Inc., Morris Plains, New Jersey) predicts that an 8.36 w/w ratio would be required to dissolve the estimated weight of natrophosphate present in the absence of other components of the heel solids. Only minor amounts of Al-bearing solids were removed from the composite solids in the water dissolution tests. The caustic metathesis/aluminate dissolution test sequence, executed at temperatures ranging from 27-30 ?C, dissolved and recovered ≈69 wt% of the gibbsite estimated to have been present in the initial crushed heel solids composite. This level of gibbsite recovery is consistent with that measured in previous scoping tests on the dissolution of gibbsite in strong caustic solutions. Overall, the sequential water and caustic dissolution tests dissolved and removed 80.3 wt% of the tank 241-C-109 aggregate solids test sample. The residual solids were 92-95 wt% gibbsite. Only a minor portion (≈4.

Callaway, William S.

2013-09-26

218

Pain Management: Post-Amputation Pain  

MedlinePLUS

Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java ... of the most frequently asked questions. Ideas about management are one of the frequent topics of conversation ...

219

Excision of a dermatobia hominis larva from the heel of a south american traveler: A case report  

Microsoft Academic Search

Although foot and ankle specialists are well versed in treating insect bites and foreign bodies, many physicians in the United States are unfamiliar with parasitic organisms that are common in other parts of the world. This article presents a case of a patient inoculated in the posterior heel with the larva of a Dermatobia hominis, or human bot fly. Excision

Donald W Adams; Ryan T Cooney

2004-01-01

220

The prevalence of musculoskeletal pain & its associated factors among female Saudi school teachers  

PubMed Central

Objectives: To quantify the prevalence and identify the associated factors of musculoskeletal pain among Saudi female school teachers. Methods: An observational quantitative cross-sectional survey of female Saudi school teachers in five different areas of Saudi Arabia was carried out between August and October 2013. A self-administered questionnaire was used in which the items related to participants’ demographic information and pain information were included. A numeric pain rating scale was used for patient self-reporting of pain. Data analysis was carried out using SPSS Pc+ version 21.0 statistical software. Results: Four hundred and eighty six female school teachers responded to the survey. Severe Low back pain was reported by 38.1% of teacher, followed by knee pain (26.3%), heel (24.1%), shoulder (20.6%), upper back (17.7%), hip joint (16.5%),ankle (12.3%), neck (11.3%). Sever pain of elbow (5.6%) and wrist (7.4%) was the least reported. Pain affected work at school in 46.1% of school teachers. A combination of variables: body mass index, Vitamin D deficiency, teaching level, presence of chronic illness, were found to be significantly associated with musculoskeletal pain. Conclusion: The results of self-reported prevalence of musculoskeletal pain among female Saudi school teachers is useful to educate the school teachers for adequate care so as to prevent these pains. There is a need for the higher authorities to address this issue and implement intervention programs to alleviate the pain and suffering of these school teachers. PMID:25674106

Abdulmonem, Alsiddiky; Hanan, Algethami; Elaf, Ahmed; Haneen, Tokhtah; Jenan, Aldouhan

2014-01-01

221

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. PMID:19648723

HOUCK, JEFF; NEVILLE, CHRISTOPHER; TOME, JOSHUA; FLEMISTER, ADOLPH

2010-01-01

222

Peripheral Pain Mechanisms in Chronic Widespread Pain  

PubMed Central

Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxious (allodynia). For example, patients with muscle hyperalgesia will rate painful muscle stimuli higher than normal controls, whereas patients with allodynia may perceive light touch as painful, something that a “normal” individual will never describe as painful. The pathogenesis of such peripheral and/or central nervous system changes in CWP is unclear, but peripheral soft tissue changes have been implicated. Indirect evidence from interventions that attenuate tonic peripheral nociceptive impulses in patients with CWP syndromes like FM suggest that overall FM pain is dependent on peripheral input. More importantly, allodynia and hyperalgesia can be improved or abolished by removal of peripheral impulse input. Another potential mechanism for CWP pain is central disinhibition. However, this pain mechanism also depends on tonic impulse input, even if only inadequately inhibited. Thus a promising approach to understanding CWP is to determine whether abnormal activity of receptors in deep tissues is fundamental to the development and maintenance of this chronic pain disorder. Conclusions Most CWP patients present with focal tissue abnormalities including myofascial trigger points, ligamentous trigger points, or osteoarthritis of the joints and spine. While not predictive for the development of CWP these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain. Local chemical mediators, including lactic acid, ATP, and cytokines seem to play an important role in sensitizing deep tissue nociceptors of CWP patients. Thus the combination of peripheral impulse input and increased central pain sensitivity may be responsible for wide-spread chronic pain disorders including FM. PMID:22094192

Staud, Roland

2011-01-01

223

Heel bone strength is related to lifestyle factors in Okinawan men with type 2 diabetes mellitus  

PubMed Central

Aims/Introduction Although male diabetic patients have an increased risk of fracture, there is little information about this in the literature. The association between heel bone stiffness and the lifestyle of male patients with diabetes was evaluated. Materials and Methods The study included 108 participants with type 2 diabetes mellitus patients and 168 age-adjusted, healthy male volunteers. None of the participants had a history of osteoporosis or other severe diseases. Heel bone stiffness was examined by quantitative ultrasound, and each participant completed a health interview survey questionnaire. Bone stiffness was taken as an indicator of bone strength. Stepwise regression analysis was used to investigate associations between bone stiffness and lifestyle-related factors, such as sunlight exposure, intake of milk or small fish, regular exercise, cigarette smoking, consumption of alcohol, and number of remaining teeth. Results Bone stiffness showed a significant negative association with cigarette smoking [standardized coefficient (SC) = ?0.297, F-value (F) = 10.059] and age (SC = ?0.207, F = 7.565) in diabetic patients. Bone stiffness showed a significant negative association with age (SC = ?0.371, F = 12.076) and height (SC = ?0.193, F = 7.898), as well as a significant positive association with sunlight exposure (SC = 0.182, F = 9.589) and intake of small fish (SC = 0.170, F = 7.393) in controls. Conclusions These findings suggest that cigarette smoking and age are negatively associated with bone stiffness in Okinawan male patients with type 2 diabetes mellitus.

Gushiken, Michiko; Komiya, Ichiro; Ueda, Shinichiro; Kobayashi, Jun

2015-01-01

224

Interventional pain treatments for cancer pain.  

PubMed

Cancer pain is prevalent and often multifactorial. For a segment of the cancer pain population, pain control remains inadequate despite full compliance with the WHO analgesic guidelines including use of co-analgesics. The failure to obtain acceptable pain or symptom relief prompted the inclusion of a fourth step to the WHO analgesic ladder, which includes advanced interventional approaches. Interventional pain-relieving therapies can be indispensable allies in the quest for pain reduction among cancer patients suffering from refractory pain. There are a variety of techniques used by interventional pain physicians, which may be grossly divided into modalities affecting the spinal canal (e.g., intrathecal or epidural space), called neuraxial techniques and those that target individual nerves or nerve bundles, termed neurolytic techniques. An array of intrathecal medications are infused into the cerebrospinal fluid in an attempt to relieve refractory cancer pain, reduce disabling adverse effects of systemic analgesics, and promote a higher quality of life. These intrathecal medications include opioids, local anesthetics, clonidine, and ziconotide. Intrathecal and epidural infusions can serve as useful methods of delivering analgesics quickly and safely. Spinal delivery of drugs for the treatment of chronic pain by means of an implantable drug delivery system (IDDS) began in the 1980s. Both intrathecal and epidural neurolysis can be effective in managing intractable cancer-related pain. There are several sites for neurolytic blockade of the sympathetic nervous system for the treatment of cancer pain. The more common sites include the celiac plexus, superior hypogastric plexus, and ganglion impar. Today, interventional pain-relieving approaches should be considered a critical component of a multifaceted therapeutic program of cancer pain relief. PMID:18837908

Christo, Paul J; Mazloomdoost, Danesh

2008-09-01

225

Sickle Cell Pain  

MedlinePLUS

... patient’s life. Folic acid prevents severe anemia in sickle cell disease. Other studies have suggested that the more severe and painful ... chance of long-lasting PHN pain. Also, some studies have concluded that people who do not ... Treatment for sickle cell pain The terrible pain of a sickle ...

226

Thai perspectives on pain.  

PubMed

This qualitative research aimed to study the meaning, the characteristics, and the dimensions of pain from a Thai point of view. It was conducted under the research project on the development of the quality of pain management for people in the hospital. The subjects were 62 patients, experiencing pain and receiving treatment in 4 hospitals in northeast Thailand. Data were analyzed through content analysis. The findings included: 1) concept from experience of pain, perceived pain as suffering physically and psychologically, 2) different characteristics between acute and chronic pain, 3) four levels of pain intensity: mild, moderate, high and severe, 4) pain effects on four dimensions: physical, psychological, behavioral and societal (family-social-economy), 5) two factors related to pain: alleviating factor and predisposing factor, and 6) pain management relies on beliefs, culture and religion i.e. good deeds in Buddhism affected six dimensions: physical, psychological, social, spiritual, treatment seeking and asking health personnel for help. The results of the present study revealed the influence of culture beliefs on the meaning of pain, pain characteristics, and the effects of pain as well as pain management in terms of cultural contexts. The findings may be implemented for the development of pain assessment and the model development of pain management more appropriately according to cultural contexts. PMID:24386747

Mongkhonthawornchai, Siriporn; Sangchart, Bumpenchit; Sornboon, Ariya; Chantarasiri, Jongkolnee

2013-09-01

227

Neuraxial pain relief for intractable cancer pain  

Microsoft Academic Search

Most patients with cancer pain achieve good analgesia using traditional analgesics and adjuvant medications; however, an important\\u000a minority of patients (2% to 5%) suffers from severe and refractory cancer pain. For these individuals, spinal analgesics (intrathecal\\u000a or epidural) provide significant hope for pain relief over months or years of treatment to help improve quality of life. Spinal\\u000a analgesics have been

Paul A. Sloan

2007-01-01

228

Gender differences in pain.  

PubMed

A review of the literature on gender and clinical pain reveals a disproportionate representation of women receiving treatment for many pain conditions and suggests that women report more severe pain, more frequent pain, and pain of longer duration than do men. Gender differences in pain perception have also been extensively studied in the laboratory, and ratings of experimentally induced pain also show some sex disparity, with females generally reporting lower pain thresholds and tolerance than males. However, there is little consensus on whether these apparent differences reflect the way men and women respond to pain, differing social rules for the expression of pain, or biologic differences in the way noxious stimuli are processed. In this paper, our working hypothesis is that the higher prevalence of chronic orofacial pain in women is a result of sex differences in generic pain mechanisms and of as-yet unidentified factors unique to the craniofacial system. We will review the evidence concerning gender differences in the prevalence of pain conditions, with a focus on orofacial pain conditions. Evidence and hypotheses concerning biologic and psychosocial factors that could influence prevalence rates will also be discussed. PMID:11203754

Dao, T T; LeResche, L

2000-01-01

229

REMOVING SLUDGE HEELS FROM SAVANNAH RIVER SITE WASTE TANKS BY OXALIC ACID DISSOLUTION  

SciTech Connect

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 the past, SRS used oxalic acid solutions to disperse or dissolve the sludge heel to complete the waste removal. To better understand the actual conditions of oxalic acid cleaning of waste from carbon steel tanks, the authors developed and conducted an experimental program to determine its effectiveness in dissolving sludge, the hydrogen generation rate, the generation rate of other gases, the carbon steel corrosion rate, the impact of mixing on chemical cleaning, the impact of temperature, and the types of precipitates formed during the neutralization process. The test samples included actual SRS sludge and simulated SRS sludge. The authors performed the simulated waste tests at 25, 50, and 75 C by adding 8 wt % oxalic acid to the sludge over seven days. They conducted the actual waste tests at 50 and 75 C by adding 8 wt % oxalic acid to the sludge as a single batch. Following the testing, SRS conducted chemical cleaning with oxalic acid in two waste tanks. In Tank 5F, the oxalic acid (8 wt %) addition occurred over seven days, followed by inhibited water to ensure the tank contained enough liquid to operate the mixer pumps. The tank temperature during oxalic acid addition and dissolution was approximately 45 C. The authors analyzed samples from the chemical cleaning process and compared it with test data. The conclusions from the work are: (1) Oxalic acid addition proved effective in dissolving sludge heels in the simulant demonstration, the actual waste demonstration, and in SRS Tank 5F. (2) The oxalic acid dissolved {approx} 100% of the uranium, {approx} 100% of the iron, and {approx} 40% of the manganese during a single contact in the simulant demonstration. (The iron dissolution may be high due to corrosion of carbon steel coupons.) (3) The oxalic acid dissolved {approx} 80% of the uranium, {approx} 70% of the iron, {approx} 50% of the manganese, and {approx} 90% of the aluminum in the actual waste demonstration for a single contact. (4) The oxalic acid dissolved {approx} 100% of the uranium, {approx} 15% of the iron, {approx} 40% of the manganese, and {approx} 80% of the aluminum in Tank 5F during the first contact cycle. Except for the iron, these results agree well with the demonstrations. The data suggest that a much larger fraction of the iron in the sludge dissolved, but it re-precipitated with the oxalate added to Tank 5F. (5) The demonstrations produced large volumes (i.e., 2-14 gallons of gas/gallon of oxalic acid) of gas (primarily carbon dioxide) by the reaction of oxalic acid with sludge and carbon steel. (6) The reaction of oxalic acid with carbon steel produced hydrogen in the simulant and actual waste demonstrations. The volume produced varied from 0.00002-0.00100 ft{sup 3} hydrogen/ft{sup 2} carbon steel. The hydrogen production proved higher in unmixed tanks than in mixed tanks.

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

2009-03-01

230

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

PubMed

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

2013-01-01

231

Analysis of release of the first branch of the lateral plantar nerve.  

PubMed

The authors conducted a retrospective study of the release of the first branch of the lateral plantar nerve in the treatment of chronic heel pain unrelieved by conservative treatment modalities. A total of 17 patients (18 feet) were evaluated following external neurolysis for heel pain caused by entrapment of the first branch of the lateral plantar nerve. The average postoperative follow-up time was 32.8 months, with a range of 10 to 72 months. Every patient deemed the surgery successful. At the time of follow-up examination, nine feet were asymptomatic and nine feet experienced mild pain after extended activity. There was one postoperative complication, medial calcaneal nerve entrapment; it was successfully treated with neurectomy. PMID:10881458

Goecker, R M; Banks, A S

2000-06-01

232

Managing your chronic back pain  

MedlinePLUS

... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

233

Chiropractic care for back pain  

MedlinePLUS

... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

234

Epidural injections for back pain  

MedlinePLUS

... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

235

Pediatric pain management.  

PubMed

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

1997-01-01

236

Central modulation of pain  

PubMed Central

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

2010-01-01

237

Pain as a channelopathy  

PubMed Central

Mendelian heritable pain disorders have provided insights into human pain mechanisms and suggested new analgesic drug targets. Interestingly, many of the heritable monogenic pain disorders have been mapped to mutations in genes encoding ion channels. Studies in transgenic mice have also implicated many ion channels in damage sensing and pain modulation. It seems likely that aberrant peripheral or central ion channel activity underlies or initiates many pathological pain conditions. Understanding the mechanistic basis of ion channel malfunction in terms of trafficking, localization, biophysics, and consequences for neurotransmission is a potential route to new pain therapies. PMID:21041956

Raouf, Ramin; Quick, Kathryn; Wood, John N.

2010-01-01

238

In vitro evaluation of the antiviral effects of the homeopathic preparation Gripp-Heel on selected respiratory viruses.  

PubMed

Gripp-Heel is a homeopathic preparation frequently used in the treatment of respiratory viral infections such as various types of influenza and the common cold. The antiviral activity of Gripp-Heel was studied in vitro on human pathogenic enveloped and nonenveloped RNA and DNA viruses. Before the antiviral assays, in vitro cytotoxicity of Gripp-Heel was determined with cells used for the infection experiments (HeLa, HEp-2, MDCK, BGM) as well as with mitogen-stimulated peripheral blood mononuclear leukocytes. A concentration of 0.5 of the commercially available product slightly reduced cell viability and proliferative capacity, and experiments on antiviral activity were determined starting with a dilution of 0.2 of the commercially available product. The antiviral activity was determined against a broad panel of enveloped and nonenveloped DNA and RNA viruses with plaque reduction assay, cytopathogenic assays, virus titrations, analysis of the viral proteins in virus-specific enzyme immunoassays, and haemagglutination tests. Control substances were acyclovir (10 microg/mL), ribavirin (6 microg/mL), and amantadine hydrochloride (5 microg/mL), depending on the virus type. Gripp-Heel demonstrated dose-dependent in vitro activity (significant reductions of infectivity by 20% to 40%) against Human herpesvirus 1, Human adenovirus C serotype 5, Influenza A virus, Human respiratory syncytial virus, Human parainfluenza virus 3, Human rhinovirus B serotype 14, and Human coxsackievirus serotype A9. The mechanisms of this antiviral activity are still unclear, but type I interferon induction might be a possible explanation. Further research on this homeopathic preparation seems warranted. PMID:18066110

Glatthaar-Saalmüller, Bernadette

2007-11-01

239

What a Pain! Kids and Growing Pains  

MedlinePLUS

... your leg looks red or is swollen (puffed up), your parent should take you to the doctor. Growing pains should not keep you from running, playing, ... reviewed: July 2012 For Teens For Kids For Parents MORE ON THIS TOPIC How Do Pain Relievers Work? I'm Growing Up - But Am I Normal? What Medicines Are and ...

240

Chronic Pelvic Pain  

MedlinePLUS

... with pain. Such types include relaxation exercises and biofeedback . FREQUENTLY ASKED QUESTIONS FAQ099 GYNECOLOGIC PROBLEMS The American ... pain signals from reaching tissues and organs. Glossary Biofeedback: A technique in which an attempt is made ...

241

Communicating about Cancer Pain  

Cancer.gov

Patients with cancer may be reluctant to discuss their pain with their doctors for a variety of reasons. NCI sponsors research that examines the barriers that prevent patients from talking about pain.

242

Pain: Hope through Research  

MedlinePLUS

... comes with its own telltale brand of pain. Migraines are characterized by throbbing head pain, sensitivity to ... and visual disturbances that begine before the headache. Migraines are more frequent in women than men. Stress ...

243

What's wrong with pain?  

E-print Network

are quickly confronted with difficult questions. This thesis, through an examination of a particular feature of moral language and a description of recent research on pain, provides an analysis of how pain fits into ethical theory. It is argued...

Shriver, Adam Joseph

2006-10-30

244

Dysmenorrhea: Painful Periods  

MedlinePLUS

... dysmenorrhea? Glossary What is dysmenorrhea? Pain associated with menstruation is called dysmenorrhea . How common is dysmenorrhea? Dysmenorrhea ... the menstrual period? Pain usually occurs right before menstruation starts, as the level of prostaglandins increases in ...

245

Neuropathic pain in leprosy.  

