[Specific therapy needs of young adults with chronic pain : Results of a qualitative interview study]. / Spezifische Therapiebedürfnisse junger Erwachsener mit chronischen Schmerzen : Ergebnisse einer qualitativen Interviewstudie.

BACKGROUND: Young adults find themselves in an unstable phase of life with relationship breaks, falling structures and great challenges in life. Chronic pain makes it difficult to cope with this stage of life due to functional, emotional and social limitations. For this age group there are hardly any target group-specific treatment programs. OBJECTIVE: The aim of the study was to find out what needs the patient group of young adults with chronic pain have with regard to inpatient pain therapy and what need is indicated for a separate therapy concept for this age group. MATERIAL AND METHODS: Within the framework of a qualitative research approach, specific needs of young adults with regard to inpatient pain therapy were surveyed via guideline-based interviews. A total of 66 interviews were conducted with patients and practitioners. The evaluation was carried out using the method of structuring qualitative content analysis. RESULTS: Five main categories regarding the specific treatment needs of young adult pain patients were identified: respect, belonging, special circumstances, locating the pain and specific elements of therapy. CONCLUSION: Special living conditions and a respectful treatment attitude are of particular importance. A greater number of activation offers, a higher proportion of life counseling and perspective-creating aspects as well as psychotherapeutic offers are a necessity for an efficient therapy. Acceptance and commitment therapy techniques and the positive benefits of peer groups can expand the treatment approach for young adults. Young adults could benefit from a target group-specific and needs-adapted care structure.

A scoping review of chronic pain in emerging adults.

Much of the adult chronic pain literature addresses pain in typical pain cohorts of middle-aged to older individuals. To date, little research has focused on chronic pain in younger adults, who likely have a completely different pain experience. This scoping review aimed to address this gap by describing the emerging adult (18-29 years) chronic pain experience regarding prevalence, associated factors, outcomes, and pain management. Searches of primary electronic databases including PubMed, Embase, PsycINFO, and CINAHL were performed on February 26, 2020, restricting the publication date from database inception to December 31, 2019. The search strategy, conducted in English, covered search term combinations of "chronic pain" and "young adults." A total of 6,612 records were considered-3,141 after removing duplicates. These records were screened by title and abstract; 871 through full-text screening. Of these, 78 articles covered the topic of emerging adults with chronic pain. Collectively, results indicated that between 5% and 30% of emerging adults experience chronic pain, depending on the sample and exact chronic pain definition. The most consistent associated factors were female sex, familial chronic pain, and previous experiences of chronic pain in childhood. Anxiety, depression, and sleep issues appeared associated both before and after the onset of chronic pain. Outcomes of pain included interruptions to study and work, poorer physical functioning, and pain-related interference to socializing. We observed that few pain treatments have been tested specifically in this cohort. A greater ongoing focus on chronic pain in emerging adults is required to improve long-lasting outcomes.

[Diagnostics and therapy in children and adolescents with chronic pain : Trends in interventions potentially dangerous to health]. / Diagnostik und Therapie bei Kindern und Jugendlichen mit chronischem Schmerz : Zeitliche Entwicklung potenziell gesundheitsgefährdender Maßnahmen.

BACKGROUND AND OBJECTIVES: Current research on the treatment of chronic pain in children suggests an increasing trend internationally in the quantity as well as invasiveness of diagnostic and therapeutic interventions. The objective of this research was to examine the interventions received by patients before starting specialized inpatient pain treatment. MATERIALS AND METHODS: A retrospective survey was conducted analyzing patient files from a tertiary children's pain center from 2004, 2008, 2012 and 2016 (N = 585). In addition to diagnostic and therapeutic interventions, pain and patients' characteristics were collected. The identified measures were subsequently evaluated by an interdisciplinary expert panel regarding their invasiveness, potential risk and degree of mental burden. RESULTS: An increase in diagnostic measures and medication was found up to 2012. Thereafter, a decreasing trend was identified (χ2(3) = 11.708; p = 0.008). Invasiveness (χ2(3) = 13.342; p = 0.004), risk (χ2(3) = 13.135; p = 0.004) and mental burden (χ2(3) = 14.403; p = 0.002) showed the same pattern of change. Patients with abdominal and limb pain are particularly at risk for highly invasive and high risk diagnostics. CONCLUSIONS: Evidence for an increase in diagnostic and therapeutic measures in chronic pain was found up to 2012. Patients presenting with certain complaints receive comparably more invasive, risky and burdensome measures.

