How are socio-demographic and psycho-social factors associated with the prevalence and chronicity of severe pain in 14 different body sites? A cross-sectional population-based survey.

BACKGROUND: Severe pain and chronic pain have a high impact on individuals and society. Body location of pain is important with regard to perception, articulation, and underlying biological, mental or social causes of pain. METHODS: A cross-sectional survey was performed in the general Austrian population with 15,474 personally interviewed subjects aged 15 years and older. RESULTS: The 1­year period prevalence of severe pain in any body site was 38.6% and of chronic pain 24.9%. In all, 8.1% had pain in at least three body sites. Subjects aged 65 years and older (52.2%), those with low education (43.4%), unemployed subjects (50.4%), retired subjects (52.4%), those with anxiety/depression (67.7%), and subjects with lack of social support (49.6%) were sub-populations with high pain prevalence. In multivariate analyses, depression/anxiety was associated with prevalence and chronicity of severe pain in all body sites (range of ORs 1.89-5.01), while such associations were found for lack of social support (range of ORs 1.33-1.65), female sex (range of ORs 1.38-2.34), higher age (range of ORs 1.09-1.18 for 5 year intervals), as well as low educational (range of ORs 1.47-2.06 primary vs. tertiary education) and unemployment status (range of ORs 1.50-2.62) in most body sites. Being born in non-EU or EFTA states was associated with pain in many body sites (range of ORs 1.38-2.10). CONCLUSIONS: Psychosocial factors are associated with pain presence in similar ways irrespective of location. Regarding socio-demographic factors, differences towards the magnitude and the direction in the association with pain frequency and chronicity in different body sites emerged.

Anatomic Double-Bundle Reinsertion After Acute Proximal Anterior Cruciate Ligament Injury Using Knotless PushLock Anchors.

Direct anterior cruciate ligament (ACL) repair has been described with different suture techniques after acute ACL injury, but these procedures showed high failure rates. Recent studies, however, led to a better understanding of the biology of primary ACL healing. This article describes a novel technique combining the "healing response technique" with primary anatomic double-bundle ACL reinsertion after an acute proximal ACL tear using nonabsorbable No. 2 FiberWire (Arthrex, Naples, FL) and PushLock knotless suture anchors (Arthrex). We recommend this technique for patients with acute proximal avulsion-type ACL injuries. Postoperatively, we recommend a knee brace locked in full extension for at least 4 weeks to ensure adequate immobilization and then to increase knee flexion slowly over the next 4 weeks for subsequent healing of the ACL repair. Our technique combines anatomic positioning and reinsertion of the ACL bundles with microfracturing of the region delivering stem cells and growth factors to the repaired ACL, creating optimal conditions for the healing period. In certain cases this technique might be an alternative to conventional ACL reconstruction with autograft or allograft tendons.

Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial.

The role of calcifediol in the perception of chronic pain is a widely discussed subject. Low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome (FMS). We lack evidence of the role of vitamin D supplementation in these patients. To our knowledge, no randomized controlled trial has been published on the subject. Thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria, with serum calcifediol levels <32ng/mL (80nmol/L), were randomized to treatment group (TG) or control group (CG). The goal was to achieve serum calcifediol levels between 32 and 48ng/mL for 20weeks via oral supplementation with cholecalciferol. The CG received placebo medication. Re-evaluation was performed in both groups after a further 24weeks without cholecalciferol supplementation. The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain (visual analog scale score). Additional variables were evaluated using the Short Form Health Survey 36, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and the Somatization subscale of Symptom Checklist-90-Revised. A marked reduction in pain was noted over the treatment period in TG: a 2 (groups)×4 (time points) variance analysis showed a significant group effect in visual analog scale scores. This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36. Optimization of calcifediol levels in FMS had a positive effect on the perception of pain. This economical therapy with a low side effect profile may well be considered in patients with FMS. However, further studies with larger patient numbers are needed to prove the hypothesis.

A controlled examination of medical and psychosocial factors associated with low back pain in combination with widespread musculoskeletal pain.