PubMed

Chronic neuropathic pain in treated leprosy has received scant attention. In this article the concept, clinical features and diagnosis of neuropathic pain are reviewed. The possible pathophysiological mechanisms, treatment challenges and research needs in this area are discussed. PMID:15072122

Haanpää, Maija; Lockwood, Diana N J; Hietaharju, Aki

2004-03-01

246

Alternative medicine - pain relief  

MedlinePLUS

... relieve pain due to: Cancer Carpal tunnel syndrome Fibromyalgia Childbirth (labor) Musculoskeletal injuries (such as the neck, ... pain for: After surgery or labor Arthritis Cancer Fibromyalgia Irritable bowel syndrome Migraine headache Tension headache Both ...

247

Patient Education on Pain  

MedlinePLUS

... Education Annual Meeting Safe Prescribing Resources Clinical Pearls Patient Center Home > Patient Center > Patient Education > Patient Education ... to People with Pain Press Room Position Statements Patient Education on Pain AAPM Past President, Perry G. ...

248

What Is Back Pain?  

MedlinePLUS

... herniated disks National statistics on back pain costs Socioeconomic factors that relate to back pain costs and treatment. ... Skin Diseases (NIAMS) Information Clearinghouse National Institutes of Health 1 AMS Circle Bethesda, MD 20892-3675 Phone: ...

249

Pain in Parkinson's Disease  

MedlinePLUS

... for increased overall health care costs. A person’s perception of pain can be affected by emotional factors. ... medications such as levodopa can affect a person’s perception of pain. People with Parkinson’s who are in ...

250

Pain and your emotions  

MedlinePLUS

... low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain . 2008;134:263-276. Kroenke K, Bair ...

251

Magnets for Pain Relief  

MedlinePLUS

... for any health-related purpose, yet static, or permanent, magnets are widely marketed for pain control. This fact ... Blackman MR, Kingman A, et al. Low intensity permanent magnets in the treatment of chronic lumbar radicular pain. ...

252

Fighting Chronic Pain  

MedlinePLUS

... and inflammation Heart/Blood Vessels: Heart attack, angina, leg pain from clogged arteries Stomach/Digestive: Gallstones, intestinal obstruction, diverticulitis, ulcers, severe indigestion, severe gas pain, inflammatory bowel disease, ...

253

Multidimensional pain evaluation scale.  

PubMed

This study developed a pain evaluation scale and validated it for the Portuguese language. Development of the inventory--308 readily available pain descriptors--were searched in international literature and validated by six judges. One hundred descriptors of acute pain and 100 descriptors of chronic pain were found, which were used in the next stage. Statistical validation--493 health professionals and 146 patients experiencing acute and chronic pain participated in the study. Instructions, pain descriptors and respective definitions, pen and measuring tape were provided to participants. Psychophysical methods were used to establish categories, magnitude and cross-modality matching using line-length. Results revealed the ranking of the most frequently used descriptors of acute and chronic pain, with power equal to 0.99, close to the predicted (one), using line-length estimations. The Multidimensional Pain Evaluation Scale is thus validated for the Portuguese language. PMID:20428690

Sousa, Fátima Aparecida Emm Faleiros; Pereira, Lilian Varanda; Cardoso, Roberta; Hortense, Priscilla

2010-01-01

254

Eldercare at Home: Pain  

MedlinePLUS

... listening to music may also decrease a person's awareness of pain. Avoid stressful events when possible. Emotional stress and anxiety increase pain. Try to minimize these types of situations. Carrying Out and Adjusting Your Plan : Problems You ...

255

Exercise and Shoulder Pain  

MedlinePLUS

... the painful limb and should seek immediate medical attention. They should select other forms of exercise to ... cautions people to avoid exercise/activities that cause increased pain lasting an hour or more after exercise. ...

256

EM-31 ALTERNATIVE AND ENHANCED CHEMICAL CLEANING PROGRAM FOR SLUDGE HEEL REMOVAL - 11220  

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.

2010-12-10

257

EM-21 ALTERNATIVE ENHANCED CHEMICAL CLEANING PROGRAM FOR SLUDGE HEEL REMOVAL  

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.

2009-12-18

258

Posttonsillectomy pain in children.  

PubMed

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence. PMID:24445532

Sutters, Kimberly A; Isaacson, Glenn

2014-02-01

259

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

2005-01-01

260

Effect of Field Size and Length of Plantar Spur on Treatment Outcome in Radiation Therapy of Plantar Fasciitis: The Bigger the Better?  

SciTech Connect

Purpose: Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. Methods and Materials: A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Results: Treatment response depended upon age >53 years, length of heel spur ?6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Conclusion: Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice.

Hermann, Robert Michael, E-mail: hermann@strahlentherapie-westerstede.com [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Meyer, Andreas [Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Gemeinschaftspraxis für Strahlentherapie Hildesheim/Goslar (Germany); Becker, Alexandra [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Schneider, Michael [Orthopaedic Centre for Musculoskeletal Research, University of Würzburg (Germany); Reible, Michael; Carl, Ulrich Martin [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Christiansen, Hans [Abteilung Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover (Germany); Nitsche, Mirko [Zentrum für Strahlentherapie und Radioonkologie, Bremen/Westerstede (Germany); Klinik für Strahlentherapie, Karl-Lennert-Krebscentrum, Universität Kiel (Germany)

2013-12-01

261

THE INFLUENCE OF HEEL HEIGHT ON SAGITTAL PLANE KNEE KINEMATICS DURING LANDING TASKS IN RECREATIONALLY ACTIVE AND ATHLETIC COLLEGIATE FEMALES  

PubMed Central

Purpose: To determine if heel height alters sagittal plane knee kinematics when landing from a forward hop or drop landing. Background: Knee angles close to extension during landing are theorized to increase ACL injury risk in female athletes. Methods: Fifty collegiate females performed two single-limb landing tasks while wearing heel lifts of three different sizes (0, 12 & 24 mm) attached to the bottom of a sneaker. Using an electrogoniometer, sagittal plane kinematics (initial contact [KAIC], peak flexion [KAPeak], and rate of excursion [RE]) were examined. Repeated measures ANOVAs were used to determine the influence of heel height on the dependent measures. Results: Forward hop task- KAIC with 0 mm, 12 mm, and 24 mm lifts were 8.88±6.5, 9.38±5.8 and 11.28±7.0, respectively. Significant differences were noted between 0 and 24 mm lift (p<.001) and 12 and 24 mm lifts (p=.003), but not between the 0 and 12 mm conditions (p=.423). KAPeak with 0 mm, 12 mm, and 24 mm lifts were 47.08±10.9, 48.18±10.3 and 48.88±9.7, respectively. A significant difference was noted between 0 and 24 mm lift (p=.004), but not between the 0 and 12 mm or 12 and 24 mm conditions (p=.071 and p=.282, respectively). The RE decreased significantly from 2128/sec±52 with the 12 mm lift to 1958/sec±55 with the 24 mm lift (p=.004). RE did not differ from 0 to 12 or 0 to 24 mm lift conditions (p=.351 and p=.086, respectively). Jump-landing task- No significant differences were found in KAIC (p=.531), KAPeak (p=.741), or the RE (p=.190) between any of the heel lift conditions. Conclusions: The addition of a 24 mm heel lift to the bottom of a sneaker significantly alters sagittal plane knee kinematics upon landing from a unilateral forward hop but not from a drop jump. PMID:21904697

Carcia, Christopher R.; Phelps, Amy L.; Martin, RobRoy L.; Burrows, Anne M.

2011-01-01

262

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.

2006-01-01

263

Approaching cancer pain relief  

Microsoft Academic Search

Pain is defined as an unpleasant experience—it is subjective and achieving pain relief is achieving a change in the patient's experience. There needs to be an adequate concept of a human person (an ecological model will be discussed) and a logical process for approaching pain relief in an individual patient (e.g. the plan used in the Sydney Institute of Palliative

J. Norelle Lickiss

2001-01-01

264

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

2010-01-01

265

Complex Regional Pain Syndrome  

MedlinePLUS

Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. It may happen ... move the affected body part The cause of CRPS is unknown. There is no specific diagnostic test. ...

266

[Neurosurgical treatments for pain].  

PubMed

Pain represents the most frequent symptom faced by general practitioners and is associated with 60% of neurological troubles. Pain consists in a conscious, subjective, unpleasant and protective sensory experience transmitted by thermoalgic pathways in the central nervous system (nociceptive pain). Lesioning of peripheral or central sensory pathways can also generate pain associated with hypoesthesia (phantom or neuropathic pain). Since the 1920's, neurosurgeons have attempted to alleviate nociceptive and neuropathic chronic pain by interrupting (irreversible interruptive techniques) thermoalgic fibers (neurotomies, rhizotomies, cordotomies, tractotomies, thalamotomies, cingulotomies). Some of them (neurotomies, rhizotomies) are still used today when all medications have failed. They can provide immediate and tremendous pain relief like in trigeminal neuralgia. However, the technique, when not sufficiently selective, can generate a neuropathic pain and then a short-lating pain relief. Increasing knowledge on pathophysiological mechanisms of pain allowed surgery to interfere with the functioning of the sensory circuits without lesioning and to modulate neuronal activity in order to reduce pain (neuromodulation). Non-lesioning modulating techniques (then reversible) appeared (deep brain stimulation, epidural spinal cord or motor cortex stimulation, intrathecal infusion, radiosurgery) and are currently applied to efficiently alleviate neuropathic pain. PMID:23091942

Pirotte, B

2012-09-01

267

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. PMID:21760950

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.

2011-01-01

268

The influence of children's pain memories on subsequent pain experience.  

PubMed

Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children's reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children's memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children's memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children's expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting. PMID:22560288

Noel, Melanie; Chambers, Christine T; McGrath, Patrick J; Klein, Raymond M; Stewart, Sherry H

2012-08-01

269

An Introduction Significance of Pain  

E-print Network

and chronic pain. Because animals cannot verbally report on their pain, this state must be inferred using become sensitized (hyperalgesic) for the duration of an injury #12;Pathological Pain - Chronic Pain Inflammation or nerve damage !!65 -90 million in US !!Arthritis !!Neuropathic pain !!Back pain !!Migraine

Meagher, Mary

270

Ethnic differences in pain and pain management  

PubMed Central

SUMMARY Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers’ treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes. PMID:23687518

Campbell, Claudia M; Edwards, Robert R

2012-01-01

271

Greater trochanteric hip pain.  

PubMed

In the patient with lateral hip pain, there is a broad differential diagnosis, making appropriate evaluation and management challenging. Greater trochanteric pain syndrome is a term used to denote chronic lateral hip pain and encompasses several painful soft tissue diagnoses including coxa saltans, trochanteric bursitis, and gluteus minimus and medius tendon tears. An overview of these common causes is presented through a series of cases that encompass the anatomic associations, classic presentations, diagnostic tests, and management strategies unique to each disorder. By reviewing this information, we hope to provide clinicians with the tools to evaluate greater trochanteric pain syndrome efficiently and effectively. PMID:24651142

Kimpel, Diane M; Garner, Chadwick C; Magone, Kevin M; May, Jedediah H; Lawless, Matthew W

2014-01-01

272

Unrelieved pain: A crisis  

PubMed Central

Despite many recent advances in the past 40 years in the understanding of pain mechanisms, and in pain diagnosis and management, considerable gaps in knowledge remain, with chronic pain present in epidemic proportions in most countries. It is often unrelieved and is associated with significant socioeconomic burdens. Several opportunities and approaches to address this crisis are identified in the present article. Most crucial is the need to increase pain awareness, enhance pain education, improve access to pain care and increase pain research resources. Given the variability among countries in health care policies and programs, resources and educational programs, many of the approaches and strategies outlined will need to be tailored to each country’s socioeconomic and educational situation. PMID:22184550

Sessle, Barry J

2011-01-01

273

[Pain in nursing homes].  

PubMed

Elderly live in nursing homes if the necessary need for care cannot be realized in the home care setting. Dementia syndrome (60?% of nursing home residents) has a prominent role. Pain is a frequent problem in nursing homes, affecting functionality and quality of life. Studies often show inadequate pain therapy. Not only is the presentation of pain often atypical, but pharmacological and invasive pain therapy is limited by multimorbidity and increased risk of side effects. Nonpharmacological pain therapy is part of nursing therapy; however, the effect on nursing home residents has been insufficiently studied. This situation necessitates interprofessional coordination of all team members, in which the nursing pain assessment and the realization of both pharmacological and nonpharmacological pain therapy are very important. PMID:25701275

Nestler, N; Gnass, I; Schuler, M

2015-02-01

274

Common medical pains  

PubMed Central

Pain in infancy and childhood is extremely common. Sources of pain include illness, injury, and medical and dental procedures. Over the past two decades, tremendous progress has been made in the assessment, prevention and treatment of pain. It is important for the paediatric health care provider to be aware of the implications and consequences of pain in childhood. A multitude of interventions are available to reduce or alleviate pain in children of all ages, including neonates. These include behavioural and psychological methods, as well as a host of pharmacological preparations, which are safe and effective when used as indicated. Many complementary and alternative treatments appear to be promising in treating and relieving pain, although further research is required. The present article reviews the most common sources of pain in childhood and infancy, as well as current treatment strategies and options. PMID:19030348

Jacobson, Sheila

2007-01-01

275

Pain syndromes in children.  

PubMed

The pediatric rheumatologist cares for children who may have a wide variety of causes of musculoskeletal pain. These include such diverse conditions as arthritis, low-back pain, hypermobility, metabolic bone pain, and amplified pain syndromes such as complex regional pain syndrome and fibromyalgia. This review examines the recent literature on these and other conditions causing musculoskeletal pain in children and adolescents. Overall, headway is being made, but differentiating soma from psyche remains a problem. This is perhaps due to the marked and unique effect pain brings to each of us. Children are different from adults in causes, presentations, and outcome. Vigilance in history, physical examination, and judicious use of laboratory investigations are usually sufficient in establishing a diagnosis, as well as an appreciation for the variety of presentations each condition can manifest. PMID:11123080

Sherry, D D

2000-08-01

276

An equine pain face  

PubMed Central

Objective The objective of this study was to investigate the existence of an equine pain face and to describe this in detail. Study design Semi-randomized, controlled, crossover trial. Animals Six adult horses. Methods Pain was induced with two noxious stimuli, a tourniquet on the antebrachium and topical application of capsaicin. All horses participated in two control trials and received both noxious stimuli twice, once with and once without an observer present. During all sessions their pain state was scored. The horses were filmed and the close-up video recordings of the faces were analysed for alterations in behaviour and facial expressions. Still images from the trials were evaluated for the presence of each of the specific pain face features identified from the video analysis. Results Both noxious challenges were effective in producing a pain response resulting in significantly increased pain scores. Alterations in facial expressions were observed in all horses during all noxious stimulations. The number of pain face features present on the still images from the noxious challenges were significantly higher than for the control trial (p = 0.0001). Facial expressions representative for control and pain trials were condensed into explanatory illustrations. During pain sessions with an observer present, the horses increased their contact-seeking behavior. Conclusions and clinical relevance An equine pain face comprising ‘low’ and/or ‘asymmetrical’ ears, an angled appearance of the eyes, a withdrawn and/or tense stare, mediolaterally dilated nostrils and tension of the lips, chin and certain facial muscles can be recognized in horses during induced acute pain. This description of an equine pain face may be useful for improving tools for pain recognition in horses with mild to moderate pain. PMID:25082060

Gleerup, Karina B; Forkman, Björn; Lindegaard, Casper; Andersen, Pia H

2015-01-01

277

Interdigital dermatitis, heel horn erosion, and digital dermatitis in 14 Norwegian dairy herds.  

PubMed

The aim of this study was to assess infectious foot diseases, including identification and characterization of Dichelobacter nodosus and Treponema spp., in herds having problems with interdigital dermatitis (ID) and heel horn erosion (E) and in control herds expected to have few problems. We also wanted to compare diseased and healthy cows in all herds. The study included 14 dairy herds with a total of 633 cows. Eight herds had a history of ID and E, and 6 were control herds. All cows were scored for lameness, and infectious foot diseases on the hind feet were recorded after trimming. Swabs and biopsies were taken from the skin of 10 cows in each herd for bacterial analyses. In total, samples were taken from 34 cows with ID, 11 with E, 40 with both ID and E, and 8 with digital dermatitis (DD), and from 47 cows with healthy feet. Swabs were analyzed for identification and characterization of D. nodosus by PCR, culture, virulence testing, and serotyping. Biopsies were analyzed by fluorescent in situ hybridization regarding histopathology, identification, and characterization of Treponema spp., and identification of D. nodosus. Interdigital dermatitis was the most frequent foot disease, with a prevalence of 50.4% in problem herds compared with 26.8% in control herds. Heel horn erosion was recorded in 34.8% of the cows in problem herds compared with 22.1% in control herds. Dichelobacter nodosus was detected in 97.1% of the cows with ID, in 36.4% with E, in all cows with both ID and E, in all cows with DD, and in 66.0% of cows with healthy feet. All serogroups of D. nodosus except F and M were detected, and all isolates were defined as benign by the gelatin gel test. Treponema spp. were detected in 50.0% of the cows with ID, in 9.1% with E, in 67.5% with ID and E, in all cows with DD, and in 6.4% of those with healthy feet. In total, 6 previously described phylotypes (PT) of Treponema were detected: PT1, PT3, PT6, PT13, and PT15 in cows with ID, PT1 in a cow with E, and PT1, PT2, PT3, PT6, and PT13 in cows with both ID and E. One new phylotype (PT19) was identified. The epidermal damage score was higher but the difference in inflammatory response of the dermis was minor in cows with ID versus those with healthy feet. Fisher's exact test revealed an association between ID and D. nodosus, and between ID and Treponema spp. Logistic regression revealed an association between both ID and E and dirty claws (odds ratios=1.9 and 2.0, respectively). Our study indicates that D. nodosus, Treponema spp., and hygiene are involved in the pathogenesis of ID. PMID:24140335

Knappe-Poindecker, M; Gilhuus, M; Jensen, T K; Klitgaard, K; Larssen, R B; Fjeldaas, T

2013-12-01

278

Effects of therapeutic massage on gait and pain after delayed onset muscle soreness  

PubMed Central

Unfamiliar or sudden exercise can induce delayed onset muscle soreness (DOMS) within 12–24 h. So, several researchers have reported various interventions to treat DOMS. Massage is generally known to eliminate muscle fatigue. However, effect of massage after DOMS is still not clear. We investigated whether the massage is effective on pain and gait after DOMS. The participants were divided into a control group (n= 10) with DOMS and an experimental group (n= 11) with the massage treated after DOMS. We induced DOMS by taking isotonic exercise with going up and down 20 times in 5-story building. We applied the massage and assessment on gastrocnemius of dominant foot. The change of gait and pain was assessed using gaitrite and algometer. In the present results, the massage on gastrocnemius after DOMS showed significant difference in pain (P< 0.05). Also, there was a significant difference in gait (P< 0.05), especially, spatial parameters (distance, step length, stride length) and temporal parameters (ambulation, heel on off time, stride velocity). Moreover, the pain relief after massage-treated in DOMS correlated with gait. These results suggest that the massage on gastrocnemius after DOMS has influence on pain and gait performance. Therefore, massage can be applied as intervention for delayed onset muscle soreness. PMID:24877051

Han, Jun-Ho; Kim, Min-Jeong; Yang, Hyuk-Jin; Lee, Yu-Jin; Sung, Yun-Hee

2014-01-01

279

Chronic pain: lost inhibition?  