Play to Win: Action Video Game Experience and Attention Driven Perceptual Exploration in Categorization Learning.

Categorization learning is a fundamental and complex cognitive ability. The present EEG study examined how much action video gamers differ from non-gamers in the usage of visual exploration and attention driven perceptual analyses during a categorization learning task. Seventeen healthy right-handed non-gamers and 16 healthy right-handed action video gamers performed a visual categorization task with 14 ring stimuli, which were divided into two categories. All stimuli had the same structure but differed with respect to their color combinations and were forming two categories including a prototype, five typical stimuli and one exception. The exception shared most similarities with the prototype of the opposite group. Prototypes and typical stimuli were correctly categorized at an early stage of the experiment, whereas the successful categorization of exceptions occurred later. The behavioral data yield evidence that action video gamers perform correct categorizations of exceptions earlier than non-gamers. Additionally, groups differed with respect to differential expressions of the attention related P150 ERP component (early perceptual analysis) and the N170 ERP component, which reflected differential processing demands for the stimulus material. In comparison to non-gamers, the analyses of the eye movements yield for action video gamers different, more central fixations possibly indicating covert peripheral processing. For both groups fixations as well as saccades decrease and in the case of exceptions, one of the two segments that are decisive for correct categorization shows higher fixation rates at the end of the experiment. These findings indicate for both groups a learning process regarding the stimulus material. Regarding the group differences, we interpret the results to indicate that action video gamers show a different stimulus exploration, use an enhanced early perceptual analysis of the stimulus material and therefore may detect changes in objects faster and learned the belonging of the stimuli to their categories in an earlier trial phase.

[Interdisciplinary multimodal inpatient pain treatment for young adults : Influence of autonomy on effectiveness]. / Interdisziplinäre multimodale stationäre Schmerztherapie für junge Erwachsene : Einfluss der Autonomie auf die Effektivität.

BACKGROUND: Emerging adulthood between the ages of 18 and 25 are vulnerable years that offer many opportunities and simultaneously represent huge challenges for autonomy and identity development. Chronic pain in this vulnerable stage of life is associated with long-term negative consequences. So far, knowledge regarding the effectiveness of treatment offers for this patient group is scarce. OBJECTIVE: The aim of this study is to examine the effectiveness of a multimodal inpatient pain therapy for young adults with chronic pain. In addition, the change and influence of the autonomy development will be investigated. MATERIALS AND METHODS: The present longitudinal study examined the effectiveness of a 3-week multimodal inpatient pain treatment in young adults with chronic pain. Three-month follow-up data from 74 patients aged 18-25 years (75.7% female) were included in the study. Standardized questionnaires were used to investigate pain characteristics, pain-associated and emotional impairments quality of life, and various facets of autonomy. RESULTS: The results show that pain-related and emotional impairments are significantly reduced after therapy. Furthermore, there is a significant improvement in the quality of life and resilience. The increased quality of life and reduced pain-related and emotional impairment are associated with a gain of autonomy convictions. DISCUSSION: Multimodal inpatient pain treatment seems to be effective during emerging adulthood. Autonomy convictions seem to be an important starting point for therapeutic success and have a modulating importance in terms of positive changes in emotional impairment and quality of live. Therefore, this aspect should be considered when pain treatment offers are developed for this age group.

Predictors of treatment outcome in children with medically unexplained pain seeking primary care: A prospective cohort study.

