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1.
JAMA ; 325(7): 646-657, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33591346

RESUMEN

Importance: Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis or whether it may worsen knee symptoms. Objective: To determine whether high-intensity strength training reduces knee pain and knee joint compressive forces more than low-intensity strength training and more than attention control in patients with knee osteoarthritis. Design, Setting, and Participants: Assessor-blinded randomized clinical trial conducted at a university research center in North Carolina that included 377 community-dwelling adults (≥50 years) with body mass index (BMI) ranging from 20 to 45 and with knee pain and radiographic knee osteoarthritis. Enrollment occurred between July 2012 and February 2016, and follow-up was completed September 2017. Interventions: Participants were randomized to high-intensity strength training (n = 127), low-intensity strength training (n = 126), or attention control (n = 124). Main Outcomes and Measures: Primary outcomes at the 18-month follow-up were Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) knee pain (0 best-20 worst; minimally clinically important difference [MCID, 2]) and knee joint compressive force, defined as the maximal tibiofemoral contact force exerted along the long axis of the tibia during walking (MCID, unknown). Results: Among 377 randomized participants (mean age, 65 years; 151 women [40%]), 320 (85%) completed the trial. Mean adjusted (sex, baseline BMI, baseline outcome values) WOMAC pain scores at the 18-month follow-up were not statistically significantly different between the high-intensity group and the control group (5.1 vs 4.9; adjusted difference, 0.2; 95% CI, -0.6 to 1.1; P = .61) or between the high-intensity and low-intensity groups (5.1 vs 4.4; adjusted difference, 0.7; 95% CI, -0.1 to 1.6; P = .08). Mean knee joint compressive forces were not statistically significantly different between the high-intensity group and the control group (2453 N vs 2512 N; adjusted difference, -58; 95% CI, -282 to 165 N; P = .61), or between the high-intensity and low-intensity groups (2453 N vs 2475 N; adjusted difference, -21; 95% CI, -235 to 193 N; P = .85). There were 87 nonserious adverse events (high-intensity, 53; low-intensity, 30; control, 4) and 13 serious adverse events unrelated to the study (high-intensity, 5; low-intensity, 3; control, 5). Conclusions and Relevance: Among patients with knee osteoarthritis, high-intensity strength training compared with low-intensity strength training or an attention control did not significantly reduce knee pain or knee joint compressive forces at 18 months. The findings do not support the use of high-intensity strength training over low-intensity strength training or an attention control in adults with knee osteoarthritis. Trial Registration: ClinicalTrials.gov Identifier: NCT01489462.


Asunto(s)
Articulación de la Rodilla/fisiología , Osteoartritis de la Rodilla/terapia , Manejo del Dolor/métodos , Entrenamiento de Resistencia/métodos , Anciano , Índice de Masa Corporal , Fuerza Compresiva , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/fisiopatología , Dolor/etiología , Dolor/rehabilitación , Dimensión del Dolor , Método Simple Ciego
2.
Medicine (Baltimore) ; 100(4): e23755, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530175

RESUMEN

BACKGROUND: Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis is the most common cause of dental pain and arise from an inflamed or necrotic dental pulp. There is growing evidence to support the effectiveness of probiotics in combination with antibiotics on periodontitis. We therefor will conduct this study to evaluate the clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis. METHODS: We will systematically search the following databases: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM), and WanFang database. A grey literature search will be conducted using ZETOC Conference Proceedings and Open Grey. Only randomized controlled trials (RCTs) related to research on probiotics in combination with antibiotics to treatment patients with periodontitis will be included. All sources have to be searched from their inception to October 2020. Two authors will independently select studies, extract study data, and evaluate the quality of the included studies. We will use Review Manager Software (RevMan 5.3) to analyze data. RESULTS: This study will systematically evaluate the clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis. CONCLUSIONS: This study will generate evidence for a better clinical decision of patients with periodontitis. REGISTRATION NUMBER: DOI 10.17605/OSF.IO/QZ6SB (https://osf.io/qz6sb/).