PubMed

Human brain imaging has revealed that acute pain results from activation of a network of brain regions, including the somatosensory, insular, prefrontal, and cingulate cortices. In contrast, many investigations report little or no alteration in brain activity associated with chronic pain, particularly neuropathic pain. It has been hypothesized that neuropathic pain results from misinterpretation of thalamocortical activity, and recent evidence has revealed altered thalamocortical rhythm in individuals with neuropathic pain. Indeed, it was suggested nearly four decades ago that neuropathic pain may be maintained by a discrete central generator, possibly within the thalamus. In this investigation, we used multiple brain imaging techniques to explore central changes in subjects with neuropathic pain of the trigeminal nerve resulting in most cases (20 of 23) from a surgical event. Individuals with chronic neuropathic pain displayed significant somatosensory thalamus volume loss (voxel-based morphometry) which was associated with decreased thalamic reticular nucleus and primary somatosensory cortex activity (quantitative arterial spin labeling). Furthermore, thalamic inhibitory neurotransmitter content was significantly reduced (magnetic resonance spectroscopy), which was significantly correlated to the degree of functional connectivity between the somatosensory thalamus and cortical regions including the primary and secondary somatosensory cortices, anterior insula, and cerebellar cortex. These data suggest that chronic neuropathic pain is associated with altered thalamic anatomy and activity, which may result in disturbed thalamocortical circuits. This disturbed thalamocortical activity may result in the constant perception of pain. PMID:23616562

Henderson, Luke A; Peck, Chris C; Petersen, Esben T; Rae, Caroline D; Youssef, Andrew M; Reeves, Jenna M; Wilcox, Sophie L; Akhter, Rahena; Murray, Greg M; Gustin, Sylvia M

2013-04-24

280

Multiple sclerosis and pain.  

PubMed

Despite the common belief that multiple sclerosis (MS) is a painless disease, several studies contradict this. There are a significant number of MS patients who actually suffer from painful conditions such as central and peripheral neuropathy, migraines, trigeminal neuralgia, painful tonic spasms, complex regional pain syndrome, glossopharyngeal neuralgia, and transverse myelitis. In addition, MS relapses are usually painful with many patients complaining of paroxysmal dystonia and neuropathic pain during these episodes. Additionally, treatments for MS such as use of beta-interferons may be associated with headache and pain at the injection site. The pathophysiology of pain in MS is poorly understood, but may be related to the development of demyelinating lesions involving certain neuroanatomic pathways such as the spinothalamic tract. Management of pain in MS patients is a therapeutic challenge for clinicians. Currently, various pharmacological agents such as antiepielptics, non-steroidal anti-inflammatory agents, and even corticosteroids are used to suppress various painful conditions associated with MS. Non-pharmacological procedures such as massage therapy have also been used in the treatment of MS patients. The authors present a review of recent findings in pathophysiology and management of pain in MS patients. PMID:22909889

Nick, Saeed Talebzadeh; Roberts, Charles; Billiodeaux, Seth; Davis, Debra Elliott; Zamanifekri, Behrouz; Sahraian, Mohammad Ali; Alekseeva, Nadejda; Munjampalli, Sai; Roberts, Joann; Minagar, Alireza

2012-11-01

281

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. PMID:22067541

2012-01-01

282

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

2002-01-01

283

Neonatal pain management  

PubMed Central

The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions. PMID:25538531

Bhalla, Tarun; Shepherd, Ed; Tobias, Joseph D.

2014-01-01

284

[Painful ischemic neuropathy].  

PubMed

Chronic ischemia in patients with peripheral arterial disease (PAD) represents a common medical problem. Neuropathic changes and pain caused by chronic ischemia are often found in the lower extremities of these patients. Pain in patients with chronic critical limb ischemia fulfill the criteria of neuropathic pain. Diagnostic tools besides medical history and examination are questionnaires, quantitative sensory testing (QST) and measuring intraepidermal nerve fiber density (IENFD) when indicated. A pharmacological approach with non-opioids and opioids as well as antidepressive and anticonvulsive drugs (according to the recommendations for the therapy of neuropathic pain) seems to be indicated for treating painful ischemic neuropathy. Spinal cord stimulation (SCS) provides the best evidence for invasive procedures in treating chronic ischemic pain. PMID:25620734

Lang, P M

2015-02-01

285

Pain management in newborns.  

PubMed

As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns. PMID:25459780

Hall, Richard W; Anand, Kanwaljeet J S

2014-12-01

286

Pain management: pharmacological approaches  

Microsoft Academic Search

\\u000a More than three quarters of patients with advanced cancer experience chronic pain that is severe enough to warrant therapy\\u000a with opioid drugs [1,2]. The most prevalent pain syndromes are disease related in adults and treatment related in children\\u000a [3,4]. In adults with metastatic solid tumors, disease-related pains are usually persistent and often progressive, a pattern\\u000a that reflects the limited availability

Russell K. Portenoy; Gerri Frager

287

Pharmacoeconomics of pain management  

Microsoft Academic Search

The economic evaluation of pain management is essential because of its important role in health care. Cost-benefit analysis\\u000a is used to determine which pain management strategies best achieve their objectives despite the scarcity of monetary resources.The\\u000a costs of chronic pain control are expected to increase in the coming years because survival of these patients is improving.There\\u000a are very few economic

Giustino Varrassi; F. Marinangeli; F. Donatelli; D. Beltrutti

1998-01-01

288

[Interventional pain therapy].  

PubMed

Treatment of intractable chronic pain employs, nerve block, peripheral nerve stimulation, phototherapy, and drug therapy such as opioid and analgesia adjuvant. We also employ multi disciplinary approach with internal medicine, psychiatry and other related fields. In addition, in a portion of intractable chronic back pain, the pain relief is obtained by interventional approaches such as adhesionlysis and the neuroplasty with epiduroscopy as well as spinal cord stimulation therapy. PMID:19039964

Hosokawa, Toyoshi

2008-11-01

289

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. PMID:18615140

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

2006-01-01

290

Insufficiency fracture of the calcaneum: Sonographic findings.  

PubMed

We present a case of insufficiency fracture (IF) of the calcaneum diagnosed by sonography (US). An 83-year-old woman consulted because of pain and swelling of the left heel without history of trauma. Standard radiographs showed osteoporosis without fracture. US revealed thickening of the calcaneal periosteum associated with edema of the adjacent soft tissues. Color Doppler imaging showed marked increased vascularity of the periosteum. US changes, together with the clinical and radiographic findings, were consistent with an IF of the calcaneum that was confirmed by MRI. The patient was treated successfully by conservative treatment. In the proper clinical setting, US can suggest the diagnosis of IF of the calcaneum. PMID:19353549

Arni, Delphine; Lambert, Véronique; Delmi, Marino; Bianchi, Stefano

2009-09-01

291

Painful Boney Metastases  

PubMed Central

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.

2013-01-01

292

Athletes' leg pains.  

PubMed Central

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, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. PMID:486888

Orava, S.; Puranen, J.

1979-01-01

293

The neurobiology of pain.  

PubMed

Understanding the plasticity of pain and analgesia exhibited in different pain states may improve therapies for the two major types of pain, neuropathic and inflammatory pain, in which nerve and tissue damage leads to alterations at both peripheral and central levels. At the level of the peripheral nerve, drugs that act on particular sodium channels may target only pain-related activity. Agents that act on some of the peripheral mediators of pain may control peripheral nerve activity. A new generation of non-steroidal anti-inflammatory drugs, cyclo-oxygenase 2 inhibitors, that lack gastric actions are becoming available. In the spinal cord, the release of peptides and glutamate causes activation of multiple receptors, particularly, the N-methyl-D-aspartate receptor for glutamate, which, in concert with other spinal systems, generates spinal hypersensitivity. Blocking the generation of excitability is one approach, but increasing inhibitions may also provide analgesia. Opioid actions are via presynaptic and post-synaptic inhibitory effects on central and peripheral C fibre terminals, spinal neurones, and supraspinal mechanisms. Our knowledge of brain mechanisms of pain is still, however, limited. Other new targets have been revealed by molecular biology and animal models of clinical pain, but the possibility of a "magic bullet" is doubtful. Thus, another approach could be single molecules with dual drug actions, that encompass targets where additive or synergistic effects of different mechanisms may enable pain relief without major adverse effects. PMID:10334274

Besson, J M

1999-05-01

294

SOLID PHASE CHARACTERIZATION OF HEEL SAMPLES FROM TANK 241-C-110  

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.

PAGE JS; COOKE GA; PESTOVICH JA; HUBER HJ

2011-12-01

295

Bats go head-under-heels: the biomechanics of landing on a ceiling.  

PubMed

Bats typically roost head-under-heels but they cannot hover in this position, thus, landing on a ceiling presents a biomechanical challenge. To land, a bat must perform an acrobatic flip that brings the claws of the toes in contact with the ceiling and do so gently enough as to avoid injury to its slender hindlimbs. In the present study, we sought to determine how bats land, to seek a link between landing kinematics and ceiling impact forces, and to determine whether landing strategies vary among bat species. To do this, we measured the kinematics and kinetics of landing behaviour in three species of bats as they landed on a force-measuring platform (Cynopterus brachyotis, N=3; Carollia perspicillata, N=5; Glossophaga soricina, N=5). Kinematics were similar for all bats within a species but differed among species. C. brachyotis performed four-point landings, during which body pitch increased until the ventral surface of the body faced the ceiling and the thumbs and hindlimbs simultaneously grasped the surface. Bats of the other two species performed two-point landings, whereby only the hindlimbs made contact with the ceiling. During these two-point landings, the hindlimbs were drawn up the side of the body to come in contact with the ceiling, causing simultaneous changes in body pitch, roll and yaw over the course of the landing sequence. Right-handed and left-handed forms of the two-point landing were observed, with individuals often switching back and forth between them among landing events. The four-point landing of C. brachyotis resulted in larger peak forces (3.7+/-2.4 body weights; median +/- interquartile range) than the two-point landings of C. perspicillata (0.8+/-0.6 body weights) or G. soricina (0.8+/-0.2 body weights). Our results demonstrate that the kinematics and kinetics of landing vary among bat species and that there is a correlation between the way a bat moves its body when it lands and the magnitude of peak impact force it experiences during that landing. We postulate that these interspecific differences in impact force could result because of stronger selective pressure for gentle landing in cave-roosting (C. perspicillata, G. soricina) versus foliage-roosting (C. brachyotis) species. PMID:19282491

Riskin, Daniel K; Bahlman, Joseph W; Hubel, Tatjana Y; Ratcliffe, John M; Kunz, Thomas H; Swartz, Sharon M

2009-04-01

296

11. Lumbosacral radicular pain.  

PubMed

Lumbosacral radicular pain is characterized by a radiating pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back pain with leg pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic pain. The patient's history may give a suggestion of lumbosacral radicular pain. The best known clinical investigation is the straight-leg raising test. Final diagnosis is made based on a combination of clinical examination and potentially additional tests. Medical imaging studies are indicated to exclude possible serious pathologies and to confirm the affected level in patients suffering lumbosacral radicular pain for longer than 3 months. Magnetic resonance imaging is preferred. Selective diagnostic blocks help confirming the affected level. There is controversy concerning the effectiveness of conservative management (physical therapy, exercise) and pharmacological treatment. When conservative treatment fails, in subacute lumbosacral radicular pain under the level L3 as the result of a contained herniation, transforaminal corticosteroid administration is recommended (2 B+). In chronic lumbosacral radicular pain, (pulsed) radiofrequency treatment adjacent to the spinal ganglion (DRG) can be considered (2 C+). For refractory lumbosacral radicular pain, adhesiolysis and epiduroscopy can be considered (2 B+/-), preferentially study-related. In patients with a therapy-resistant radicular pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers. PMID:20492580

Van Boxem, Koen; Cheng, Jianguo; Patijn, Jacob; van Kleef, Maarten; Lataster, Arno; Mekhail, Nagy; Van Zundert, Jan

2010-01-01

297

Preliminary study report: topological texture features extracted from standard radiographs of the heel bone are correlated with femoral bone mineral density  

NASA Astrophysics Data System (ADS)

With the growing number of eldery patients in industrialized nations the incidence of geriatric, i.e. osteoporotic fractures is steadily on the rise. It is of great importance to understand the characteristics of hip fractures and to provide diagnostic tests for the assessment of an individual's fracture-risk that allow to take preventive action and give therapeutic advice. At present, bone-mineral-density (BMD) obtained from DXA (dual-energy x-ray-absorptiometry) is the clinical standard of reference for diagnosis and follow-up of osteoporosis. Since availability of DXA - other than that of clinical X-ray imaging - is usually restricted to specialized medical centers it is worth trying to implement alternative methods to estimate an individual's BMD. Radiographs of the peripheral skeleton, e.g. the ankle, range among the most ordered diagnostic procedures in surgery for exclusion or confirmation of fracture. It would be highly beneficial if - as a by-product of conventional imaging - one could obtain a quantitative parameter that is closely correlated with femoral BMD in addition to the original diagnostic information, e.g. fracture status at the peripheral site. Previous studies could demonstrate a correlation between calcaneal BMD and osteoporosis. The objective of our study was to test the hypothesis that topological analysis of calcaneal bone texture depicted by a lateral x-ray projection of the ankle allows to estimate femoral BMD. Our analysis on 34 post-menopausal patients indicate that texture properties based on graylevel topology in calcaneal x-ray-films are closely correlated with BMD at the hip and may qualify as a substitute indicator of femoral fracture risk.

Boehm, H. F.; Lutz, J.; Koerner, M.; Notohamiprodjo, M.; Reiser, M.

2009-02-01

298

Nurses' use of water-filled gloves in preventing heel pressure ulcer in the University College Hospital, Ibadan, Nigeria.  

PubMed

This cross-sectional descriptive survey examined use (knowledge, perception and practices) of water-filled gloves (WFGs) by nurses in the prevention of heel pressure ulcer (PU) in the University College Hospital (UCH), Ibadan, Nigeria. Participants were 250 purposively selected nurses working in the Neurosciences and Surgical units. Quantitative data were generated through the administration of a semi-structured questionnaire, whereas the qualitative data were collected through in-depth interview. Hypotheses were tested using chi-square analysis at a significance level of 0.05, whereas the manual content analysis was used to analyse the qualitative data. Results showed that a significant number of nurses at UCH, Ibadan, were knowledgeable about WFGs and actually used them in their clinical practice. Years of experience in clinical practice was found to be significantly related to knowledge and use of WFGs in heel PU (X(2) = 41·677; DF = 5; P = 0·001). Nurses with adequate knowledge of risk factors in the development of PU used WFGs more than those who were not aware (X(2) = 44·907; DF = 3; P = 0·009). Nurses' perception about WFGs was also significantly related to its use (X(2) = 4·527; DF = 1; P = 0·033). Although knowledge level and perception of WFGs and its use by nurses was fairly adequate, continuous education for practicing nurses should be encouraged in resource-limited settings. PMID:21073682

Adejumo, Prisca Olabisi; Ingwu, Justin Agorye

2010-12-01

299

[Pain management in urology].  

PubMed

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

2013-04-01

300

Genetics and pain.  

PubMed

Progress in our understanding of the roles of genetics in pain and its management is described. New techniques are discussed, along with some potential uses of gene therapy. Relative gene expression, polymorphisms, and specific genes that influence interindividual responses to pharmacotherapy for pain are described. PMID:19042855

Persson, Elise; Rhodin, Annica

2008-01-01

301

Hypnosis and Clinical Pain  

Microsoft Academic Search

Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute

David R. Patterson; Mark P. Jensen

2003-01-01

302

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

1979-01-01

303

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

1999-01-01

304

Lower Back Pain  

MedlinePLUS

... or injury or when you lifted an object? No Go to Question 5.* Yes 2. Do you have numbness or pain extending ... pain. No 6. Do you have a fever? No Go to Question 8.** Yes 7. Do you have blood in your urine ...

305

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

1986-01-01

306

Painful and painless channelopathies.  

PubMed

The discovery of genetic variants that substantially alter an individual's perception of pain has led to a step-change in our understanding of molecular events underlying the detection and transmission of noxious stimuli by the peripheral nervous system. For example, the voltage-gated sodium ion channel Nav1.7 is expressed selectively in sensory and autonomic neurons; inactivating mutations in SCN9A, which encodes Nav1.7, result in congenital insensitivity to pain, whereas gain-of-function mutations in this gene produce distinct pain syndromes such as inherited erythromelalgia, paroxysmal extreme pain disorder, and small-fibre neuropathy. Heterozygous mutations in TRPA1, which encodes the transient receptor potential cation channel, can cause familial episodic pain syndromes, and variants of genes coding for the voltage-gated sodium channels Nav1.8 (SCN10A) and Nav1.9 (SCN11A) lead to small-fibre neuropathy and congenital insensitivity to pain, respectively. Furthermore, other genetic polymorphisms have been identified that contribute to risk or severity of more complex pain phenotypes. Novel models of sensory disorders are in development-eg, using human sensory neurons differentiated from human induced pluripotent stem cells. Understanding rare heritable pain disorders not only improves diagnosis and treatment of patients but may also reveal new targets for analgesic drug development. PMID:24813307

Bennett, David L H; Woods, C Geoffrey

2014-06-01

307

INTERVENTIONAL PAIN FOR MORE INFORMATION  

E-print Network

INTERVENTIONAL PAIN FOR MORE INFORMATION Sinead Irvine, Event Coordinator Continuing Health experience in interventional pain management. The diagnostic and therapeutic approach to the patient suffering from chronic low back and neck pain will be reviewed. The technical skills of common

Haykin, Simon

308

Taking narcotics for back pain  

MedlinePLUS

Narcotics are strong drugs that are sometimes used to treat pain. They are also called opioids. You ... types of pain medicine do not relieve pain. Narcotics can provide short-term relief of severe back ...

309

Complex Regional Pain Syndrome (CPRS)  

MedlinePLUS

... Find a Hand Surgeon Complex Regional Pain Syndrome - CRPS Email to a friend * required fields From * To * ... Reflex Sympathetic Dystrophy (RSD) Complex regional pain syndrome (CRPS) is a pain condition that is constant over ...

310

Physiology of Chronic Pain  

Microsoft Academic Search

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Dawn A. Marcus

311

Musculoskeletal chest wall pain  

PubMed Central

The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804

Fam, Adel G.; Smythe, Hugh A.

1985-01-01

312

Postoperative pain management  

PubMed Central

Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesia-related complications or side effects. PMID:25774311

Kolettas, Alexandros; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Lampaki, Sofia; Karavergou, Anastasia; Pataka, Athanasia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Fassiadis, Nikolaos; Zarogoulidis, Konstantinos

2015-01-01

313

Pain and thyroid hormones.  