BACKGROUND: Medically unexplained pain in children and adolescents is a common and increasing health care problem. Primary care is usually the first point of contact for these patients. It is the overall objective of this study to investigate treatment outcome of medically unexplained pain in paediatric primary care and to identify predictors of treatment failure. METHOD: In a prospective observational cohort study with three assessments over 6 months, N = 266 children (6-17 years) presenting to paediatric primary care due to medically unexplained pain were included. The primary outcome is treatment failure after 6 months defined as disabling chronic pain. Risk factors for treatment failure were identified by means of logistic regression analyses. RESULTS: At the 6-months follow-up, treatment proved unsuccessful in 22.6% of patients. In patients with headaches, high functional impairment and strong emotional pain burden at study inclusion, the risk for treatment failure was increased. However, when also including data on the initial treatment response, pain location and functional impairment were no longer significant. Patients who did not respond to treatment within the first 3 months were more likely to experience treatment failure (OR = 203.7 ; p < 0.001) at 6 months, as were children with a higher emotional pain burden at study inclusion (OR = 1.3; p = 0.007; R2  = 0.781). CONCLUSIONS: This study indicates that paediatric primary care is not sufficient for nearly one-quarter of the children with medically unexplained pain. Individuals without a positive treatment response after 3 months are at increased risk for treatment failure. SIGNIFICANCE: This study investigates the treatment outcome of medically unexplained pain in paediatric primary care. Individuals with a higher emotional pain burden at the first visit and those without positive treatment response after 3 months are at increased risk for treatment failure. Therefore, a stepped-care approach seems warranted. After an insufficient primary care trial of 3 months, patients should be transferred to pain specialists for a more intense treatment.

Games people play: How video games improve probabilistic learning.

Recent research suggests that video game playing is associated with many cognitive benefits. However, little is known about the neural mechanisms mediating such effects, especially with regard to probabilistic categorization learning, which is a widely unexplored area in gaming research. Therefore, the present study aimed to investigate the neural correlates of probabilistic classification learning in video gamers in comparison to non-gamers. Subjects were scanned in a 3T magnetic resonance imaging (MRI) scanner while performing a modified version of the weather prediction task. Behavioral data yielded evidence for better categorization performance of video gamers, particularly under conditions characterized by stronger uncertainty. Furthermore, a post-experimental questionnaire showed that video gamers had acquired higher declarative knowledge about the card combinations and the related weather outcomes. Functional imaging data revealed for video gamers stronger activation clusters in the hippocampus, the precuneus, the cingulate gyrus and the middle temporal gyrus as well as in occipital visual areas and in areas related to attentional processes. All these areas are connected with each other and represent critical nodes for semantic memory, visual imagery and cognitive control. Apart from this, and in line with previous studies, both groups showed activation in brain areas that are related to attention and executive functions as well as in the basal ganglia and in memory-associated regions of the medial temporal lobe. These results suggest that playing video games might enhance the usage of declarative knowledge as well as hippocampal involvement and enhances overall learning performance during probabilistic learning. In contrast to non-gamers, video gamers showed better categorization performance, independently of the uncertainty of the condition.

Out of sight, out of mind: Categorization learning and normal aging.

The present combined EEG and eye tracking study examined the process of categorization learning at different age ranges and aimed to investigate to which degree categorization learning is mediated by visual attention and perceptual strategies. Seventeen young subjects and ten elderly subjects had to perform a visual categorization task with two abstract categories. Each category consisted of prototypical stimuli and an exception. The categorization of prototypical stimuli was learned very early during the experiment, while the learning of exceptions was delayed. The categorization of exceptions was accompanied by higher P150, P250 and P300 amplitudes. In contrast to younger subjects, elderly subjects had problems in the categorization of exceptions, but showed an intact categorization performance for prototypical stimuli. Moreover, elderly subjects showed higher fixation rates for important stimulus features and higher P150 amplitudes, which were positively correlated with the categorization performances. These results indicate that elderly subjects compensate for cognitive decline through enhanced perceptual and attentional processing of individual stimulus features. Additionally, a computational approach has been applied and showed a transition away from purely abstraction-based learning to an exemplar-based learning in the middle block for both groups. However, the calculated models provide a better fit for younger subjects than for elderly subjects. The current study demonstrates that human categorization learning is based on early abstraction-based processing followed by an exemplar-memorization stage. This strategy combination facilitates the learning of real world categories with a nuanced category structure. In addition, the present study suggests that categorization learning is affected by normal aging and modulated by perceptual processing and visual attention.