Asunto(s)
Antibacterianos/uso terapéutico , Metaanálisis como Asunto , Periodontitis Periapical/tratamiento farmacológico , Probióticos/uso terapéutico , Revisiones Sistemáticas como Asunto , Toma de Decisiones Clínicas , Protocolos Clínicos , Quimioterapia Combinada , Humanos , Dolor/prevención & control , Periodontitis Periapical/complicaciones , Proyectos de Investigación
3.
BMC Psychol ; 9(1): 34, 2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33622412

RESUMEN

BACKGROUND: Pain is one of the most common and unpleasant symptoms of patients with cancer. The Short Form Brief Pain Inventory (SF-BPI), has been psychometrically validated in several languages and widely used globally. Availability of a validated pain tool in Sinhala is a current requirement enabling the use among the majority of Sinhala-speaking cancer patients in Sri Lanka. The purpose of the study was to evaluate the psychometric properties of Sinhala translated version of SF BPI. METHODS: The translation was done by forward-backward translation method. Content and face validity were evaluated by a panel of experts and patients with cancer pain respectively. The study included 151 participants with cancer pain, registered at the Pain Clinic, Apeksha Hospital, Sri Lanka. The reliability, discriminant and convergent validity were assessed. The confirmatory factor analysis (CFA) was conducted and evaluated the two factor (severity, interference) and three factor models (severity, affective/ activity interference). In the three factor model-1, item 'sleep' was included within the affective interference along with mood, relationship with others and enjoyment of life. In the three factor model-2, item 'sleep' was included within the activity interference along with general activities, walking and normal works. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. RESULTS: A total of 151 participants (79 males, 72 females) with a mean age of 54.6 (+/- 13.2) years were included. The composite reliability (0.902, 0.879), average variance extracted (AVE) (0.647, 0.568) and Cronbach's alpha (0.819, 0.869) calculated for each severity and interference subscales were acceptable. The discriminant validity assessed with the heterotrait-monotrait criterion was 0.18. According to the Fornell-Larcker criterion, the square root of AVE of severity and interference factors (0.804, 0.753) greater than the correlation between the factors (0.140) demonstrated the discriminant validity. The CFA supported the three-factor model-2 (CFI-0.959, SRMR-0.0513, RMSEA-0.0699) and the values for two-factor and three-factor model-1 were marginally acceptable. CONCLUSIONS: The Sinhala version of SF BPI is a reliable and valid instrument for the assessment of cancer pain among Sinhala speaking patients in Sri Lanka.


Asunto(s)
Dolor en Cáncer , Neoplasias , Adulto , Anciano , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Dolor , Psicometría , Reproducibilidad de los Resultados , Sri Lanka
6.
Oral Health Prev Dent ; 19(1): 115-120, 2021 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-33600088

RESUMEN

PURPOSE: Psychosocial impacts on quality of life among adolescents with access to affordable dental care is not well documented. In addition, dental pain is accelerating towards a public health problem that needs immediate attention. The objective was to determine impacts on quality of life using the Oral Impacts on Daily Performances (OIDP) frequency scale and to determine prevalence of dental pain with its impact. METHODS: A total of 288 students (mean age 15.72 ± 1.5) completed the survey instrument (sociodemographic variables, consumption of chocolates/candies, perceived need for dental care, history of dental pain in last 6 months and OIDP frequency scale) designed to measure subjective oral health indicators. Mean OIDP simple count scores were analysed using logistic regression and additive (ADD) scores for dental pain were compared using student's t test. RESULTS: The response rate was 96%. About 44.4% reported impacts affecting daily performances. About 11.4% consumed tobacco and 92.7% consumed forms of refined sugars. About 39% perceived a need for dental care and 32.3% experienced dental pain with problem in eating and cleaning teeth. Those not perceiving a need for dental care were more likely to have an impact (OR: 2.3; CI: 1.2-4.4). Males had higher OIDP ADD scores for dental pain than females (p = 0.015). CONCLUSION: Overall impact was less than 50%. Dental pain was reported among students with access to dental care with impacts on eating and cleaning of teeth. Oral health promotion needs to be reinforced by strengthening school community relationship.


Asunto(s)
Salud Bucal , Calidad de Vida , Actividades Cotidianas , Adolescente , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Dolor , Encuestas y Cuestionarios
7.
Vet Clin North Am Food Anim Pract ; 37(1): 1-16, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33541693

RESUMEN

Small ruminants are increasing in popularity as both production and companion animals in the United States. Among sheep, goats, and camelids, there are many disease processes and management techniques that have the potential to result in painful or noxious stimuli. In these species, many medications and therapeutic techniques can be used to reduce or eliminate the long-term consequences of pain. This review focuses on the commonly used medications available for pain management of small ruminants and discusses the benefits and negative aspects of their use.