PubMed

The role of endocrine systems in chronic pain mechanisms is slowly getting increasing experimental and clinical consideration. Many painful conditions appear to be directly and/or indirectly induced, reduced or, in some cases, modulated by hormones. We have done much work in trying to understand the relationship between hormones and pain, with particular attention to the hypothalamus-pituitary-gonadal axis. To expand our knowledge of this field, we have directed our attention to another axis, the hypothalamus-pituitary-thyroid (HPT). The literature on thyroid functions is vast but very few studies have focused on the HPT axis and pain. The few available data are considered in the present review to stimulate interest in the possible interactions between the HPT axis and pain. PMID:23609461

Aloisi, Anna Maria; Vodo, Stella; Buonocore, Michelangelo

2013-09-01

314

Gender role expectations of pain: relationship to experimental pain perception  

PubMed Central

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 (VAS) rating of pain intensity during the procedure. Subjects completed the GREP questionnaire to assess sex-related stereotypic attributions of pain sensitivity, pain endurance, and willingness to report pain. Consistent with previous research, significant sex differences emerged for measures of pain threshold, pain tolerance, and pain unpleasantness. After statistically controlling for age, GREP scores were significant predictors of threshold, tolerance, and pain unpleasantness, accounting for an additional 7, 11, and 21% of the variance, respectively. Sex remained a significant predictor of pain tolerance in hierarchical regression analyses after controlling for GREP scores. Results provide support for two competing but not mutually exclusive hypotheses related to the sex differences in experimental pain. Both psychosocial factors and first-order, biological sex differences remain as viable explanations for differences in experimental pain report between the sexes. It appears that GREP do play a part in determining an individual’s pain report and may be contributing to the sex differences in the laboratory setting. PMID:11973007

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

2008-01-01

315

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

2000-01-01

316

[Multimodal pain therapy].  

PubMed

Chronic pain has both high prevalence and a significant economic impact in Germany. The most common chronic pain types are low back pain and headache. On the one hand, the management of chronic pain patients is incomplete, yet it is often overtreated in orthopaedic surgical settings with interventional procedures. The reason for this is the structure of outpatient management and the way it is paid for in Germany. Pain management of patients with private insurance cover is no better because of "doctor shopping". Medical guidelines could be of some help in improving the situation, but they are widely unknown, and have still to demonstrate whether they have any impact on GP treatment pathways. The "gold standard" multimodal pain therapy shows significant improvement in many studies compared to monomodal therapy regimes and interventional regimes, but is too rarely recommended by the patients' physicians, whether GPs or specialists. Because of the huge number of institutions nowadays that, for the sake of form, offer such multimodal therapies, these need to be differentiated in terms of their structural and process quality. A first step is the "k edoq" project. It is essential to improve knowledge of the principles of modern pain management. This includes better networking and communication between doctors, physiotherapists and psychologists, and at the grassroots level, providing the public with more detailed and better information. PMID:25000627

Böger, A

2014-06-01

317

Neuropathic pain in cancer.  

PubMed

Unrelieved neuropathic pain continues to be a substantial health problem in a cancer patient arises either due to disease itself or its treatment. Review of literature showed that neuropathic pain has high prevalence rate, greater severity and analgesic requirement with worse quality of life. Underreporting by patient and under treatment by physician is an important causative factor of indefinite persistence of neuropathic pain. Careful history taking, elaborated physical examination, patient's self report and diagnostic tools with high sensitivity and specificity are needed for accurate assessment of neuropathic pain. Neuropathic cancer pain is difficult to treat and also shows poor response to opioids so in this situation alternate a treatment strategy that also includes psycosocial and spiritual counseling with yoga and meditation exercises under the palliative care framework should be practiced. To find out the burden and estimation of resource generation of this widely recognized problem, accurate establishment of incidence, prevalence, severity, and effectiveness of treatment is quite mandatory. Complex phenomenon of neuropathic pain abolishes establishment of early diagnosis and accurate etiology of this symptom, emphasizes the need of sensitive and reliable clinical grading scale, international classification system and validated diagnostic tools that correspond with clinical assessment. Multiple studies towards this direction has been culminated and some are still going on, though the data and literature is very scant and require further research for the complete evaluation of neuropathic pain. PMID:25841479

Goyal, Alka; Bhatnagar, Sushma

2014-01-01

318

The relationship of gender to pain  

Microsoft Academic Search

Gender differences have been identified in the perception of pain intensity for both acute and chronic pain and with responses to analgesics. Women seem to show lower pain thresholds, a greater ability to discriminate painful sensations, higher pain ratings, and a lower tolerance for pain. Although some pain syndromes, such as facial pain, are more common in women, gender-related responses

April Hazard Vallerand; Rosemary C. Polomano

2000-01-01

319

Painful neuropathy: Mechanisms.  

PubMed

Painful neuropathy, like the other complications of diabetes, is a growing healthcare concern. Unfortunately, current treatments are of variable efficacy and do not target underlying pathogenic mechanisms, in part because these mechanisms are not well defined. Rat and mouse models of type 1 diabetes are frequently used to study diabetic neuropathy, with rats in particular being consistently reported to show allodynia and hyperalgesia. Models of type 2 diabetes are being used with increasing frequency, but the current literature on the progression of indices of neuropathic pain is variable and relatively few therapeutics have yet been developed in these models. While evidence for spontaneous pain in rodent models is sparse, measures of evoked mechanical, thermal and chemical pain can provide insight into the pathogenesis of the condition. The stocking and glove distribution of pain tantalizingly suggests that the generator site of neuropathic pain is found within the peripheral nervous system. However, emerging evidence demonstrates that amplification in the spinal cord, via spinal disinhibition and neuroinflammation, and also in the brain, via enhanced thalamic activity or decreased cortical inhibition, likely contribute to the pathogenesis of painful diabetic neuropathy. Several potential therapeutic strategies have emerged from preclinical studies, including prophylactic treatments that intervene against underlying mechanisms of disease, treatments that prevent gains of nociceptive function, treatments that suppress enhancements of nociceptive function, and treatments that impede normal nociceptive mechanisms. Ongoing challenges include unraveling the complexity of underlying pathogenic mechanisms, addressing the potential disconnect between the perceived location of pain and the actual pain generator and amplifier sites, and finding ways to identify which mechanisms operate in specific patients to allow rational and individualized choice of targeted therapies. PMID:25410243

Lee-Kubli, Corinne A; Calcutt, Nigel A

2014-01-01

320

Neuromodulation of cancer pain.  

PubMed

Managing cancer-related chronic pain is challenging to health care professionals as well as cancer patients and survivors. The management of cancer-related pain has largely consisted of pharmacological treatments, which has caused researchers to focus on neurotransmitter activity as a mediator of patients' perception of pain rather than the electrical activity during neurobiological processes of cancer-related pain. Consequently, brain-based pain treatment has focused mainly on neurotransmitters and not electrical neuromodulation. Neuroimaging research has revealed that brain activity is associated with patients' perceptions of symptoms across various diagnoses. The brain modulates internally generated neural activity and adjusts perceptions according to sensory input from the peripheral nervous system. Cancer-related pain may result not only from changes in the peripheral nervous system but also from changes in cortical activity over time. Thus, cortical reorganization by way of the brain's natural, plastic ability (neuroplasticity) may be used to manage pain symptoms. Physical and psychological distress could be modulated by giving patients tools to regulate neural activity in symptom-specific regions of interest. Initial research in nononcology populations suggests that encouraging neuroplasticity through a learning paradigm can be a useful technique to help treat chronic pain. Here we review evidence that indicates a measurable link between brain activity and patient-reported psychological and physical distress. We also summarize findings regarding both the neuroelectrical and neuroanatomical experience of symptoms, review research examining the mechanisms of the brain's ability to modify its own activity, and propose a brain-computer interface as a learning paradigm to augment neuroplasticity for pain management. PMID:23439659

Prinsloo, Sarah; Gabel, Stephanie; Lyle, Randall; Cohen, Lorenzo

2014-01-01

321

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. PMID:18589864

Pacharinsak, Cholawat; Beitz, Alvin

2008-01-01

322

The Painful Face Pain Expression Recognition Using Active Appearance Models  

E-print Network

The Painful Face ­ Pain Expression Recognition Using Active Appearance Models Ahmed Bilal Ashraf-John Theobald ¶ b.theobald@uea.ac.uk ABSTRACT Pain is typically assessed by patient self-report. Self-reported pain, however, is difficult to interpret and may be impaired or not even possible, as in young children

Chen, Tsuhan

323

Low Pain vs No Pain Multi-core Haskells  

E-print Network

Chapter 1 Low Pain vs No Pain Multi-core Haskells M. KH. Aswad , P. W. Trinder, A. D. Al Zain, G. J uses 15 'typical' programs to compare a 'no pain', i.e. entirely implicit, parallel language with three 'low pain', i.e. semi-explicit languages. The parallel Haskell implementations use different versions

Trinder, Phil

324

Comparative Pain Scale 0 No pain. Feeling perfectly normal.  

E-print Network

Comparative Pain Scale 0 No pain. Feeling perfectly normal. Minor Does not interfere with most activities. Able to adapt to pain psychologically and with medication or devices such as cushions. 1 Very Mild Very light barely noticeable pain, like a mosquito bite or a poison ivy itch. Most of the time you

Kay, Mark A.

325

PAIN MEDICINE Neural Correlates of Chronic Low Back Pain Measured  

E-print Network

PAIN MEDICINE Neural Correlates of Chronic Low Back Pain Measured by Arterial Spin Labeling Ajay D.D., Randy L. Gollub, M.D., Ph.D.# ABSTRACT Background: The varying nature of chronic pain (CP) is difficult and radicular pain and matched healthy normal subjects, undergoing identical procedures, participated in three

Napadow, Vitaly

326

Pain measurement in patients with low back pain  

Microsoft Academic Search

Pain is a multidimensional experience that is a prominent feature of many musculoskeletal disorders. Despite its subjective nature, pain is a highly relevant complaint; hence, nothing should deter physicians from attempting to formally assess it. This Review summarizes the main aspects of pain measurement from a practical standpoint, with a specific focus on low back pain. On balance, for the

Federico Balagué; Ferran Pellisé; Christine Cedraschi; Anne F Mannion

2007-01-01

327

Improving paediatric pain management: introducing the 'Pain Passport'.  

PubMed

The 'Pain Passport' is a novel method of improving the management of pain in children. It consists of a leaflet carried by the patient which records serial pain scores. It attempts to empower patients and prompt medical and nursing staff to evaluate the child's pain. Preliminary audit data in support of this concept are encouraging. PMID:22396384

Newstead, Beth A; Armitage, Sarah; Appelboam, Andrew

2013-01-01

328

Nonspecific Arm Pain  

PubMed Central

Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness. PMID:25207288

Moradi, Ali; Ebrahimzadeh, Mohammad H; Ring, David

2013-01-01

329

Large heel soft tissue defects managed successfully with reverse medial crural fasciocutaneous flap: a 7-year single-center experience with 21 consecutive cases.  

PubMed

The medial crural fasciocutaneous flap is a reliable cutaneous flap that can be used for soft tissue reconstruction in the extremities. The purpose of this article is to evaluate the application and clinical significance of this surgical technique in the reconstruction of heel soft tissue defects. Twenty-one cases of heel soft tissue defect between March 2005 and March 2012 were included in this study. Wound sizes varied from 5.0 × 5.5 to 7.5 × 10.0 cm. All cases were managed with a reverse medial crural fasciocutaneous flap. Patient demographics and case information were analyzed and are reported. The sizes of the reverse medial crural fasciocutaneous flap varied from 6.5 × 10.0 to 9.0 × 15.0 cm; the average size was 7.7 × 13.8 cm. Out of the 21 consecutive cases, 20 flaps survived intact and one flap underwent partial necrosis. Follow-up observations were conducted for 6-36 months. The cosmetic results were satisfactory, without apparent bulkiness; the weight-bearing outcomes were satisfactory. The donor site can be closed primarily or by skin graft. Reverse medial crural fasciocutaneous flap transfer is appropriate for the reconstruction of heel soft tissue defects. The method is safe and can cover large heel defects. PMID:25448373

Jing-Chun, Zhao; Kai, Shi; Jia-Ao, Yu; Chun-Jing, Xian; Lai-Jin, Lu; Chun-Hui, Xie

2015-01-01

330

The Daily Tar Heel URL: http://www.dailytarheel.com/index.php/article/2010/09/grant_money_to_help_scholars  

E-print Network

The Daily Tar Heel URL: http://www.dailytarheel.com/index.php/article/2010/09/grant_money_to_help_scholars Current Date: Sun, 26 Sep 2010 13:05:26 -0400 Grant money to help scholars To benefit biomedical students in biology, physics and chemistry, as well as high-level math and applied sciences courses. The grant money

Sekelsky, Jeff

331

Differential diagnosis and treatment of iliotibial band pain secondary to a hypomobile cuboid in a 24-year-old female tri-athlete  

PubMed Central

The purpose of this case report is to relate an episode of movement impairment at the cuboid calcaneal articulation leading to symptoms of iliotibial band (ITB) syndrome. An explanation of the etiology and clinical diagnosis in relation to the differential diagnosis, treatment techniques, and patient outcomes are described. The 24-year-old female tri-athlete reported pain at Gerdy’s tubercle and lateral femoral condyle areas occurring within 2 miles of a run. VAS score was 6/10 for the running activity and the lower extremity functional scale (LEFS) score was 93% (74/80). Over the previous 2 years, the ITB symptoms had failed to resolve with extensive conservative treatment at the knee. On weight bearing, the patient demonstrated pain free limitation of active midtarsal pronation more than supination, which correlated with a decrease in passive internal rotation of the cuboid. Symptoms resolved after one cuboid whip manipulation and the patient was able to run pain free. Post-manipulation treatment consisted of two more sessions, which included motor retraining for weight bearing active midtarsal pronation and supination. LEFS was 100% (80/80) and VAS 0/10 with running greater than 10 miles. While causality cannot be inferred from a single case, this report may foster further investigation regarding the differential diagnosis and treatment of a hypomobile cuboid. PMID:24421625

Brandon, Kristina; Patla, Catherine

2013-01-01

332

Over-the-counter pain relievers  

MedlinePLUS

... Analgesics; Acetaminophen; NSAID; Nonsteroidal anti-inflammatory drug; Pain medicine - over-the-counter; Pain medicine - OTC ... Pain medicines are also called analgesics. Each kind of pain medicine has benefits and risks. Some types of pain ...

333

A decrease in anandamide signaling contributes to the maintenance of cutaneous mechanical hyperalgesia in a model of bone cancer pain  

PubMed Central

Tumors in bone are associated with pain in humans. Data generated in a murine model of bone cancer pain suggests a disturbance of local endocannabinoid signaling contributes to the pain. When tumors formed following injection of osteolytic fibrosarcoma cells into the calcaneous bone of mice, cutaneous mechanical hyperalgesia was associated with a decrease in the level of anandamide (AEA) in plantar paw skin ipsilateral to tumors. The decrease in AEA occurred in conjunction with increased degradation of AEA by fatty acid amide hydrolase (FAAH). Intraplantar injection of AEA reduced the hyperalgesia, and intraplantar injection of URB597, an inhibitor of FAAH, increased the local level of AEA and also reduced hyperalgesia. An increase in FAAH mRNA and enzyme activity in dorsal root ganglia (DRG) L3-L5 ipsilateral to the affected paw suggests DRG neurons contribute to the increased FAAH activity in skin in tumor-bearing mice. Importantly, the anti-hyperalgesic effects of AEA and URB597 were blocked by a CB1 receptor antagonist. Increased expression of CB1 receptors by DRG neurons ipsilateral to tumor-bearing limbs may contribute to the anti-hyperalgesic effect of elevated AEA levels. Furthermore, CB1 receptor protein-immunoreactivity as well as inhibitory effects of AEA and URB597 on the depolarization-evoked Ca2+ transient were increased in small DRG neurons co-cultured with fibrosarcoma cells indicating that fibrosarcoma cells are sufficient to evoke phenotypic changes in AEA signaling in DRG neurons. Together, the data provide evidence that manipulation of peripheral endocannabinoid signaling is a promising strategy for the management of bone cancer pain. PMID:18971457

Khasabova, I.A.; Khasabov, S.G.; Harding-Rose, C.; Coicou, L.G.; Seybold, B.A.; Lindberg, A.E.; Steevens, C.D.; Simone, D.A.; Seybold, V.S.

2008-01-01

334

Complex Regional Pain Syndrome  

MedlinePLUS

... aspartate (NMDA) receptor antagonists such as dextromethorphan and ketamine nasal calcitonin, especially for deep bone pain, and ... involving individuals with acute-phase CRPS is planned. Ketamine . Investigators are using low doses of ketamine—a ...

335

Low Back Pain  

MedlinePLUS

... 30 minutes at a time. Ice packs and massages may also give relief. Nonprescription medicines that reduce pain and/or swelling include aspirin, acetaminophen (brand name: Tylenol), naproxen (brand ...

336

[Greater trochanteric pain syndrome].  

PubMed

Greater trochanteric pain is one of the common complaints in orthopedics. Frequent diagnoses include myofascial pain, trochanteric bursitis, tendinosis and rupture of the gluteus medius and minimus tendon, and external snapping hip. Furthermore, nerve entrapment like the piriformis syndrome must be considered in the differential diagnosis. This article summarizes essential diagnostic and therapeutic steps in greater trochanteric pain syndrome. Careful clinical evaluation, complemented with specific imaging studies and diagnostic infiltrations allows determination of the underlying pathology in most cases. Thereafter, specific nonsurgical treatment is indicated, with success rates of more than 90?%. Resistant cases and tendon ruptures may require surgical intervention, which can provide significant pain relief and functional improvement in most cases. PMID:24414233

Gollwitzer, H; Opitz, G; Gerdesmeyer, L; Hauschild, M

2014-01-01

337

Greater trochanteric pain syndrome.  

PubMed

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

2013-02-01

338

[Pain and bone metastases].  

PubMed

Average 20% of the cancer patients will have bone metastasis most of time painful and with variable clinical expressions. Due to animal models, the bone metastasis pain is better known and it explains the different treatments mechanisms. After a suitable evaluation of the pain, several therapeutic approaches can be suggested. In addition to the classical analgesics, several medications are known to be efficient in few indications like neuropathic pain. Besides a local surgery, an external radiotherapy or an interventional radiology treatment can often be useful along with a medical treatment. When there is a bone progression, the anti-cancer treatment by chemotherapy, hormonotherapy or targeted therapies must always be reviewed, because if efficient it could have an analgesic action. PMID:19070823

Wassermann, J; De La Lande, B; Pecking, A; Brasseur, L

2008-11-01

339

Diet and Pain  

MedlinePLUS

... Dietician View full profile Rheumatoid Arthritis: Lifestyle Management Diet and Pain Many people who suffer from chronic ... and risks associated with diet restrictions. Vegan/Vegetarian Diets Vegan/Vegetarian diets are composed predominantly of plant ...

340

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. PMID:17015228

Campbell, James N.; Meyer, Richard A.

2007-01-01

341

Managing pain during labor  

MedlinePLUS

A systemic analgesic is a pain medicine that is injected into your vein or muscle. This medicine acts on your entire ... away, but it will be dulled. With systemic analgesics, some women have an easier labor and feel ...

