The effect of pain neuroscience education on chronic postsurgical pain after total knee arthroplasty: a randomized controlled trial.

BACKGROUND AND PURPOSE:  Chronic postsurgical pain after total knee arthroplasty (TKA) is frequent and may be reduced by pain neuroscience education (PNE), teaching people about pain from a neurobiological perspective. This study investigated primarily the effectiveness of 2 individual sessions of PNE versus usual care on pain levels 3 months postoperatively in patients undergoing TKA. Secondary outcomes were physical functioning, stiffness, health-related quality of life, pain catastrophizing, attention to pain, and levels of anxiety and depression. METHODS:  A prospective single-center, parallel-group randomized controlled trial was undertaken including patients aged 18 years or older scheduled for primary TKA. 68 patients were randomly assigned to PNE or usual care. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score 3 months postoperatively. Outcomes were measured preoperatively, at 2 weeks (acute phase), and at 3 and 12 months postoperatively. RESULTS:  We found no statistically significant difference (0.4 points; 95% confidence interval [CI] -1.7 to 2.4) in WOMAC pain scores 3 months after TKA between the PNE and control group. We found a statistically significant difference between the 2 groups for attention to pain at 3 months in favor of PNE (P = 0.02). CONCLUSION:  This RCT showed that PNE was not superior to usual care in terms of reducing pain at 3 months after TKA. Attention to pain, as a secondary outcome, was significantly lower in the PNE group compared with usual care. Other secondary outcome measures showed no significant differences.

Molecular epidemiology of Cryptosporidium in humans and cattle in The Netherlands.

The protozoan parasite Cryptosporidium is found world-wide and can cause disease in both humans and animals. To study the zoonotic potential of Cryptosporidium in The Netherlands we isolated this parasite from the faeces of infected humans and cattle and genotyped those isolates for several different markers. The overall genotyping results showed: for humans isolates, 70% Cryptosporidium hominis, 19% Cryptosporidium parvum, 10% a combination of C. hominis and C. parvum, and 1% Cryptosporidium felis; and for cattle isolates 100% C. parvum. Analysis of the genetic variants detected for the HSP70, ML1 and GP60 markers showed: for human isolates, one C. hominis and two C. parvum variants (C. parvum and C. parvum NL) for HSP70, one C. hominis and five C. parvum variants (C1, C2, C3, and C2 NL1 and C2 NL2) for ML1, four C. hominis (mainly IbA10G2) and four C. parvum variants (mainly IIaA15G2R1) for GP60; and the cattle isolates only C. parvum (not C. parvum NL1) for HSP70, C1 and C2 for ML1, and 17 different IIa sub-types (mainly IIaA15G2R1) for GP60. Molecular epidemiological analysis of the human data showed a C. hominis peak in autumn. The majority (80%) of the human cases were children aged between 0 and 9 years and >70% of these were caused by C. hominis. Patients >25 years of age were infected mainly with C. parvum. We conclude that C. hominis IbA10G2 is found at high frequencies in autumn in humans and not in cattle. The high prevalence of C. parvum IIaA15G2R1 in both humans and cattle indicates that cattle may be a reservoir for this sub-type in The Netherlands.