Asunto(s)
Camélidos del Nuevo Mundo , Enfermedades de las Cabras/tratamiento farmacológico , Manejo del Dolor/veterinaria , Dolor/veterinaria , Enfermedades de las Ovejas/tratamiento farmacológico , Analgésicos/uso terapéutico , Animales , Cabras , Ovinos
8.
Vet Clin North Am Food Anim Pract ; 37(1): 17-31, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33541697

RESUMEN

Small ruminants are increasing in popularity as production and companion animals in the United States, and among sheep, goats, and camelids there are many disease processes and management techniques that have the potential to result in painful or noxious stimuli. In these species, many medications and therapeutic techniques can be used to reduce or eliminate the long-term consequences of pain. In this second portion of the review, we focus on the application of pain management in these species. These strategies include mono- and multimodal and the use of precision pain management, such as epidural drug administration, regional perfusions, and transdermal applications.


Asunto(s)
Camélidos del Nuevo Mundo , Enfermedades de las Cabras/tratamiento farmacológico , Manejo del Dolor/veterinaria , Dolor/veterinaria , Enfermedades de las Ovejas/tratamiento farmacológico , Analgesia/métodos , Analgesia/veterinaria , Animales , Cabras , Dolor/tratamiento farmacológico , Manejo del Dolor/métodos , Rumiantes , Ovinos , Estados Unidos
9.
Arthroscopy ; 37(2): 518-520, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33546790

RESUMEN

Lack of high-quality evidence has limited the widespread acceptance of platelet-rich plasma, bone marrow aspirate, and other therapeutics, collectively referred to as "orthobiologics," for partial-thickness rotator cuff tears and associated tendinopathies. The existing literature is limited, among other things, by underpowered studies and imprecise descriptions of the administration and/or formulation of the platelet-rich plasma being investigated. However, recent research favors platelet-rich plasma over corticosteroid injections in the nonoperative treatment of rotator cuff pathology. In light of evidence showing a deleterious effect of corticosteroids on subsequent surgical interventions, surgeons should continue to be wary of subacromial corticosteroid injections if alternatives such as platelet-rich plasma exist. A corticosteroid injection may have been the "go-to" nonoperative intervention in the past, but platelet-rich plasma may be a more effective arrow in our quiver. Of course, the conspicuous cost differential between these 2 different injections remains a very real consideration. However, this should be weighed against the increased risk (and cost) of a revision repair in the event that a surgical repair is performed subsequent to a corticosteroid injection.


Asunto(s)
Plasma Rico en Plaquetas , Lesiones del Manguito de los Rotadores , Tendinopatía , Corticoesteroides/uso terapéutico , Método Doble Ciego , Humanos , Dolor , Manguito de los Rotadores , Lesiones del Manguito de los Rotadores/tratamiento farmacológico
10.
PLoS One ; 16(2): e0245999, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33529226

RESUMEN

This study aimed to understand the impact of COVID-19 distress on psychological status, features of central sensitization and facial pain severity in people with temporomandibular disorders (TMDs). In this prospective cohort study, 45 adults (19 chronic, 26 acute/subacute TMD) were recruited prior to the COVID-19 outbreak. Baseline assessment took place before the outbreak while a follow-up was performed immediately after the lockdown period. Multiple variables were investigated including age, gender, perceived life quality, sleep quality, anxiety and depression, coping strategies, central sensitization, pain intensity, pain-related disability and oral behaviour. COVID Stress Scales (CSS) were applied at follow-up to measure the extent of COVID-related distress. CSS were significantly higher in those with chronic TMDs compared to those with acute/subacute TMDs (p<0.05). In people with chronic TMD, the variation in anxiety and depression from baseline to follow-up was significantly correlated with scores on the CSS (r = 0.72; p = 0.002). Variations of the central sensitization inventory (r = 0.57; p = 0.020) and graded chronic pain scale (r = 0.59; p = 0.017) were significantly correlated with scores on the CSS. These initial findings indicate that people with chronic TMD were more susceptible to COVID-19 distress with deterioration of psychological status, worsening features of central sensitization and increased chronic facial pain severity. These findings reinforce the role of stress as a possible amplifier of central sensitization, anxiety, depression, chronic pain and pain-related disability in people with TMDs. Trial Registration: ClinicalTrials.gov ID: NCT03990662.