342

Employees with Chronic Pain  

MedlinePLUS

Accommodation and Compliance Series: Employees with Chronic Pain By Beth Loy, Ph.D. Preface Introduction Information About Americans with Disabilities Act Accommodating Employees Resources References PDF Version DOC Version Share Introduction ...

343

Chronic Pelvic Pain  

MedlinePLUS

... Us Sign In AAPM&R - American Academy of Physical Medicine and Rehabilitation Physicians Adding Quality to Life ® AAPM& ... pelvic pain, too What you can do: A physical medicine and rehabilitation physician (physiatrist) can evaluate you for ...

344

Complex Regional Pain Syndrome  

MedlinePLUS

... an important role in sustaining the pain. Another theory is that CRPS is caused by a triggering ... de Dolor Regional Complejo Prepared by: Office of Communications and Public Liaison National Institute of Neurological Disorders ...

345

Low Back Pain  

MedlinePLUS

... rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the ... the back of the leg. This compression causes shock-like or burning low back pain combined with ...

346

Complex regional pain syndrome  

MedlinePLUS

CRPS; RSDS; Causalgia - RSD; Shoulder-hand syndrome; Reflex sympathetic dystrophy syndrome; Sudeck atrophy ... Doctors are not sure what causes CRPS. In some cases, the sympathetic ... role in the pain. Another theory is that CRPS is caused by ...

347

Block That Pain!  

MedlinePLUS

... 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 ...

348

Pain following spinal cord injury  

Microsoft Academic Search

Chronic pain is an important problem following spinal cord injury (SCI) and is a major impediment to effective rehabilitation. The reported prevalence of chronic SCI pain is variable but averages 65% with around one third of these people rating their pain as severe. The mechanisms responsible for the presence of pain are poorly understood. However, evidence from clinical observations and

PJ Siddall; JD Loeser

2001-01-01

349

Male Infant Circumcision Pain Management  

Microsoft Academic Search

The American Society for Pain Management Nursing (ASPMN) holds the position that nurses and other healthcare professionals must provide optimal pain management throughout the circumcision process for male infants. Parents must be prepared for the procedure and educated about infant pain assessment. They must also be informed about pharmacologic and integrative pain management therapies.

Susan O'Conner-Von; Helen N. Turner

350

Pain Assessment for Older Adults  

Microsoft Academic Search

WHY: Studies on pain in older adults (persons 65 years of age and older) have demonstrated that 25%-50% of community dwelling older people have persistent pain. Additionally, 45-80% of nursing home residents report pain that is often left untreated. Pain is strongly associated with depression and can result in decreased socialization, impaired ambulation and increased healthcare utilization and costs. Older

Ellen Flaherty

351

Complex regional pain syndrome  

Microsoft Academic Search

Opinion statement  Complex regional pain syndrome (CRPS) is a heterogeneous disorder that falls in the spectrum of neuropathic pain disorders.\\u000a It is maintained by abnormalities throughout the neuraxis (the peripheral, autonomic, and central nervous systems). The pathophysiology\\u000a of CRPS is not fully known. There are no scientifically well-established treatments. The diagnostic criteria for CRPS at this\\u000a time are purely clinical, and

Ok Yung Chung; Stephen P. Bruehl

2003-01-01

352

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

2001-01-01

353

God and animal pain  

Microsoft Academic Search

It seems that animal pain is an obstacle to belief in a good God, though Christianity has not been much concerned with the\\u000a issue. A systemic approach to pain is not a complete answer, nor is there any merit in denying that God is subject to moral\\u000a appraisal. Marilyn McCord Adams recommends that such investigations be located in the specifics

Brian Scarlett

2003-01-01

354

Biologic poisons for pain  

Microsoft Academic Search

Pain therapies from natural sources date back thousands of years to the use of plant and animal extracts for a variety of\\u000a painful conditions and injuries. We certainly are all familiar with modern uses of plant-derived analgesic compounds such\\u000a as opium derivatives from papaverum somniferum and salicylates from willow bark (Salix species). Local anesthetics were isolated\\u000a from coca leaves in

Lori Reisner

2004-01-01

355

Pain in osteochondral lesions.  

PubMed

Pain is the key symptom of patients suffering from osteochondral lesions (OCLs) of the ankle joint. Routine radiographic imaging methods for diagnosis and staging of OCL fail to visualize the pain-inducing focus within the joint. SPECT-CT (Single-photon emission computed tomography-computed tomography) is a new hybrid imaging technique allowing exact digital fusion of scintigraphic and computer tomographic images. This allows precise localization and size determination of an OCL within the joint. Using this novel imaging method, we conducted a study to evaluate the correlation between pathological uptake within an OCL and pain experienced by patients suffering from this condition; 15 patients were assessed in the orthopaedic ambulatory clinic for unilateral OCL of the ankle joint. Pain status was measured with the Visual Analogue Scale (VAS). A SPECT-CT was performed. All patients underwent CT-guided ankle injection with a local anesthetic and iodine contrast medium. The VAS score assessed immediately postinfiltration was compared with the preinterventional VAS score obtained in the outpatient clinic. Pain relief was defined as a reduction of the VAS score to ?50% of the preinterventional score, if expected immediately after infiltration. Pain relief was found in all 15 patients. The results of our study show that there is a highly significant correlation between pain and pathological uptake seen on SPECT-CT, indicating that pathologically remodeled bone tissue is an important contributor to pain in OCL. Adequate addressing of involved bone tissue needs to be taken into consideration when choosing a surgical treatment method. PMID:21321364

Wiewiorski, Martin; Pagenstert, Geert; Rasch, Helmut; Jacob, Augustinus Ludwig; Valderrabano, Victor

2011-04-01

356

Low Back Pain  

PubMed Central

Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention. PMID:2930949

Reuler, James B.

1985-01-01

357

Management of Foot Pain  

PubMed Central

This paper deals chiefly with the young adult foot, the older adult foot, and pain of mechanical origin. It does not discuss treatment by surgical methods, but rather by the use of exercises, foot supports and shoe corrections. Foot pain resulting from mechanical disorders can be treated effectively by determination of the biomechanical causative factors, usually by simple physical examination. Relief can often be gained with simple mechanical devices, provided at low cost. ImagesFigure 1Figure 2Figure 4 PMID:21263862

Godfrey, Charles M.

1987-01-01

358

Tonsillolithiasis and orofacial pain.  

PubMed

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

2012-06-01

359

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.

1998-09-01

360

Evaluation of Pain in Healthy Newborns and in Newborns with Developmental Problems (Down Syndrome).  

PubMed

Newborns are often subjected to invasive and painful medical procedures. This happens even more frequently when they require hospitalization. The aim of this paper was to evaluate pain in healthy newborns and in newborns with Down syndrome (DS). We performed a prospective cohort study in the neonatal service of the San Cecilio University Hospital in Granada (Spain) from January 2008 to September 2013. The universe of our study comprised a study group of 20 newborns with DS and a control group of 20 newborns without DS. All of the infants were hospitalized, and thus had to undergo painful medical procedures. The variables studied were basal recovery time (as reflected in crying and the normalization of biological constants), number of punctures, oxygen saturation, heartbeat, blood pressure, response to skin-to-skin contact, and gestational age. The evaluation was performed during blood extraction, vein canalization, and heel puncture. The significant differences in the basal recovery time between the two groups of newborns indicated that those with DS were slower to express pain, and when they did, their response was not as clearly defined as that of babies without DS. The oxygen saturation in babies with DS after the puncture was found to be significantly lower than that of the control group (p < .001). The results of this study revealed that babies with DS were not as quick to perceive pain after a puncture. However, when pain was finally perceived, it persisted for a longer time. This situation should be taken into account in the design of pharmacologic and nonpharmacologic therapies. PMID:25439126

Aguilar Cordero, Maria José; Mur Villar, Norma; García García, Inmaculada

2014-11-01

361

Measurement properties of painDETECT by average pain severity  

PubMed Central

Background Since the burden of neuropathic pain (NeP) increases with pain severity, it is important to characterize and quantify pain severity when identifying NeP patients. This study evaluated whether painDETECT, a screening questionnaire to identify patients with NeP, can distinguish pain severity. Materials and methods Subjects (n=614, 55.4% male, 71.8% white, mean age 55.5 years) with confirmed NeP were identified during office visits to US community-based physicians. The Brief Pain Inventory – Short Form stratified subjects by mild (score 0–3, n=110), moderate (score 4–6, n=297), and severe (score 7–10, n=207) average pain. Scores on the nine-item painDETECT (seven pain-symptom items, one pain-course item, one pain-irradiation item) range from ?1 to 38 (worst NeP); the seven-item painDETECT scores (only pain symptoms) range from 0 to 35. The ability of painDETECT to discriminate average pain-severity levels, based on the average pain item from the Brief Pain Inventory – Short Form (0–10 scale), was evaluated using analysis of variance or covariance models to obtain unadjusted and adjusted (age, sex, race, ethnicity, time since NeP diagnosis, number of comorbidities) mean painDETECT scores. Cumulative distribution functions on painDETECT scores by average pain severity were compared (Kolmogorov–Smirnov test). Cronbach’s alpha assessed internal consistency reliability. Results Unadjusted mean scores were 15.2 for mild, 19.8 for moderate, and 24.0 for severe pain for the nine items, and 14.3, 18.6, and 22.7, respectively, for the seven items. Adjusted nine-item mean scores for mild, moderate, and severe pain were 17.3, 21.3, and 25.3, respectively; adjusted seven-item mean scores were 16.4, 20.1, and 24.0, respectively. All pair-wise comparisons of scores between pain-severity groups showed sizable and statistically significant differences (P<0.0001). Cumulative distribution functions showed distinct separation between severity (P<0.0001). Cronbach’s alphas were 0.76 and 0.80 for the nine- and seven-item scales, respectively. Conclusion This study provides strong psychometric evidence on the validity and reliability of painDETECT for distinguishing average pain severity in patients with NeP. PMID:25395867

Cappelleri, Joseph C; Bienen, E Jay; Koduru, Vijaya; Sadosky, Alesia

2014-01-01

362

Sensitization in patients with painful knee osteoarthritis  

Microsoft Academic Search

Pain is the dominant symptom in osteoarthritis (OA) and sensitization may contribute to the pain severity. This study investigated the role of sensitization in patients with painful knee OA by measuring (1) pressure pain thresholds (PPTs); (2) spreading sensitization; (3) temporal summation to repeated pressure pain stimulation; (4) pain responses after intramuscular hypertonic saline; and (5) pressure pain modulation by

Lars Arendt-Nielsen; Hongling Nie; Mogens B. Laursen; Birgitte S. Laursen; Pascal Madeleine; Ole H. Simonsen; Thomas Graven-Nielsen

2010-01-01

363

Neuropathic pain after dental treatment.  

PubMed

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

2013-01-01

364

Positive Traits Linked to Less Pain through Lower Pain Catastrophizing  

PubMed Central

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

2011-01-01

365

Genetic determinants of heel bone properties: genome-wide association meta-analysis and replication in the GEFOS/GENOMOS consortium.  

PubMed

Quantitative ultrasound of the heel captures heel bone properties that independently predict fracture risk and, with bone mineral density (BMD) assessed by X-ray (DXA), may be convenient alternatives for evaluating osteoporosis and fracture risk. We performed a meta-analysis of genome-wide association (GWA) studies to assess the genetic determinants of heel broadband ultrasound attenuation (BUA; n = 14 260), velocity of sound (VOS; n = 15 514) and BMD (n = 4566) in 13 discovery cohorts. Independent replication involved seven cohorts with GWA data (in silico n = 11 452) and new genotyping in 15 cohorts (de novo n = 24 902). In combined random effects, meta-analysis of the discovery and replication cohorts, nine single nucleotide polymorphisms (SNPs) had genome-wide significant (P < 5 × 10(-8)) associations with heel bone properties. Alongside SNPs within or near previously identified osteoporosis susceptibility genes including ESR1 (6q25.1: rs4869739, rs3020331, rs2982552), SPTBN1 (2p16.2: rs11898505), RSPO3 (6q22.33: rs7741021), WNT16 (7q31.31: rs2908007), DKK1 (10q21.1: rs7902708) and GPATCH1 (19q13.11: rs10416265), we identified a new locus on chromosome 11q14.2 (rs597319 close to TMEM135, a gene recently linked to osteoblastogenesis and longevity) significantly associated with both BUA and VOS (P < 8.23 × 10(-14)). In meta-analyses involving 25 cohorts with up to 14 985 fracture cases, six of 10 SNPs associated with heel bone properties at P < 5 × 10(-6) also had the expected direction of association with any fracture (P < 0.05), including three SNPs with P < 0.005: 6q22.33 (rs7741021), 7q31.31 (rs2908007) and 10q21.1 (rs7902708). In conclusion, this GWA study reveals the effect of several genes common to central DXA-derived BMD and heel ultrasound/DXA measures and points to a new genetic locus with potential implications for better understanding of osteoporosis pathophysiology. PMID:24430505

Moayyeri, Alireza; Hsu, Yi-Hsiang; Karasik, David; Estrada, Karol; Xiao, Su-Mei; Nielson, Carrie; Srikanth, Priya; Giroux, Sylvie; Wilson, Scott G; Zheng, Hou-Feng; Smith, Albert V; Pye, Stephen R; Leo, Paul J; Teumer, Alexander; Hwang, Joo-Yeon; Ohlsson, Claes; McGuigan, Fiona; Minster, Ryan L; Hayward, Caroline; Olmos, José M; Lyytikäinen, Leo-Pekka; Lewis, Joshua R; Swart, Karin M A; Masi, Laura; Oldmeadow, Chris; Holliday, Elizabeth G; Cheng, Sulin; van Schoor, Natasja M; Harvey, Nicholas C; Kruk, Marcin; del Greco M, Fabiola; Igl, Wilmar; Trummer, Olivia; Grigoriou, Efi; Luben, Robert; Liu, Ching-Ti; Zhou, Yanhua; Oei, Ling; Medina-Gomez, Carolina; Zmuda, Joseph; Tranah, Greg; Brown, Suzanne J; Williams, Frances M; Soranzo, Nicole; Jakobsdottir, Johanna; Siggeirsdottir, Kristin; Holliday, Kate L; Hannemann, Anke; Go, Min Jin; Garcia, Melissa; Polasek, Ozren; Laaksonen, Marika; Zhu, Kun; Enneman, Anke W; McEvoy, Mark; Peel, Roseanne; Sham, Pak Chung; Jaworski, Maciej; Johansson, Åsa; Hicks, Andrew A; Pludowski, Pawel; Scott, Rodney; Dhonukshe-Rutten, Rosalie A M; van der Velde, Nathalie; Kähönen, Mika; Viikari, Jorma S; Sievänen, Harri; Raitakari, Olli T; González-Macías, Jesús; Hernández, Jose L; Mellström, Dan; Ljunggren, Osten; Cho, Yoon Shin; Völker, Uwe; Nauck, Matthias; Homuth, Georg; Völzke, Henry; Haring, Robin; Brown, Matthew A; McCloskey, Eugene; Nicholson, Geoffrey C; Eastell, Richard; Eisman, John A; Jones, Graeme; Reid, Ian R; Dennison, Elaine M; Wark, John; Boonen, Steven; Vanderschueren, Dirk; Wu, Frederick C W; Aspelund, Thor; Richards, J Brent; Bauer, Doug; Hofman, Albert; Khaw, Kay-Tee; Dedoussis, George; Obermayer-Pietsch, Barbara; Gyllensten, Ulf; Pramstaller, Peter P; Lorenc, Roman S; Cooper, Cyrus; Kung, Annie Wai Chee; Lips, Paul; Alen, Markku; Attia, John; Brandi, Maria Luisa; de Groot, Lisette C P G M; Lehtimäki, Terho; Riancho, José A; Campbell, Harry; Liu, Yongmei; Harris, Tamara B; Akesson, Kristina; Karlsson, Magnus; Lee, Jong-Young; Wallaschofski, Henri; Duncan, Emma L; O'Neill, Terence W; Gudnason, Vilmundur; Spector, Timothy D; Rousseau, François; Orwoll, Eric; Cummings, Steven R; Wareham, Nick J; Rivadeneira, Fernando; Uitterlinden, Andre G; Prince, Richard L; Kiel, Douglas P; Reeve, Jonathan; Kaptoge, Stephen K

2014-06-01

366

Cognitive behavioral therapy for back pain  

MedlinePLUS

Cognitive behavioral therapy (CBT) can help many people deal with chronic back pain. ... Nonspecific back pain - cognitive behavioral; Backache - chronic - ... - back - chronic - cognitive behavioral; Chronic back pain - low - ...

367

Pain pharmacology: focus on opioids  

PubMed Central

Summary The incidence of chronic pain is estimated to be 20–25% worldwide. Although major improvements in pain control have been obtained, more than 50% of the patients reports inadequate relief. It is accepted that chronic pain, if not adequately and rapidly treated, can become a disease in itself, often intractable and maybe irreversible. This is mainly due to neuroplasticity of pain pathways. In the present review I will discuss about pain depicting the rational for the principal pharmacological interventions and finally focusing on opioids, that represent a primary class of drug to treat pain. PMID:25568646

Fornasari, Diego

2014-01-01

368

[Inflammatory low back pain].  

PubMed

Low back pain is a frequent symptom to consult the general practioner or the osteo-articular specialist. It is important to identify patients with inflammatory back pain (5 to 10 %) because the management and the treatment are different. Spondylarthropathies, especially ankylosing spondylitis (AS) are the most frequently encountered. The inflammatory characteristics of pain give clues for the diagnosis and allow to make appropriate management. Biological tests and imaging from X rays to MRI are used. As therapy is primarily based on NSAID use, in case of unsatifactory response in peripheral arthritis, disease modyfing drugs such as salazopyrine and methotexate (MTX) are used. Anti TNF are used in AS patients unresponsive to previous therapy (infliximab, etanercept, adalimumab) with a response in 50% of the patients. Etanercept is however not indicated in patients with uveitis. PMID:17958023

Peretz, A

2007-09-01

369

Pain Catastrophizing in Youths With Physical Disabilities and Chronic Pain  

PubMed Central

Objective?The current study examined the associations between catastrophizing and pain intensity, psychological adjustment, functional ability, and community participation in youths with physical disability and chronic pain.?Methods?Participants consisted of 80 youths, aged 8–20 years, with cerebral palsy (n = 34), neuromuscular disease (n = 22), or spina bifida (n = 24). Measures from a cross-sectional survey included demographic, pain, and disability information, the Pain Catastrophizing Scale, the Child Health Questionnaire, and the Functional Disability Inventory.?Results?Results suggested that catastrophizing was significantly associated with pain intensity and psychological adjustment; however, catastrophizing did not demonstrate significant associations with functional ability or community participation.?Conclusions?The study extends previous findings of significant associations between catastrophizing and both pain intensity and psychological adjustment to samples of youths with chronic pain and disabilities not previously examined. Further research that examines the causal association between catastrophizing and outcomes in youths with chronic pain and physical disability is warranted. PMID:23033363

Engel, Joyce M.; Wilson, Sylia; Tran, Susan T.; Jensen, Mark P.; Ciol, Marcia A.