Reconstituted high-density lipoprotein can elevate plasma alanine aminotransferase by transient depletion of hepatic cholesterol: role of the phospholipid component.

Human apolipoprotein A-I preparations reconstituted with phospholipids (reconstituted high-density lipoprotein [HDL]) have been used in a large number of animal and human studies to investigate the physiological role of apolipoprotein A-I. Several of these studies observed that intravenous infusion of reconstituted HDL might cause transient elevations in plasma levels of hepatic enzymes. Here we describe the mechanism of this enzyme release. Observations from several animal models and in vitro studies suggest that the extent of hepatic transaminase release (alanine aminotransferase [ALT]) correlates with the movement of hepatic cholesterol into the blood after infusion. Both the amount of ALT release and cholesterol movement were dependent on the amount and type of phospholipid present in the reconstituted HDL. As cholesterol is known to dissolve readily in phospholipid, an HDL preparation was loaded with cholesterol before infusion into rats to assess the role of diffusion of cholesterol out of the liver and into the reconstituted HDL. Cholesterol-loaded HDL failed to withdraw cholesterol from tissues and subsequently failed to cause ALT release. To investigate further the role of cholesterol diffusion, we employed mice deficient in SR-BI, a transporter that facilitates spontaneous movement of cholesterol between cell membranes and HDL. These mice showed substantially lower movement of cholesterol into the blood and markedly lower ALT release. We conclude that initial depletion of hepatic cholesterol initiates transient ALT release in response to infusion of reconstituted HDL. This effect may be controlled by appropriate choice of the type and amount of phospholipid in reconstituted HDL. Copyright © 2015 John Wiley & Sons, Ltd.

Biodistribution of the recombinant fusion protein linking coagulation factor IX with albumin (rIX-FP) in rats.

INTRODUCTION: The recombinant fusion protein linking coagulation factor IX with albumin (rIX-FP) is undergoing clinical trials for prophylaxis and on-demand treatment of haemophilia B patients. The aim of this study was to investigate the pharmacokinetics, whole-body and knee joint distribution of rIX-FP following intravenous administration to rats, compared with a marketed, non-fused rFIX and recombinant human albumin. MATERIAL AND METHODS: [(3)H]-rIX-FP, [(3)H]-rFIX or [(3)H]-albumin were administered to rats followed by quantitative whole-body autoradiography over 24 or 240 hours, and the tissue distribution as well as elimination of radioactivity were measured. RESULTS: Elimination of all radioactivity derived from the three proteins was shown to occur primarily via the urine. The tissue distribution of [(3)H]-rIX-FP and [(3)H]-rFIX (but not of [(3)H]-albumin) was comparable, both penetrating predominantly into bone, and well-perfused tissues, suggesting that the rIX moiety determines the distribution pattern of rIX-FP, while the albumin moity is responsible for the prolonged plasma and tissue retention. Detailed knee-joint analysis indicated rapid presence of [(3)H]-rIX-FP and [(3)H]-rFIX in synovial and mineralised bone tissue, mostly localised to the zone of calcified cartilage. Longest retention times were observed in the bone marrow and the endosteum of long bones. Intriguingly, [(3)H]-rIX-FP- and [(3)H]-albumin-derived radioactive signals were detectable up to 240 hours, while [(3)H]-rFIX-derived radioactivity rapidly declined after 1hour post-dosing correlating to the extended plasma half-life of [(3)H]-rIX-FP. CONCLUSION: The prolonged plasma and tissue retention of rIX-FP achieved by albumin fusion may allow a reduction in dosing frequency leading to increased therapeutic compliance and convenience.