Asunto(s)
/psicología , Trastornos de la Articulación Temporomandibular/epidemiología , Adulto , Femenino , Humanos , Italia/epidemiología , Masculino , Dolor/epidemiología , Estudios Prospectivos , Distrés Psicológico , Índice de Severidad de la Enfermedad , Trastornos de la Articulación Temporomandibular/terapia
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(1): 84-88, 2021 Jan.
Artículo en Chino | MEDLINE | ID: mdl-33565407

RESUMEN

OBJECTIVE: To study the optimal pain control goal for preventing delirium in critical patients. METHODS: A prospective cohort study were conducted. The patients admitted to general departments and transferred to the intensive care unit (ICU) due to critical illness in the First People's Hospital of Changde from January 2017 to November 2019 were enrolled. The General data of the patients were collected within 48 hours after admission. All patients admitted to the ICU were evaluated for pain level using the critical care pain observation tool (CPOT) every 8 hours by nurses, and confusion assessment method of ICU (CAM-ICU) was used to screen delirium patient every 8 hours by the leader of nursing team without knowing the pain level of the patients, until the subjects were transferred out of ICU. The receiver operating characteristic (ROC) curve was drawn, the area under ROC curve (AUC) and the optimal threshold were analyzed with delirium as the reference standard; according to the optimal threshold, multivariate Logistic regression analysis was used to evaluate the correlation between CPOT score and delirium. RESULTS: During the study period, 575 patients were admitted to the participating departments and passed the preliminary screening according to the inclusion and exclusion criteria. During the study period, 34 patients were excluded due to incomplete data. Finally, a total of 541 patients were enrolled in the analysis, including 149 patients in delirium group and 392 patients in non-delirium group. There was no significant difference in gender, age, source of patients, education level, smoking history, drinking history, family mental history, acute physiology and chronic health evaluation II (APACHE II) score or other general information between the two groups. There were 10.1% (15/149) of patients in the delirium group used opioids, which was significantly higher than 4.3% (17/392) in the non-delirium group, and the difference was statistically significant (P < 0.05). The CPOT score in the delirium group was significantly higher than that in the non-delirium group (4.24±1.78 vs. 2.75±1.95, P < 0.01). The patients were subdivided into young group (< 40 years old), middle-aged group (40-65 years old) and old group (> 65 years old) according to age. The analysis results were consistent with the overall analysis results. ROC curve analysis showed that the AUC of CPOT score predicting delirium was 0.719; when the best threshold value of CPOT score was 2.5, the sensitivity was 91.3%, the specificity was 49.0%, the positive predictive value was 40.5% and the negative predictive value was 93.7%. Multivariate Logistic regression analysis showed that the risk of delirium in ICU patients with CPOT score ≥ 3 was 10.043 times higher than that in patients with CPOT score < 3 [odds ratio (OR) = 10.043, 95% confidence interval (95%CI) was 5.498-18.345, P < 0.001]. When the gender, age, APACHE II score, smoking history, drinking history, opioids usage were adjusted, the risk of delirium in patients with CPOT score ≥ 3 was 10.719 times higher than that in patients with CPOT score < 3 (OR = 10.719, 95%CI was 5.689-20.196, P < 0.001). CONCLUSIONS: The best pain control goal for preventing the occurrence of delirium in ICU patients is a CPOT score of 3 or less.


Asunto(s)
Delirio , Objetivos , APACHE , Adulto , Anciano , Delirio/prevención & control , Humanos , Unidades de Cuidados Intensivos , Persona de Mediana Edad , Dolor , Pronóstico , Estudios Prospectivos , Curva ROC
12.
Rev Med Liege ; 76(2): 122-127, 2021 Feb.
Artículo en Francés | MEDLINE | ID: mdl-33543859

RESUMEN

Because the knee is the joint of the human body with the largest surface, it is no wonder that gonalgia is one of the most common complaints in the general population. Although the management of a painful traumatic knee is relatively well standardized, that of a non-traumatic knee pain is less codified. History and a rigorous systematic clinical examination play a key role in the management of nontraumatic gonalgia. The diagnostic approach is mainly guided by the inflammatory or mechanical nature of the pain and its topography. This article aims to clarify the diagnostic approach to gonalgia without notion of prior trauma.


Asunto(s)
Articulación de la Rodilla , Rodilla , Humanos , Dolor , Examen Físico
13.
FP Essent ; 501: 30-37, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595266

RESUMEN

Ear pain (otalgia) is a common reason for visits to family physician offices and emergency departments. Otalgia is primary when the pathology originates from the ear, and is secondary for disease processes associated with otalgia and an ear examination with normal findings. The most common diagnosis related to otalgia in children and adults is acute otitis media (AOM). It is characterized by an erythematous, bulging, and cloudy tympanic membrane. Otitis media with effusion is the presence of fluid behind the tympanic membrane without signs of inflammation. Chronic middle ear effusion is managed definitively with myringotomy and tympanostomy tube placement. Tympanic membrane rupture is a common complication after AOM or trauma. Tympanic membranes that do not heal develop chronic infection, leading to chronic suppurative otitis media. Initial management is cleaning and drying of the ear and application of topical antibiotics. Otitis externa is a painful cellulitis of the external auditory canal associated with erythema, edema, and occasional drainage. Cerumen impaction is managed with cerumenolytics, irrigation, or manual extraction. Foreign bodies in the ear are common in children younger than 6 years. Many foreign bodies can be removed with irrigation or forceps.