2013-01-01

370

Chiropractic and Neck Pain: Conservative Care of Cervical Pain, Injury  

MedlinePLUS

... this flexibility makes the neck very susceptible to pain and injury. The neck’s susceptibility to injury is ... normal aging, and everyday wear and tear. Neck pain can be very bothersome, and it can have ...

371

Schmidt Sting Pain Index  

NSDL National Science Digital Library

This Wikipedia page has the cleanest version of the Schmidt Sting Pain Index I've seen online. Justin O. Schmidt created this index after years of work with Hymenoptera, and relates his vast experience with their venom to a scale that can be understood by all. The page has only a few references, but one of those will take you to Christ Starr's four stage sting pain scale. At the top of the scale are bullet ants, and pepsis wasps, at the bottom are sweat bees and fire ants.

0000-00-00

372

Immunoglobulin Responsive Chronic Pain  

Microsoft Academic Search

Introduction  Over the last 15 years, clinical and experimental data have emerged that suggest that peripheral and central, glial-mediated\\u000a neuroimmune activation is both necessary and sufficient to sustain chronic pain. Immune modulation appears to be, therefore,\\u000a a possible new therapeutic option.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  The Medline database and international trial registry databases were searched using the keywords “intravenous immunoglobulin”\\u000a or “IVIG,” “pain” or

Andreas Goebel

2010-01-01

373

Discogenic pain in acute nonspecific low-back pain  

Microsoft Academic Search

Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral

Hironori Hyodo; Tetsuro Sato; Hirotoshi Sasaki; Yasuhisa Tanaka

2005-01-01

374

Pain perception model of human skin using multiple pain sensors  

Microsoft Academic Search

In the coexistence circumstance with human and robot, sensory and emotional feelings of human should be considered in case of interaction. A typical unpleasant feeling influenced by this interaction is pain. In order to keep this interaction safe between human and robot, the pain sensing will be an important ability for the robot. In this paper, we provide a pain

Aydin Tarik Zengin; Nobutomo Matsunaga; Hiroshi Okajima; Shigeyasu Kawaji

2010-01-01

375

Neonatal pain facial expression: Evaluating the primal face of pain  

Microsoft Academic Search

The primal face of pain (PFP) is postulated to be a common and universal facial expression to pain, hardwired and present at birth. We evaluated its presence by applying a computer-based methodology consisting of “point-pair” comparisons captured from video to measure facial movement in the pain expression by way of change across two images: one image before and one image

Martin Schiavenato; Jacquie F. Byers; Paul Scovanner; James M. McMahon; Yinglin Xia; Naiji Lu; Hua He

2008-01-01

376

Expressing pain: The communication and interpretation of facial pain signals  

Microsoft Academic Search

This article reviews recent theory and research on the origins, nature, and meaning of facial expressions of pain. A general model of pain expression, distinguishing experiential, encoding, and decoding processes involved in pain episodes, is proposed. Variables which are known to or may affect these processes are reviewed. Relationships between elements of the model and clinical phenomena of interest to

Kenneth M. Prkachin; Kenneth D. Craig

1995-01-01

377

Effective pain management in patients with dementia: benefits beyond pain?  

PubMed

This current opinion aims to provide a literature overview of the associations between pain and neuropsychiatric symptoms and the efficacy of pain management for both pain and neuropsychiatric symptoms in patients with dementia. In addition, international guidelines and recommendations for pain management have been collated, and important developing research areas are highlighted. Pain is, in general, under-recognized and undertreated in people with dementia and may therefore trigger or exacerbate neuropsychiatric symptoms. While there is an abundance of pain assessment instruments intended for people with dementia, few have been adequately tested for their feasibility, reliability and validity. In patients with dementia, vocalizations, facial expressions and body movements may be the only valid expressions of pain. Further, pain has been related to the neuropsychiatric symptoms of agitation, aggression, mood syndrome and sleep problems. Unfortunately, health personnel may misinterpret these symptoms as neuropsychiatric symptoms of dementia. A differential assessment of dementia, its presenting neuropsychiatric symptoms and the potential presence of pain is crucial to provide the correct treatment. To achieve this, use of pain assessment tools that are responsive to change and are validated for use in patients with dementia is a prerequisite. To date, there have been few studies, with inconsistent findings on the association between pain and neuropsychiatric symptoms. To ensure a better differential assessment of pain and neuropsychiatric symptoms, and consequently more accurate treatment for patients with dementia, studies with adequate statistical power and high-quality study designs, including randomized controlled trials, are needed. PMID:25373921

Flo, Elisabeth; Gulla, Christine; Husebo, Bettina S

2014-12-01

378

Evaluation of pain management interventions for neonatal circumcision pain  

Microsoft Academic Search

Introduction: The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics (EMLA) on pain responses of neonates undergoing circumcision. Method: A randomized, double-blind experimental design was used with 23 neonates. Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate, respiratory rate, oxygen saturation

Betsy A. Joyce; Juanita F. Keck; Janis Gerkensmeyer

2001-01-01

379

Psychologic interventions for chronic pain.  

PubMed

As a biopsychosocial understanding of chronic pain has become more sophisticated during recent decades, a variety of psychologically based treatment approaches have been developed and empirically validated for helping people better manage their pain. These approaches to pain management have much to offer persons with chronic pain in terms of enhancing quality of life and pain-related coping, as well as reducing disability and pain-related interference with functioning. Although some treatments, like hypnotic analgesia, may require referral to a specialized provider, several of the principles of other psychologically based treatment approaches for pain management (eg, operant behavioral therapy, cognitive-behavioral therapy, motivational interviewing) can easily be integrated into work with persons with pain in a rehabilitation setting. Rehabilitation providers who are interested in incorporating these treatment strategies into their clinical work who do not have prior exposure to these approaches are encouraged to review the suggested references and to seek out related training opportunities. PMID:16616275

Osborne, Travis L; Raichle, Katherine A; Jensen, Mark P

2006-05-01

380

Pain Management and the Amputee  

MedlinePLUS

... Purdue Pharma L.P. A7158 6/03 Pain Management This Fact Sheet provides important—and practical—information ... more information about your condition, treatment, and pain management. Remember: You have a right to ask questions ...

381

Definitions and Types of Pain  

MedlinePLUS

... of pain receptors in either the surface or deep tissues of the body. There are two types: " ... to skin, muscles, bone, joint, and connective tissues. Deep somatic pain is usually described as dull or ...

382

Dyspareunia: Painful Sex for Women  

MedlinePLUS

... part of the genitals can cause pain during sex. Some conditions affect the skin around the vagina. ... types of birth control) does not fit correctly, sex may also be painful. Vaginismus (say: "vag-in- ...

383

Breastfeeding FAQs: Pain and Discomfort  

MedlinePLUS

Breastfeeding FAQs: Pain and Discomfort KidsHealth > Parents > Pregnancy & Newborn Center > Newborn Care > Breastfeeding FAQs: Pain and Discomfort ... have. Is it normal to have cramps while nursing? Yes. During the first few days to weeks ...

384

JAMA Patient Page: Chest Pain  

MedlinePLUS

... have many causes. Pain can come from the heart, lungs, gastrointestinal tract, muscles and bones of the chest ... CAUSES OF CHEST PAIN FOR MORE INFORMATION • National Heart, Lung, and Blood Institute www.nhlbi.nih.gov/health/ • ...

385

Vertebroplasty for Spine Fracture Pain  

MedlinePLUS

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 ...

386

Knee Pain (Beyond the Basics)  

MedlinePLUS

... muscle strain injuries. Over-the-counter acetaminophen or ibuprofen can decrease pain, but should generally not be ... non-prescription pain medication such as acetaminophen (Tylenol), ibuprofen (eg, Advil, Motrin) or naproxen (eg, Aleve) can ...

387

Healthcare disparities in pain management.  

PubMed

Despite efforts targeted at physicians for improving the way in which they manage pain, discrepancies still abound in how they treat certain patients for this condition. Special populations of patients such as racial minorities, women, and substance abusers are victims of deficiencies in pain management and suffer needlessly. Healthcare providers need to be aware of disparities that may not be readily apparent. To provide appropriate care, physicians need to follow pain management guidelines; however, they receive contradictory information on how to treat patients in pain, and they may be apprehensive about prescribing opioids. Recognizing that pain is one of the most frequent reasons a patient may see a physician, it is important to recognize the healthcare disparities in managing pain as well as the barriers to providing appropriate treatment for pain. Only when physicians acknowledge disparities and barriers can they begin to evaluate and improve on their own practices of pain management. PMID:16118357

Paulson, Margaret; Dekker, Anthony H

2005-06-01

388

Overview of Neck Pain  

MedlinePLUS

... broad and general approaches to the treatment of neck pain. The physiatrist that you choose will develop an individual treatment plan for you. As a public service, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) provides listings of its member physiatrists ...

389

PainPsychologist  

Cancer.gov

The Departments of Psychiatry and Anesthesiology, Boston Children’s Hospital are seeking a pediatric psychologist for a full time position in the Pediatric Pain Rehabilitation Center at Boston Children’s Hospital Waltham. This is a primarily clinical position with opportunities to participate in ongoing clinical research within this innovative program and potential to develop independent research projects.

390

Painful bladder: Case studies  

PubMed Central

As part of the program at the 3rd Annual Canadian Urology Forum (2013), participants engaged in interactive discussions of difficult cases throughout the event. The following is a summary of discussions pertaining to two cases illustrating the difficulties in diagnosis and management of bladder pain symptoms. PMID:24523849

Bailly, Greg

2013-01-01

391

Descending control of pain  

Microsoft Academic Search

Upon receipt in the dorsal horn (DH) of the spinal cord, nociceptive (pain-signalling) information from the viscera, skin and other organs is subject to extensive processing by a diversity of mechanisms, certain of which enhance, and certain of which inhibit, its transfer to higher centres. In this regard, a network of descending pathways projecting from cerebral structures to the DH

Mark J. Millan

2002-01-01

392

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; )

2004-02-20

393

Interview with Robert Paine  

E-print Network

Robert Paine reviews his life as an anthropologist - his training and fieldwork with the Saami nomands of Norway in the 1950's; the inception of the Anthropology Department at Bergen and his later move to St John's Newfoundland; themes of welfare...

Paine, Robert; Vitebsky, Piers; Jacobs, Julian

2004-08-23

394

Pain in Neonatal Circumcision  

Microsoft Academic Search

Because newborn circumcision is a quick and safe surgical procedure, any method to relieve pain must be almost risk-free in order to be acceptable. General anesthesia and narcotic analgesia are not appropriate. Dorsal penile nerve block (DPNB) with lidocaine hydrochloride is probably the most effective and safest form of anesthesia for newborn circumcision currently available, but it can cause significant

Edgar J. Schoen; Anne A. Fischell

1991-01-01

395

Painful diabetic neuropathy.  

PubMed

Diabetes is a worldwide epidemic, and associated neuropathy is its most costly and disabling complication. Given the rising prevalence of painful diabetic neuropathy, it is increasingly important that we understand the best ways to diagnose and treat this condition. Diagnostic tests in this field are evolving rapidly. These include the use of skin biopsies to measure small unmyelinated fibers, as well as even newer techniques that can measure both small unmyelinated fibers and large myelinated fibers in the same biopsy. The main treatments for painful diabetic neuropathy remain management of the underlying diabetes and drugs for the relief of pain. However, emerging evidence points to major differences between type 1 and type 2 diabetes, including the ability of glycemic control to prevent neuropathy. Enhanced glucose control is much more effective at preventing neuropathy in patients with type 1 diabetes than in those with type 2 disease [corrected]. This dichotomy emphasizes the need to study the pathophysiologic differences between the two types of diabetes, because different treatments may be needed for each condition. The impact of the metabolic syndrome on neuropathy in patients with type 2 diabetes may account for the difference between the two types of diabetes and requires further study. Finally, neuropathic pain is under-recognized and undertreated despite an ever evolving list of effective drugs. Evidence exists to support several drugs, but the optimal sequence and combination of these drugs are still to be determined. PMID:24803311

Peltier, Amanda; Goutman, Stephen A; Callaghan, Brian C

2014-01-01

396

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

397

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

2001-01-01

398

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

399

Distally based sural fasciomyocutaneous flap: anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel.  

PubMed

The reconstruction of the distal third leg and weight-bearing heel, especially when complicated with infection and/or dead space, remains a challenge in reconstructive surgery. The distally based sural neurofasciomyocutaneous flap has been proved a valuable tool in repair of the soft tissue defects of those areas. In this report, we present the results of the anatomical study on vascular communication between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle and a modified technique in clinical applications for reconstruction of the soft tissue defects in the distal lower leg and heel. Six lower limbs of fresh cadavers were injected with red gelatin and dissected. A constant vascular connection with average four musculo-fasciocutaneous perforators with diameter 0.2-0.5 mm was identified in the overlapping area between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle. Based on these findings, a modified distally based sural neurofasciomyocutaneous flap including the distal gastrocnemius muscle component was designed and used for repairs of the soft tissue defects in the distal lower limb and plantar heel pad in six patients. The blood supplies of flaps comprised either the peroneal perforator and adipofascial pedicle or the peroneal perforator only. The average size of the fasciocutaneous flap was 51 cm(2), and the muscle component 17.7 cm(2). All flaps survived uneventfully. Our results suggest that this technical modification could provide wider range for applications of the distally based sural neurofasciomyocutaneous flap in repair of the soft tissue defects of the lower extremity and heel. PMID:19031395

Chang, Shi-Min; Zhang, Kai; Li, Hai-Feng; Huang, Yi-Gang; Zhou, Jia-Qian; Yuan, Feng; Yu, Guang-Rong

2009-01-01

400

The Neuromodulation of Neuropathic Pain by Measuring Pain Response Rate and Pain Response Duration in Animal  

PubMed Central

Objective Neuropathic pain causes patients feel indescribable pain. Deep Brain Stimulation (DBS) is one of the treatment methods in neuropathic pain but the action mechanism is still unclear. To study the effect and mechanism of analgesic effects from DBS in neuropathic pain and to enhance the analgesic effect of DBS, we stimulated the ventral posterolateral nucleus (VPL) in rats. Methods To observe the effect from VPL stimulation, we established 3 groups : normal group (Normal group), neuropathic pain group (Pain group) and neuropathic pain+DBS group (DBS group). Rats in DBS group subjected to electrical stimulation and the target is VPL. Results We observed the behavioral changes by DBS in VPL (VPL-DBS) on neuropathic pain rats. In our study, the pain score which is by conventional test method was effectively decreased. In specific, the time of showing withdrawal response from painful stimulation which is not used measuring method in our animal model was also decreased by DBS. Conclusion The VPL is an effective target on pain modulation. Specifically we could demonstrate changes of pain response duration which is not used, and it was also significantly meaningful. We thought that this study would be helpful in understanding the relation between VPL-DBS and neuropathic pain. PMID:25674337

Kim, Jinhyung; Lee, Sung Eun; Shin, Jaewoo; Jung, Hyun Ho; Kim, Sung June

2015-01-01

401

Spinal cord plasticity in peripheral inflammatory pain   

E-print Network

Inflammatory pain is a debilitating condition that can occur following tissue injury or inflammation and results in touch evoked pain (allodynia), exaggerated pain (hyperalgesia) and spontaneous pain, yet the neural ...

Dickie, Allen Charles

2014-06-28

402

Spectroelectrochemical characterization of pain biomarkers  

Microsoft Academic Search

This article reports the first electrochemical characterization of pain biomarkers that include arachidonic acid (AA), prostaglandin G2 (PGG2), and cyclooxygenase 2 (COX-2). These biomarkers are mediators of pathophysiology of pain, inflammation, and cell proliferation in cancer. The article also reports the development of an electrochemical immunosensor for monitoring these pain biomarkers. The results revealed that direct electron transfer between AA

Marcells A. Omole; Naumih Noah; Lisa Zhou; Anas Almaletti; Omowunmi A. Sadik; Helen N. Asemota; Elvira S. William; Jason Gilchrist

2009-01-01

403

Scrotal pain: Evaluation and management  

PubMed Central

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia. PMID:25598931

Gordhan, Chirag G

2015-01-01

404

Scrotal pain: evaluation and management.  

PubMed

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia. PMID:25598931

Gordhan, Chirag G; Sadeghi-Nejad, Hossein

2015-01-01

405

Radiographic Assessment for Back Pain  

MedlinePLUS

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 ...

406

Cortical pathophysiology of chronic pain  

E-print Network

Cortical pathophysiology of chronic pain A. Vania Apkarian Department of Physiology multiple non-invasive brain imaging techniques to study the characteristics of patients with chronic pain in chronic pain are summarized, emphasizing the unique role of the prefrontal cortex in chronic, especially

Apkarian, A. Vania

407

American Academy of Pain Medicine  

MedlinePLUS

... Neuropathic Pain February 6, 2015 [Source: University of California - Davis Health System] Don’t Let Back Pain Disrupt your Sleep ... Glutamate and Ends with Activation of Dopamine Reward System November 12, 2014 [Source: NIDA] ... Glia as the "Bad Guys": Clinical Implications of Glial Dysregulation of Pain, Opioids, and Other ...

408

[Prediction of postoperative pain - beneficial to perioperative pain management?].  

PubMed

Pain treatment of surgical patients is still a deficient area, even if there are evidence-based possibilities of pain management. The aim of this study is to identify patients with a higher risk of severe postoperative pain at an early stage and improve nurses' pain management by identifying pain predictors whilst including them in analgesic treatment. In addition to the identification of predictors by a literature review, a cross-sectional study with 84 surgical patients of a convenience sample was undertaken to find possible predictors. The enquiry was conducted by means of a questionnaire which the patient had to fill in prior surgery. The intensity of pain was surveyed in a personal interview on the first post-operative day. Correlation analysis was applied to verify the statistical significance of patient characteristics as well as surgical variables. Out of the 14 variables preoperative pain was found to increase the risk of postoperative pain. Comparison with other studies showed inconsistent results for pain predictors, and therefore nursing pain management based on pain predictors seems questionable. PMID:21480176

Schadewaldt, Verena; Nielsen, Gunnar H

2011-04-01

409

Pain Treatment in Arthritis-Related Pain: Beyond NSAIDs  

PubMed Central

Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain. PMID:23264838

van Laar, Mart; Pergolizzi, Joseph V; Mellinghoff, Hans-Ulrich; Merchante, Ignacio Morón; Nalamachu, Srinivas; O'Brien, Joanne; Perrot, Serge; Raffa, Robert B

2012-01-01

410

Dopamine Precursor Depletion Influences Pain Affect Rather than Pain Sensation  

PubMed Central

Pain is a multidimensional experience, which includes sensory, cognitive, and affective aspects. Converging lines of evidence indicate that dopaminergic neurotransmission plays an important role in human pain perception. However, the precise effects of dopamine on different aspects of pain perception remain to be elucidated. To address this question, we experimentally decreased dopaminergic neurotransmission in 22 healthy human subjects using Acute Phenylalanine and Tyrosine Depletion (APTD). During APTD and a control condition we applied brief painful laser stimuli to the hand, assessed different aspects of pain perception, and recorded electroencephalographic responses. APTD-induced decreases of cerebral dopaminergic activity did not influence sensory aspects of pain perception. In contrast, APTD yielded increases of pain unpleasantness. The increases of unpleasantness ratings positively correlated with effectiveness of APTD. Our finding of an influence of dopaminergic neurotransmission on affective but not sensory aspects of phasic pain suggests that analgesic effects of dopamine might be mediated by indirect effects on pain affect rather than by direct effects on ascending nociceptive signals. These findings contribute to our understanding of the complex relationship between dopamine and pain perception, which may play a role in various clinical pain states. PMID:24760082

Schulz, Enrico; Baumkötter, Jochen; Ploner, Markus

2014-01-01

411

Outcome of neurolysis for failed tarsal tunnel surgery.  