BACKGROUND: Little is known about chronic low back pain (CLBP) in combination with widespread musculoskeletal pain (WMP). OBJECTIVE: This study examined factors that may be common to these conditions, with the objective of detecting factors that could improve the course of these diseases. DESIGN: This was a prospective case control study. PATIENTS AND INTERVENTION: A group of patients with CLBP and WMP (CLBP+WMP group, n=97) was compared with a group of individuals who were pain-free and without a history of musculoskeletal problems (control group, n=97) and with a group of patients with CLBP but without WMP (CLBP-only group, n=52). The mean age of the participants was 42.9 years (SD=8.74); 76% were women, and 24% were men. MEASUREMENTS: A total of 74 variables were measured, including sociodemographic, physical, and psychosocial variables. After univariate examination for group differences and analyses of variables available for all 3 groups, logistic regression on selected factors was performed. The alpha level was set at .05, but was adjusted to avoid randomly significant results. RESULTS: For a number of variables, significant differences among the 3 groups were observed. For regression model 1 for the CLBP+WMP and control groups, 4 out of 9 variables showed significant likelihood tests: income (lower in the WMP group), depression, anxiety, and fear-avoidance behavior. For regression model 2, 2 out of 13 variables showed significant likelihood tests: endurance capacity (more in the CLBP+WMP group) and balance capability (worse in the CLBP+WMP group). The models predicted at least 91.2% of all cases to the correct group. The regression analysis regarding the CLBP+WMP and CLBP-only groups predicted 86.7% of all cases to the correct group. Three out of 10 variables showed significant likelihood tests: high disability, fear-avoidance behavior, and number of treatments. LIMITATIONS: Some variables in testing the patients with WMP and the individuals who were pain-free were not used with the patients with CLBP only. CONCLUSIONS: Patients with CLBP and WMP should be examined for indicated physical and psychosocial factors. Therapeutic management should consider them in the early stage of the disease. These findings also might apply to patients with fibromyalgia or myofascial pain.

[Motivation for physical activity - a survey in a Central European state]. / Motivation zur Bewegung - Eine Umfrage in einem zentraleuropäischen Staat.

INTRODUCTION: Physical activity has high importance in the prevention of diseases, particularly where lifestyle diseases are concerned. To motivate a person to be physically active often proves to be difficult in clinical practice. Thus it was the aim of this study to find out through interviews how to best motivate most notably the part of the population that is less active. METHODS: 500 persons aged from 15 years onwards were asked in face-to-face interviews about their leisure activities, self-assessment of their personal fitness, and about inhibiting and motivating factors in connection with their physical activity. RESULTS: Only every second interviewed person is intentionally active in order to improve his/her own fitness. The better part of the inactive population can envisage introducing more physical activity into their everyday life. There are various reasons that instigate to be more active: above all, the recommendation of doctors, but also the wish for physical wellbeing or group dynamics act as a stimulant. Would there be an advertising campaign promoting the importance of physical activity, top athletes and physicians would have the most motivating impact. CONCLUSION: A sustainable and favourable effect on health promotion could be achieved most notably by motivating people to add more physical activity to their everyday life.

[Treatment with crystal singing bowls for chronic spinal pain and chronobiologic activities - a randomized controlled trial]. / Quarzklangschalentherapie bei Wirbelsäulenbeschwerdenund chronobiologische Vorgänge - eine randomisiertekontrollierte Studie.

INTRODUCTION: This prospective randomized controlled trial examined the effect of harmonic vibrations of crystal singing bowls on the perception of pain, subjective wellbeing and chronobiologic activities (quality of sleep) in patients with chronic unspecific spinal pain. SUBJECTS AND METHODS: 54 persons with chronic, unspecific spinal pain participated in the study. The treatment group (IG) received 6 units of a singing bowl therapy, the placebo group (KG) received a placebo treatment. The control group (NG) was not treated at all. Pain intensity, pain disability and quality of life were evaluated right before and 1 week after the intervention, pulse rate and skin conductance were measured during 3 therapeutic sessions. A 24-hour measurement of the heart rate variability to evaluate quality of sleep was made four times. Before and after each session the Multidimensional Mood State Questionnaire (MDBF) was filled out. RESULTS: IG and KG had significant lower pain intensities compared to the NG. The NG even experienced an increase in pain intensity. The results of the MDBF suggest an unspecific relaxing effect of the intervention in IG and KG. Twice during the treatment a significant decrease of the pulse rate could be observed. CONCLUSION: Under the given conditions the hypothesis of pain relief and chronobiologic changes in patients with chronic spinal pain by a treatment with crystal singing bowls compared to placebo could not be confirmed.