Pretreatment anxiety and pain acceptance are associated with response to trigger point injection therapy for chronic myofascial pain.

BACKGROUND AND AIM: This study examined the psychosocial profile of patients who responded or did not respond to trigger point injection therapy for chronic myofascial pain. METHODS: Seventy one patients with a diagnosis of chronic myofascial pain of the paraspinous muscles completed a pretreatment questionnaire measuring demographic and social factors, and validated scales to assess pain intensity, pain interference (physical and emotional), and defined psychological characteristics (pain catastrophizing, pain acceptance, pain self-efficacy, mood and anxiety). Trigger point injection therapy of the affected areas of myofascial pain was performed and follow-up was conducted by telephone at one week (n = 65) and one month (n = 63) post intervention to assess treatment outcome (pain intensity and pain-related physical interference). RESULTS: At one week follow-up and one-month follow-up, using pain-related physical interference as the outcome measure, we found that those who responded well to treatment were characterized by a lower level of pretreatment anxiety and a higher level of pain acceptance, with anxiety being the strongest predictor. CONCLUSION: These results suggest that responses to interventional pain management in chronic myofascial paraspinous pain may be influenced by psychological characteristics, especially pretreatment anxiety.

The impact of emergency remote teaching on a blended engineering course: perspectives and implications for the future.

Higher education institutions globally were forced to transition to remote teaching and learning when the Covid-19 pandemic impacted the world in 2020. The rushed, unplanned nature of the transition led to the approach being labeled Emergency Remote Teaching (ERT). This paper evaluates the impact of ERT on a blended course in engineering using a descriptive case study approach applying the Context, Input, Process and Product (CIPP) evaluation model. The context analysis highlighted the need for consistent training in the use of technology, technical support for stakeholders, greater access to the Internet and timely, targeted communication. Students appreciated the convenience of online classes and accessibility to recorded lectures and labs allowing them to review at their own pace. There was a perception that the new learning environment placed some students at a disadvantage. These findings suggested a need to ensure deliberate planning for online learning from the start and attention to building a community of learners. Findings from the study can contribute to a university's exploration of the academic enterprise. These findings can also help identify mitigating factors for effective online learning. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43545-021-00172-z.

Design and development of a pool and billiards assistive device for the physically challenged.

This research entailed the development and prototyping of a bespoke assistive device for a subject who was a local pool and billiards championship player. The subject was diagnosed with a brain tumor and had to undergo surgery followed by chemotherapy to completely remove the mass in the brain. Following this, there was some loss in motor skills on the right side of his body affecting his gait and grip on objects and his ability to play pool and billiards. Concepts were developed to enable the subject to regain some form. A final design was made, with subsequent alterations for fit and comfort. Testing was done over a 7-day period and results using aid were compared without using any aid over a similar period. There was an 88% decrease in time taken to execute the shot, a 140% increase in strength of shot and a 75% increase in accuracy. The results suggest greater improvement in these performance characteristics with extended use of the device. The device also serves to improve the quality of life of the subject. Implications for Rehabilitation A subject lost some physical ability following the removal of a brain tumor. A bespoke design was found to significantly enhance the performance of the subject in pool and billiards, a game that the subject loved to play before loss of the physical ability. Of increasing importance to those that have lost physical ability is the aim to restore quality of life similar to before the loss of the physical ability, especially with respect to activities that a subject would have been motivated to do due to intrinsic love/interest of the activity.

Cognitive Impairment in Patients with Chronic Neuropathic or Radicular Pain: An Interaction of Pain and Age.

A growing body of empirical research has confirmed an association between chronic pain and cognitive dysfunction. The aim of the present study was to determine whether cognitive function is affected in patients with a diagnosis of chronic neuropathic or radicular pain relative to healthy control participants matched by age, gender, and years of education. We also examined the interaction of pain with age in terms of cognitive performance. Some limitations of previous clinical research investigating the effects of chronic pain on cognitive function include differences in the pain and cognitive scale materials used, and the heterogeneity of patient participants, both in terms of their demographics and pathological conditions. To address these potential confounds, we have used a relatively homogenous patient group and included both experimental and statistical controls. We have also specifically investigated the interaction effect of pain and age on cognitive performance. Patients (n = 38) and controls (n = 38) were administered a battery of cognitive tests measuring IQ, spatial and verbal memory, attention, and executive function. Educational level, depressive symptoms, and state anxiety were assessed as were medication usage, caffeine, and nicotine consumption to control for possible confounding effects. Both the level of depressive symptoms and the state anxiety score were higher in chronic pain patients than in matched control participants. Chronic pain patients had a lower estimated IQ than controls, and showed impairments on measures of spatial and verbal memory. Attentional responding was altered in the patient group, possibly indicative of impaired inhibitory control. There were significant interactions between chronic pain condition and age on a number of cognitive outcome variables, such that older patients with chronic pain were more impaired than both age-matched controls and younger patients with chronic pain. Chronic pain did not appear to predict performance on the Wisconsin Card Sorting Task, which was used a measure of executive function. This study supports and extends previous research indicating that chronic pain is associated with impaired memory and attention. Perspective: Compared to healthy control participants, patients with chronic neuropathic or radicular pain showed cognitive deficits which were most pronounced in older pain patients.

New strategies to control the inflammatory response in cardiac surgery.

PURPOSE OF REVIEW: To present and interpret data from recent clinical studies (July 2002-August 2003) of strategies to control the inflammatory response after cardiac surgery. RECENT FINDINGS: Off-pump coronary artery bypass techniques, which avoid the need for extracorporeal circulation, attenuate the inflammatory response and appear to confer clinical benefit. Concerns regarding the quality of the revascularization after off-pump coronary artery bypass appear to have been allayed. At present, ventricular assist devices do not enhance the efficacy of off-pump coronary artery bypass. In patients undergoing cardiopulmonary bypass, heparin-coated circuits, hypothermic pulmonary perfusion, normoxic reperfusion after aortic unclamping, and modified ultrafiltration hold promise. Strategies to maintain perioperative haemodynamic stability, such as enoximone therapy, may be beneficial, particularly in elderly patients. Aprotinin may have important beneficial anti-inflammatory actions in higher-risk adult and paediatric patients. The therapeutic potential of corticosteroids, particularly when administered in multiple dosages is increasingly clear. Direct anti-mediator therapies that focus upon key effector molecules and pathways of the inflammatory response offer future therapeutic options. SUMMARY: The potential for strategies that inhibit the inflammatory response to improve outcome after cardiac surgery is clear. Large-scale multicentre trials investigating the most promising strategies, including off-pump coronary artery bypass, heparin-coated circuits, and perioperative corticosteroid and aprotinin therapy, are urgently needed. These trials need to be restricted to the high-risk patient groups most likely to experience benefit. In the interim, the optimal strategy to minimize the inflammatory response to cardiac surgery will remain elusive.