PubMed

Revision tarsal tunnel surgery was performed on 44 patients (two bilaterally). The surgical procedure included a neurolysis of the tibial nerve in the tarsal tunnel, the medial plantar, lateral plantar, and calcaneal nerves in their respective tunnels, excision of the intertunnel septum, and neuroma resection as indicated. A painful tarsal tunnel scar or painful heel was treated, respectively, by resection of the distal saphenous nerve or a calcaneal nerve branch. Postoperative, immediate ambulation was permitted. Outcomes were assessed with a numerical grading scale that included neurosensory measurements. Outcomes were also assessed by patient satisfaction and their own estimate of residual pain and/or numbness. Mean follow-up time was 2.2 years. Outcomes in terms of patient satisfaction were 54% excellent, 24% good, 13% fair, and 9% poor results. The mean preoperative numerical score was 6.0 and the mean postoperative score was 2.7. There was a significant improvement seen, based on the median difference between scores (P<0.001). Prognostic indicators of poor results in our patient group were coexisting lumbosacral disc disease and/or neuropathy. An approach related to resecting painful cutaneous nerves and neurolysis of all tibial nerve branches at the ankle offers hope for relief of pain and recovery of sensation for the majority of patients with failed previous tarsal tunnel surgery. PMID:18473284

Barker, Allison R; Rosson, Gedge D; Dellon, A Lee

2008-02-01

412

[Neurosurgical treatment of chronic pain].  

PubMed

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

2013-06-01

413

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. PMID:19376965

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

2009-01-01

414

Behavioural assessment of pediatric pain  

PubMed Central

Behavioural assessment methods have been used to signal the need for intervention and to evaluate treatment effectiveness. Direct observation and rating scales have been used to assess pain and distress associated with acute medical procedures, postoperative pain, critical care, analogue pain induction procedures and other sources. Two recent scholarly reviews of behavioural assessment methods were conducted by the Society of Pediatric Psychology Evidence-Based Assessment Task Force and the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials, which classified various instruments as well established, approaching well established or promising. The characteristics of the eight behavioural assessment scales that were recommended by one of these task forces are further reviewed in the present paper. The results indicate that behavioural assessment scales have been used flexibly to assess pain in a wide variety of situations, across different pediatric populations and for patients of different ages. In the present review, there appears to be no basis for designating the scales as measures of distress versus pain; both emotional and sensory components of pain seem to be assessed by each of the scales. There is considerable overlap among the behavioural indicators of pain used in the different scales. Furthermore, the behavioural codes indicative of pain may occur before, during and after painful events. Recommendations for future research are provided, including using behavioural assessment to focus on children’s coping and adults’ behaviours, as well as pain. PMID:19262916

Blount, Ronald L; Loiselle, Kristin A

2009-01-01

415

Stress and chronic pelvic pain.  

PubMed

Chronic pelvic pain is the number one reason that patients suffering from irritable bowel syndrome, interstitial cystitis/painful bladder syndrome, vulvodynia, or chronic prostatitis/chronic pelvic pain syndrome seek medical attention. These syndromes generally have no associated pathology or identified underlying etiology, although dysfunction within the immune system, central nervous system, and peripheral nervous system has been identified. Due to the lack of pathology, chronic pelvic pain syndromes are often diagnosed by exclusion, and the high degree of comorbid symptomology among these and other functional pain disorders complicate identifying appropriate treatment strategies. Chronic stress exposure early in life has been shown to increase the likelihood of pelvic pain later in life, and acute stress exposure can induce or increase symptom severity. In this chapter, we describe the individual chronic pelvic pain syndromes and how stress influences the likelihood of diagnosis and the severity of symptoms experienced by patients. PMID:25744684

Pierce, Angela N; Christianson, Julie A

2015-01-01

416

Groin pain in athletes.  

PubMed

Groin pain in athletes is one of the most difficult to treat clinical entities in sports medicine. The reasons are the amount of differential diagnoses, complexity of pathophysiologic causes and the long time of limited participation in sport. In order to maximize efficient treatment, thorough diagnostics and a clear therapeutic regimen are crucial. To succeed with this issue, a close cooperation between physicians and radiologists is mandatory. MRI is gold standard in the diagnostic work-up of the principal differential diagnoses, such as muscle tears, avulsion injuries, stress fractures, tears of acetabular labrum, and osteitis pubis. The article gives a comprehensive overview of the special anatomy and biomechanics of the pubic region and of typical MRI findings in athletes with groin pain. The use of dedicated imaging protocols is also discussed. PMID:23893752

Weber, M-A; Rehnitz, C; Ott, H; Streich, N

2013-12-01

417

Cross-cultural conceptions of pain and pain control  

PubMed Central

Pain is a ubiquitous feature of the human experience. This paper presents an anthropology of pain. Anthropology is defined as the cross-cultural and comparative study of human behavior. Pain can be acute and episodic, and pain can be constant and uninterrupted. Acute pain, lasting for minutes or hours, is reported at some time by virtually all adults and by most juveniles and is indicated by the cries and facial expressions of toddlers and infants. This universality of pain as a part of the human condition has been established by the research of many biological, physical, and social scientists. Ethnographers, physicians, and public health experts describe pain complaints for a variety of modern, industrial societies and traditional, undeveloped societies. Pain is the most frequent complaint brought to the offices of physicians in North America, and it is a focus of attention in the literate medical traditions of China, India, and Islamic cultures. Hence, the study of pain and the cultural perceptions of pain are prominent foci of anthropologists. Given that the goal of medicine is to offer medical care to all people who seek it, the practice of modern medicine may be assisted by an exploration of the possibility of cultural differences in medical beliefs and practices in the multiethnic and racially diverse patient populations today. PMID:16333427

2002-01-01

418

Biobehavioral pain profile in individuals with chronic spine pain.  

PubMed

Pain in the spine is the most frequently described pain problem in primary care, afflicting at least 54 million Americans. When spinal pain becomes chronic, the prognosis for recovery is poor, often leading to disability and reduced quality of life. Clinical treatment is inadequate, often focusing on physical pathology alone. To improve treatment outcomes for chronic pain as recommended by current guidelines, the Biobehavioral Pain Profile (BPP), which includes six pain response subscales, was developed to guide cognitive behavioral therapy (CBT). The purpose of this study was to describe the BPP in 100 individuals with chronic spine pain and examine the associations between the BPP and important clinical outcomes, including chronic pain, disability, and quality of life. Participants reported a high level of pain, a low quality of life, and a high level of disability despite receiving treatment with opioids. Scores on BPP subscales including evaluating loss of control, past and current experience, physiologic responsivity, and thoughts of disease progression were elevated, indicating a need for CBT. Five of the six BPP subscales had a significant association with quality of life, chronic pain, and disability with the thought of disease progression being a strong factor for most of the clinical outcome variables. By identifying BPP, clinicians can provide appropriate treatments to improve individuals' quality of life and prevent further disability. Further study using the BPP to guide CBT is needed. PMID:24602429

Matteliano, Deborah; Scherer, Yvonne Krall; Chang, Yu-Ping

2014-03-01

419

For the pain in fish(eries) Consequenses of pain perception in fish for catch  

E-print Network

For the pain in fish(eries) Consequenses of pain perception in fish for catch and release fishing 2 DO FISH FEEL PAIN? VIEWS FROM A SCIENTIFIC PERSPECTIVE 4 Sensing pain 4 Experiencing pain 5 Pain could not sense pain (Rowan 1984). Also subsequent philosophers, such as Augustin (354-430) and Aquinas

Bech, Claus

420

Pain and depression in acute traumatic spinal cord injury: Origins of chronic problematic pain?  

Microsoft Academic Search

Objective: To examine the relationship between pain and depression over time during acute phases of traumatic spinal cord injury (SCI). Theoretical models of the pain-depression relationship provided a framework: (1) pain causes depression; (2) depression causes pain; (3) pain and depression are independent sequelae to SCI. Understanding the pain-depression relationship provides treatment implications and bypotheses for origins of chronic pain

Douglas M. Cairns; Rodney H. Adkins; Michael D. Scott

1996-01-01

421

Interventional Pain Management  

Microsoft Academic Search

Chronic back pain is a widespread disease. (Manchikanti et al. 2004; Neuhauser et al. 2005; Schwarzer et al. 1995). Due to\\u000a the anatomy of the intervertebral joints and the increasing static load towards the lumbar spine, the lumbar facet syndrome\\u000a is definitely more frequently observed than the cervical or thoracic one (Masharawi et al. 2004; Yoganandan et al. 2003).\\u000a In

Jan Hoeltje; Roland Bruening; Bruno Kastler; Reto Bale; Gerlig Widmann; Bernd Turowski; Gero Wieners; Oliver Beuing

422

Beyond pleasure and pain  

Microsoft Academic Search

People approach pleasure and avoid pain. To discover the true nature of approach-avoidance motivation, psy-chologists need to move beyond this hedonic principle to the principles that underlie the different ways that it operates. One such principle is regulatory focus, which distinguishes self-regulation with a promotion focus (ac-complishments and aspirations)from self-regulation with a prevention focus (safety and responsibilities). This principle is

E. Tory Higgins

1997-01-01

423

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

424

Multimodal treatment of pain.  

PubMed

Chronic pain is a complex disorder with extensive overlap in sensory and limbic pathways. It needs systemic therapy in addition to focused local treatment. This article discusses treatment modalities other than surgical and interventional approaches and also discusses the literature regarding these treatment modalities, including pharmacotherapy, physical and occupational therapy, psychological approaches including cognitive behavior therapy, and other adjunctive treatments like yoga and tai chi. PMID:25240667

Mathews, Manu

2014-10-01

425

[Congenital insensitivity to pain].  

PubMed

Congenital insensitivity to pain belongs to rare diseases called hereditary sensory neuropathy (HSN). The disturbance of sense and secondary harms are creating clinical picture. The aim of this report was to describe therapeutic problems with which we met with a three siblings with congenital insensitivity to pain. The authors have described three children with congenital insensitivity to pain. The disease was diagnosed at the age of 3-5. These children painlessly have broken their lower limbs. These fractures were late diagnosed what resulted in a badly healed deformation of legs. For this reason, the right knee of the oldest boy had to be stiffened. This boy had also late diagnosed the left hip luxation, and hematomas had arisen, which become filled with pus. The boy was in sepsis and a dramatic life-and-death struggle was performed. A purulent focuses were removed from abdomen and femoral head was also resected. The other two siblings had fractures and infections, but not such severe as the oldest boy. It is well known that a causal treatment of this disease in unknown. Patients must learn to avoid mechanical and thermal trauma. It is the only way to prevent complications of this disease. PMID:24720108

Popko, Janusz; Karpi?ski, Micha?; Guszczyn, Tomasz

2014-02-01

426

Back pain in athletes.  

PubMed

The athlete with back pain presents a clinical challenge. Self-limited symptoms must be distinguished from persistent or recurrent symptoms associated with identifiable pathology. Athletes involved in impact sports appear to have risk factors for specific spinal pathologies that correlate with the loading and repetition demands of specific activities. For example, elite athletes who participate in longer and more intense training have higher incidence rates of degenerative disk disease and spondylolysis than athletes who do not. However, data suggest that the recreational athlete may be protected from lumbar injury with physical conditioning. Treatment of athletes with acute or chronic back pain usually is nonsurgical, and symptoms generally are self-limited. However, a systematic approach to the athlete with back pain, involving a thorough history and physical examination, pertinent imaging, and treatment algorithms designed for specific diagnoses, can facilitate symptomatic improvement and return to play. There are no reliable studies examining the long-term consequences of athletic activity on the lumbar spine. PMID:17148620

Lawrence, James P; Greene, Hunter S; Grauer, Jonathan N

2006-12-01

427

Effects of long-term wearing of high-heeled shoes on the control of the body's center of mass motion in relation to the center of pressure during walking.  

PubMed

High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. This study investigated the effects of habitual wearing of high-heeled shoes on the body's center of mass (COM) motion relative to the center of pressure (COP) during gait. Fifteen female experienced wearers and 15 matched controls walked with high-heeled shoes (7.3cm) while kinematic and ground reaction force data were measured and used to calculate temporal-distance parameters, joint moments, COM-COP inclination angles (IA) and the rate of IA changes (RCIA). Compared with inexperienced wearers, experienced subjects showed significantly reduced frontal IA with increased ankle pronator moments during single-limb support (p<0.05). During double-limb support (DLS), they showed significantly increased magnitudes of the frontal RCIA at toe-off and contralateral heel-strike, and reduced DLS time (p<0.05) but unaltered mean RCIA over DLS. In the sagittal plane experienced wearers showed significantly increased mean RCIA (p<0.05) and significant differences in the RCIA at toe-off and contralateral heel-strike (p<0.05). Significantly increased hip flexor moments and knee extensor moments at toe-off (p<0.05) were needed for forward motion of the trailing limb. The current results identified the change in the balance control in females after long-term use of high-heeled shoes, providing a basis for future design of strategies to minimize the risk of falling during high-heeled gait. PMID:24508016

Chien, Hui-Lien; Lu, Tung-Wu; Liu, Ming-Wei

2014-04-01

428

Spousal congruence on disability, pain, and spouse responses to pain  

PubMed Central

We examined congruence between chronic pain patients and their spouses on their reports of patient pain severity, patient disability, and spouse responses to pain. Patients reported that they were more physically and psychosocially disabled than their spouses reported them to be. However, spouses reported that the patients’ pain was more severe than patients reported. Depressive disorders in the patient and gender interacted with patient–spouse ratings. For physical and psychosocial disability, depressed patient couples reported significantly larger differences in disability ratings than non-depressed patient couples. In addition, female patients’ disability was rated as more severe by the female patients than by their husbands. Male patient couples did not report differences on physical disability. Findings relating to other forms of disability and to spouse responses are also described. The results are discussed in the context of an interpersonal perspective of chronic pain and have implications for the assessment of pain and disability. PMID:15157686

Cano, Annmarie; Johansen, Ayna B.; Geisser, Michael

2009-01-01

429

Pain determinants of pain in autosomal dominant polycystic kidney disease.  

PubMed

Pain is the most common symptom reported by ADPKD patients, afflicting approximately 60% of cases and may result from renal hemorrhage, calculi, urinary tract infections, cyst rupture, or due to stretching of the capsule or traction of the renal pedicle. We have recently investigated pain patterns in AD-PKD patients using a translated version of a pain questionnaire specific for AD-PKD population. The questionnaire revealed that 67% patients with ADPKD exhibited some type of pain. The findings of that study emphasized that pain appeared early in the course of ADPKD, when patients still exhibited preserved renal function. In the present study, a multivariate logistic regression analysis disclosed that renal volume (9-fold increased risk) and nephrolithiasis (4-fold increased risk) were the most important determinant factors for pain in ADPKD patients with preserved renal function, after adjustments for the presence of hypertension and duration of the disease. PMID:24100745

Nishiura, José Luiz; Eloi, Samara Rodrigues Moreira; Heilberg, Ita Pfeferman

2013-01-01

430

TRANSLATIONAL PAIN RESEARCH: ACHIEVEMENTS AND CHALLENGES  

PubMed Central

The achievements in both preclinical and clinical pain research over the past four decades have led to significant progresses in clinical pain management. However, pain research still faces enormous challenges and there remain many obstacles in the treatment of clinical pain, particularly chronic pain. Translational pain research needs to involve a number of important areas including a) bridging the gap between pain research and clinical pain management, b) developing objective pain assessment tools, c) analyzing current theories of pain mechanisms and their relevance to clinical pain, d) exploring new tools for both preclinical and clinical pain research, and e) coordinating research efforts among basic scientists, clinical investigators, and pain medicine practitioners. These issues are discussed in this article in light of the achievements and challenges of translational pain research. PMID:19628433

Mao, Jianren

2009-01-01

431

The neurobiology of skeletal pain.  

PubMed

Disorders of the skeleton are one of the most common causes of chronic pain and long-term physical disability in the world. Chronic skeletal pain is caused by a remarkably diverse group of conditions including trauma-induced fracture, osteoarthritis, osteoporosis, low back pain, orthopedic procedures, celiac disease, sickle cell disease and bone cancer. While these disorders are diverse, what they share in common is that when chronic skeletal pain occurs in these disorders, there are currently few therapies that can fully control the pain without significant unwanted side effects. In this review we focus on recent advances in our knowledge concerning the unique population of primary afferent sensory nerve fibers that innervate the skeleton, the nociceptive and neuropathic mechanisms that are involved in driving skeletal pain, and the neurochemical and structural changes that can occur in sensory and sympathetic nerve fibers and the CNS in chronic skeletal pain. We also discuss therapies targeting nerve growth factor or sclerostin for treating skeletal pain. These therapies have provided unique insight into the factors that drive skeletal pain and the structural decline that occurs in the aging skeleton. We conclude by discussing how these advances have changed our understanding and potentially the therapeutic options for treating and/or preventing chronic pain in the injured, diseased and aged skeleton. PMID:24494689

Mantyh, Patrick W

2014-02-01

432

Painful varicoceles: Role of varicocelectomy.  

PubMed

The incidence of varicocele in the general population is up to 15%. It is estimated that the prevalence of pain with varicoceles is around 2-10%. Till the year 2000, only two studies evaluated efficacy of varicocelectomy in painful varicoceles with conflicting results. Over the past decade many other studies have addressed this issue and reported on the treatment outcome and predictors of success. We critically appraised studies published from March 2000 to May 2013 evaluating surgical management in painful varicoceles to provide an evidence based review of effectiveness of varicocelectomy in relieving pain in patients with symptomatic painful varicoceles. The association between varicoceles and pain is not clearly established. Conservative treatment is warranted as the first line of treatment in men with painful clinical varicoceles. In carefully selected men with clinically palpable varicoceles and associated characteristic chronic dull ache, dragging or throbbing pain who do not respond to conservative therapy, varicocelectomy is warranted and is associated with approximately 80% success. However, surgical success does not always translate into resolution of pain and pain might persist even when no varicoceles are detected postoperatively. PMID:25378815

Abrol, Nitin; Panda, Arabind; Kekre, Nitin S

2014-10-01

433

Modulation of pain by estrogens.  

PubMed

It has become increasingly apparent that women suffer a disproportionate amount of pain during their lifetime compared to men. Over the past 15 years, a growing number of studies have suggested a variety of causes for this sex difference, from cellular to psychosocial levels of analysis. From a biological perspective, sexual differentiation of pain appears to occur similarly to sexual differentiation of other phenomena: it results in large part from organizational and activational effects of gonadal steroid hormones. The focus of this review is the activational effects of a single group of ovarian hormones, the estrogens, on pain in humans and animals. The effects of estrogens (estradiol being the most commonly examined) on experimentally induced acute pain vs. clinical pain are summarized. For clinical pain, the review is limited to a few syndromes for which there is considerable evidence for estrogenic involvement: migraine, temporomandibular disorder (TMD) and arthritis. Because estrogens can modulate the function of the nervous, immune, skeletal, and cardiovascular systems, estrogenic modulation of pain is an exceedingly complex, multi-faceted phenomenon, with estrogens producing both pro- and antinociceptive effects that depend on the extent to which each of these systems of the body is involved in a particular type of pain. Forging a more complete understanding of the myriad ways that estrogens can ameliorate vs. facilitate pain will enable us to better prevent and treat pain in both women and men. PMID:17951003

Craft, Rebecca M

2007-11-01

434

Vicissitudes of pain and suffering: Chronic pain and liminality  

Microsoft Academic Search

This article looks at how the Finnish experience of chronic pain is shaped by socio?cultural practices. Along with the ambiguity that is necessarily present in all chronic illnesses, the invisibility of chronic pain blurs biomedical categorization and confuses diagnostics. This results in a double delegitimation—that of suffering a chronic illness and that of suffering chronic pain—which, obviously, has a serious

2001-01-01

435

Electroacupuncture alleviates affective pain in an inflammatory pain rat model  

Microsoft Academic Search

Pain has both sensory–discriminative and emotional–affective dimensions. Previous studies demonstrate that electroacupuncture (EA) alleviates the sensory dimension but do not address the affective. An inflammatory pain rat model, produced by a complete Freund adjuvant (CFA) injection into the hind paw, was combined with a conditioned place avoidance (CPA) test to determine whether EA inhibits spontaneous pain-induced affective response and, if

Yu Zhang; Xianze Meng; Aihui Li; Jiajia Xin; Brian M. Berman; Lixing Lao; Ming Tan; Ke Ren; Rui-Xin Zhang

436

Pain without Nociceptors? Nav1.7-Independent Pain Mechanisms  

PubMed Central

Summary Nav1.7, a peripheral neuron voltage-gated sodium channel, is essential for pain and olfaction in mice and humans. We examined the role of Nav1.7 as well as Nav1.3, Nav1.8, and Nav1.9 in different mouse models of chronic pain. Constriction-injury-dependent neuropathic pain is abolished when Nav1.7 is deleted in sensory neurons, unlike nerve-transection-related pain, which requires the deletion of Nav1.7 in sensory and sympathetic neurons for pain relief. Sympathetic sprouting that develops in parallel with nerve-transection pain depends on the presence of Nav1.7 in sympathetic neurons. Mechanical and cold allodynia required distinct sets of neurons and different repertoires of sodium channels depending on the nerve injury model. Surprisingly, pain induced by the chemotherapeutic agent oxaliplatin and cancer-induced bone pain do not require the presence of Nav1.7 sodium channels or Nav1.8-positive nociceptors. Thus, similar pain phenotypes arise through distinct cellular and molecular mechanisms. Therefore, rational analgesic drug therapy requires patient stratification in terms of mechanisms and not just phenotype. PMID:24440715

Minett, Michael S.; Falk, Sarah; Santana-Varela, Sonia; Bogdanov, Yury D.; Nassar, Mohammed A.; Heegaard, Anne-Marie; Wood, John N.

2014-01-01

437

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.

2011-06-01

438

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.

2010-12-01

439

Pathogenesis of Painful Diabetic Neuropathy  

PubMed Central

The prevalence of diabetes is rising globally and, as a result, its associated complications are also rising. Painful diabetic neuropathy (PDN) is a well-known complication of diabetes and the most common cause of all neuropathic pain. About one-third of all diabetes patients suffer from PDN. It has a huge effect on a person's daily life, both physically and mentally. Despite huge advances in diabetes and neurology, the exact mechanism of pain causation in PDN is still not clear. The origin of pain could be in the peripheral nerves of the central nervous system. In this review, we discuss various possible mechanisms of the pathogenesis of pain in PDN. We discuss the role of hyperglycaemia in altering the physiology of peripheral nerves. We also describe central mechanisms of pain. PMID:24891949

Rajbhandari, Satyan

2014-01-01

440

Pain Management in Pancreatic Cancer  

PubMed Central

A majority of pancreatic cancer patients present with pain at the time of diagnosis. Pain management can be challenging in light of the aggressive nature of this cancer. Apart from conventional pharmacotherapy, timely treatment with neurolytic celiac plexus block (NCPB) has been shown to be of benefit. NCPB has demonstrated efficacious pain control in high quality studies with analgesic effects lasting one to two months. NCPB has also shown to decrease the requirements of narcotics, and thus decrease opioid related side effects. Another option for the control of moderate to severe pain is intrathecal therapy (IT). Delivery of analgesic medications intrathecally allows for lower dosages of medications and thus reduced toxicity. Both of the above mentioned interventional procedures have been shown to have low complication rates, and be safe and effective. Ultimately, comprehensive pancreatic cancer pain management necessitates understanding of pain mechanisms and delivery of sequential validated therapeutic interventions within a multidisciplinary patient care model. PMID:24212605

Hameed, Mariam; Hameed, Haroon; Erdek, Michael

2011-01-01

441

Pain Catastrophizing: An Updated Review  

PubMed Central

Pain catastrophizing has been described for more than half a century which adversely affects the pain coping behavior and overall prognosis in susceptible individuals when challenged by painful conditions. It is a distinct phenomenon which is characterized by feelings of helplessness, active rumination and excessive magnification of cognitions and feelings toward the painful situation. Susceptible subjects may have certain demographic or psychological predisposition. Various models of pain catastrophizing have been proposed which include attention-bias, schema-activation, communal-coping and appraisal models. Nevertheless, consensus is still lacking as to the true nature and mechanisms for pain catastrophizing. Recent advances in population genomics and noninvasive neuroimaging have helped elucidate the known determinants and neurophysiological correlates behind this potentially disabling behavior. PMID:23441031

Leung, Lawrence

2012-01-01

442

Gynecological Management of Neuropathic Pain  

PubMed Central

Obstetrician/gynecologists often are the initial management clinicians for pelvic neuropathic pain. While treatment may require comprehensive team management and consultation with other specialists, there a few critical and basic steps that can be performed on an office visit that offer the opportunity to significantly improve quality of life in this patient population. A key first step is a thorough clinical examination to physically map the pain site and identify potentially involved nerves. Only limited evidence exists on how best to manage neuropathic pain, but generally a combination of surgical, manipulative or pharmacological methods should be considered. Experimental methods for more precisely characterizing the nature of the nerve dysfunction exist to diagnose and treat neuropathic pain, but additional scientific evidence is needed to unanimously recommend these options. In the meantime, an approach adopted from guidelines of the International Association for Study of Pain tailored for gynecological pain is suggested. PMID:21777899

TU, Frank F.; HELLMAN, Kevin; BACKONJA, Miroslav

2011-01-01

443

Genomics of pain in osteoarthritis  

PubMed Central

Summary Osteoarthritis (OA) accounts for the majority of the disease burden for musculoskeletal disorders and is one of the leading causes of disability worldwide. This disability is the result not of the cartilage loss that defines OA radiographically, but of the chronic pain whose presence defines symptomatic OA. It is becoming clear that many genes, each with a small effect size, contribute to the risk of developing OA. However, the genetics of OA pain are only just starting to be explored. This review will describe the first genes to have been identified in genomic studies of OA pain, as well as the possible dual roles of genes previously identified in genomic studies of OA in the context of pain. Difficulties associated with attempting to characterise the genetics of OA pain will be discussed and promising future avenues of research into genetic and epigenetic factors affecting OA pain described. PMID:23973152

Thakur, M.; Dawes, J.M.; McMahon, S.B.

2013-01-01

444

Abstract--Pain assessment is of high priority in the clinical setting. Facial Pain Scales (FPSs) are pain assessment tools  

E-print Network

Abstract-- Pain assessment is of high priority in the clinical setting. Facial Pain Scales (FPSs) are pain assessment tools generally used with school-aged children. The implicit theoretical bases not been addressed. We support the existence of a universal pain expression ­the Primal Face of Pain (PFP

Central Florida, University of

445

Imaging the pain of low back pain: functional magnetic resonance imaging in combination with monitoring subjective pain perception  

E-print Network

Imaging the pain of low back pain: functional magnetic resonance imaging in combination with monitoring subjective pain perception allows the study of clinical pain states A. Vania Apkariana,*, Beth R December 2000 Abstract Most brain imaging studies of pain are done using a two-state subtraction design

Apkarian, A. Vania

446

Usefulness of Cordotomy in Patients With Cancer Who Experience Bilateral Pain: Implications of Increased Pain and New Pain  

PubMed Central

BACKGROUND: Although mirror pain occurs after cordotomy in patients experiencing unilateral pain via a referred pain mechanism, no studies have examined whether this pain mechanism operates in patients who have bilateral pain. OBJECTIVE: To assess the usefulness of cordotomy for bilateral pain from the viewpoint of increased pain or new pain caused by a referred pain mechanism. METHODS: Twenty-six patients who underwent percutaneous cordotomy through C1-C2 for severe bilateral cancer pain in the lumbosacral nerve region were enrolled. Pain was dominant on 1 side in 23 patients, and pain was equally severe on both sides in 3 patients. Unilateral cordotomy was performed for the dominant side of pain, and bilateral cordotomy was performed for 13 patients in whom pain on the nondominant side developed or remained severe after cordotomy. RESULTS: After unilateral cordotomy, 19 patients (73.1%) exhibited increased pain, which for 14 patients was as severe as the original dominant pain. After bilateral cordotomy, 7 patients (53.4%) exhibited new pain, which was located cephalad to the region rendered analgesic by cordotomy and was better controlled than the original pain. No pathological organic causes of new pain were found in any patient, and evidence of a referred pain mechanism was found in 3 patients after bilateral cordotomy. CONCLUSION: These results show that a referred pain mechanism causes increased or new pain after cordotomy in patients with bilateral pain. Nevertheless, cordotomy can still be indicated for patients with bilateral pain because postoperative pain is better controlled than the original pain. PMID:25603110

Higaki, Nobuhiro; Yorozuya, Toshihiro; Tsubota, Shinzo; Fujii, Tomomi; Fukunaga, Tomoe; Moriyama, Mitsuhide; Yoshikawa, Takeki

2015-01-01

447

Effect of pain chronification and chronic pain on an endogenous pain modulation circuit in rats.  

PubMed

We tested the hypothesis that chronic pain development (pain chronification) and ongoing chronic pain (chronic pain) reduce the activity and induce plastic changes in an endogenous analgesia circuit, the ascending nociceptive control. An important mechanism mediating this form of endogenous analgesia, referred to as capsaicin-induced analgesia, is its dependence on nucleus accumbens ?-opioid receptor mechanisms. Therefore, we also investigated whether pain chronification and chronic pain alter the requirement for nucleus accumbens ?-opioid receptor mechanisms in capsaicin-induced analgesia. We used an animal model of pain chronification in which daily subcutaneous prostaglandin E2 (PGE2) injections into the rat's hind paw for 14 days, referred to as the induction period of persistent hyperalgesia, induce a long-lasting state of nociceptor sensitization referred to as the maintenance period of persistent hyperalgesia, that lasts for at least 30 days following the cessation of the PGE2 treatment. The nociceptor hypersensitivity was measured by the shortening of the time interval for the animal to respond to a mechanical stimulation of the hind paw. We found a significant reduction in the duration of capsaicin-induced analgesia during the induction and maintenance period of persistent mechanical hyperalgesia. Intra-accumbens injection of the ?-opioid receptor selective antagonist Cys(2),Tyr(3),Orn(5),Pen(7)amide (CTOP) 10 min before the subcutaneous injection of capsaicin into the rat's fore paw blocked capsaicin-induced analgesia. Taken together, these findings indicate that pain chronification and chronic pain reduce the duration of capsaicin-induced analgesia, without affecting its dependence on nucleus accumbens ?-opioid receptor mechanisms. The attenuation of endogenous analgesia during pain chronification and chronic pain suggests that endogenous pain circuits play an important role in the development and maintenance of chronic pain. PMID:25451282

Miranda, J; Lamana, S M S; Dias, E V; Athie, M; Parada, C A; Tambeli, C H

2015-02-12

448

Cultural perspectives on pain management.  

PubMed

Bedouin women tend to remain quiet and expressionless while giving birth despite reporting high levels of pain and fear (Harrison 1991). Culture undoubtedly influences pain perception and expression but there are dangers in making assumptions about particular groups. This article explores the underlying research and the complex clinical picture highlighting the need for cultural awareness--but ultimately we must care for the individual person in pain. PMID:19051959

Briggs, Emma

2008-11-01

449

Cerebral cortex modulation of pain  

Microsoft Academic Search

Pain is a complex experience encompassing sensory-discriminative, affective-motivational and cognitiv e-emotional components mediated by different mechanisms. Contrary to the traditional view that the cerebral cortex is not involved in pain perception, an extensive cortical network associated with pain processing has been revealed using multiple methods over the past decades. This network consistently includes, at least, the anterior cingulate cortex, the

Yu-feng Xie; Fu-quan Huo; Jing-shi Tang

2009-01-01

450

Migraine as a visceral pain  

Microsoft Academic Search

Migraine is a reversible brain dysfunction characterized by pain and passive coping strategies consistent with sickness behaviour.\\u000a The brain contains no pain fibres and the only way it may signal pain is through the trigemino-vascular system. Here, it is\\u000a postulated that migraine is an example of genetically determined behavioural responses and that sickness behaviour, a pan-mammalian\\u000a adaptive response to internal

Pietro Cortelli; Pasquale Montagna

2009-01-01

451

Psychosocial Issues in Cancer Pain  

Microsoft Academic Search

Cancer pain is a complex and multidimensional experience that affects and is affected by psychological and social factors.\\u000a This article reviews recent research that points to a number of key psychosocial factors associated with pain, including psychological\\u000a distress, coping, and social support, as well as the impact of socioeconomic factors on barriers to pain management. We also\\u000a review recent research

Laura S. Porter; Francis J. Keefe

452

Gene Therapy for Chronic Pain  

Microsoft Academic Search

\\u000a Gene therapy shows great potential to assist numerous patients with inadequate relief of inflammatory or neuropathic pain,\\u000a or intractable pain associated with advanced cancer. A brief overview is provided of the methods of gene therapy and of preclinical\\u000a findings in animal models of prolonged inflammatory, neuropathic and cancer pain. Preclinical findings demonstrate no efficacy\\u000a of gene therapy on basal thermal

William R. Lariviere; Doris K. Cope

453

Neck Pain following Laminoplasty.  

PubMed

Study Design?Retrospective evaluation of prospectively collected data. Objective?To compare preoperative and postoperative neck pain following laminoplasty using the Neck Disability Index (NDI). Methods?Seventy-two patients undergoing laminoplasty from 2006 to 2009 at a single institution were identified. Thirty-four patients with a minimum 1-year follow-up who completed preoperative, 6-week, and 1-year postoperative NDI questionnaires were enrolled. Demographic data and surgical data including estimated blood loss (EBL), length of surgery, number of laminoplasty levels, complications, and length of hospitalization were collected. Results?Mean age was 62 years (range: 34 to 88), mean follow-up was 17 months (range: 12 to 31), and there were 21 men and 13 women. Diagnoses were cervical spondylotic myelopathy (n?=?26), ossification of the posterior longitudinal ligament (n?=?6), and central cord syndrome (n?=?2). Mean EBL was 120 mL (range: 50 to 200), and mean surgical time was 152 minutes (range: 70 to 240). Average number of laminoplasty levels was 3 (range: 1 to 5). The open door technique was used, and 24/34 (71%) did not have laminoplasty at C3 and C7. No intraoperative complications were noted, and average hospital stay was 1.6 days (range: 1 to 7). Significant improvement in NDI total score was noted at 1?year (p?pain score at 6 weeks (p?pain subscore and NDI total scores at a minimum of 1?year postoperatively. PMID:25650126

Mesfin, Addisu; Park, Moon-Soo; Piyaskulkaew, Chaiwat; Chuntarapas, Tapanut; Song, Kwang Sup; Kim, Han Jo; Riew, K Daniel

2015-02-01

454

Corporatization of pain medicine: implications for widening pain care disparities.  

PubMed

The current health care system in the United States is structured in a way that ensures that more opportunity and resources flow to the wealthy and socially advantaged. The values intrinsic to the current profit-oriented culture are directly antithetical to the idea of equitable access. A large body of literature points to disparities in pain treatment and pain outcomes among vulnerable groups. These disparities range from the presence of disproportionately higher numbers and magnitude of risk factors for developing disabling pain, lack of access to primary care providers, analgesics and interventions, lack of referral to pain specialists, longer wait times to receive care, receipt of poor quality of pain care, and lack of geographical access to pharmacies that carry opioids. This article examines the manner in which the profit-oriented culture in medicine has directly and indirectly structured access to pain care, thereby widening pain treatment disparities among vulnerable groups. Specifically, the author argues that the corporatization of pain medicine amplifies disparities in pain outcomes in two ways: 1) directly through driving up the cost of pain care, rendering it inaccessible to the financially vulnerable; and 2) indirectly through an interface with corporate loss-aversion/risk management culture that draws upon irrelevant social characteristics, thus worsening disparities for certain populations. Thus, while financial vulnerability is the core reason for lack of access, it does not fully explain the implications of corporate microculture regarding access. The effect of corporatization on pain medicine must be conceptualized in terms of overt access to facilities, providers, pharmaceuticals, specialty services, and interventions, but also in terms of the indirect or covert effect of corporate culture in shaping clinical interactions and outcomes. PMID:21392249

Meghani, Salimah H

2011-04-01

455

[Acute anal pain].  

PubMed

Acute anal pain is a common proctological problem. A detailed history together with the clinical examination are crucial for the diagnosis. An acute perianal vein thrombosis can be successfully excised within the first 72 hours. Acute anal fissures are best treated conservatively using stool regulation and topical medications reducing the sphincter spasm. A chronic anal fissure needs surgery. Perianal abscesses can very often be incised and drained in local anesthesia. Proctalgia fugax and the levator ani syndrome are exclusion diagnoses and are treated symptomatically. PMID:23798022

Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

2013-07-01

456

[Acute thoracic pain].  

PubMed

We report the case of a 56 year-old female patient without previous medical history presenting in the emergency room with acute left-sided thoracic pain and dyspnea. Initial lab exams, ECG and chest X-ray in supine position were normal and excluded most common pathologies, e.g. a large pneumothorax or myocardial infarction. A subsequent computed tomography to exclude an aortic dissection or pulmonary embolism showed left-sided sero-pneumothorax and mediastinal air. A spontaneous esophageal rupture (Boerhaave Syndrome) was diagnosed. An additional fluoroscopic study was performed to evaluate the exact site of rupture. PMID:17639965

Matt, D; Kubik-Huch, R A; Teufelberger, G; Knüsel, P R

2007-06-20

457

Intelligent back pain advisor  

SciTech Connect

There is a great need for expert systems in the medical field for expert system applications in the field of medical diagnosis. There aren`t any expert systems available for diagnosing back pain, and this too