Asunto(s)
Otitis Media con Derrame , Otitis Media , Adulto , Antibacterianos/uso terapéutico , Niño , Humanos , Ventilación del Oído Medio , Otitis Media/complicaciones , Otitis Media/diagnóstico , Otitis Media/terapia , Otitis Media con Derrame/tratamiento farmacológico , Otitis Media con Derrame/cirugía , Dolor/tratamiento farmacológico , Examen Físico
14.
Schmerz ; 35(1): 21-29, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33534105

RESUMEN

The question of pain prevention is becoming increasingly important, both in society and in science. According to the International Society for the Study of Pain, general areas for which pain prevention measures can be recommended have been defined. These approaches are mostly limited to unspecific recommendations with the aim of improving general health behaviour. Common to all of them is that they essentially address psychosocial and psychobehavioral aspects. In contrast to genetic factors or other non-modifiable environmental factors, psychosocial and psychobehavioral aspects are potentially modifiable variables, making them possible starting points for prevention programs. Furthermore, recent studies provide important knowledge about psychological and social risk factors of pain chronification and thus offer new approaches for future pain prevention strategies. At the same time, the efficacy and successful implementation of such programs is so complex that valid statements on effectiveness and benefit can only be made through care-related evaluation. This review addresses psychological and social factors in the prevention of pain. A selective literature search was carried out to this end. Based on selected studies, psychological and social predictors of pain development are presented and their potential for future pain prevention programs discussed. The article concludes with a discussion of possible implications.


Asunto(s)
Dolor , Humanos , Dolor/prevención & control , Dolor/psicología , Conducta Social
15.
Soins Gerontol ; 26(147): 25-31, 2021.
Artículo en Francés | MEDLINE | ID: mdl-33549238

RESUMEN

Pain in old age is still too common. Yet it deserves our interest because it weakens elderly patients who are already very vulnerable. As medical knowledge is constantly evolving, all caregivers are concerned in updating their knowledge in order to control the multiple pains of the elderly. Review of key points relating to the evaluation of pain, but also to today's drug and non-drug treatments, in order to optimise algological management in geriatrics.


Asunto(s)
Geriatría , Manejo del Dolor , Anciano , Cuidadores , Humanos , Dolor/tratamiento farmacológico
16.
Stomatologiia (Mosk) ; 100(1): 44-51, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33528955

RESUMEN

AIM OF THE STUDY: Assessment of the effectiveness of botulinum toxin A in the treatment of temporomandibular joint pain dysfunction syndrome. MATERIAL AND METHODS: In accordance with the diagnostic and treatment guidelines for TMJPDS, 20 patients with TMJPDS with pronounced pain on palpation of the chewing muscles, discoordination of the chewing muscles according to the EMG, and degenerative changes in the temporomandibular joint according to the MRI were examined. The patients had no contraindications to the use of botulinum toxin. Exclusion criteria: 1) age under 21 years, 2) somatic pathology, 3) refusal of the steps of the proposed diagnostic and treatment algorithm. Methods used: clinical, psychometric (visual analogue scale (VAS) - for pain assessment), X-ray, electromyographic and statistical methods. RESULTS: An objective reduction in the tone of the chewing muscles was observed after treatment In both groups. However, 30 days after the injection of BtA the IMPACT indicator in the first group was reduced by 403.5 µV or more (38.5%, p<0.05), while in the second group it decreased by 201.5 µV or more (25%, p<0.05). A correlation was identified between the VAS index (mean 7 points, severe pain level) and IMPACT (p<0.05). The onset of a significant pain reduction was observed one week after BtA injection, the most pronounced effect was achieved after 2 weeks and lasted for about 3 months. CONCLUSION: The use of BtA as part of the temporomandibular joint pain dysfunction syndrome treatment algorithm contributes to the creation of a «therapeutic window¼ for comprehensive rehabilitation of patients in this group. It increases the efficacy of the conducted treatment and contributes to a significant prolongation of the TMJPDS remission.


Asunto(s)
Toxinas Botulínicas Tipo A , Trastornos de la Articulación Temporomandibular , Síndrome de la Disfunción de Articulación Temporomandibular , Adulto , Humanos , Dolor , Articulación Temporomandibular , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/tratamiento farmacológico , Síndrome de la Disfunción de Articulación Temporomandibular/complicaciones , Síndrome de la Disfunción de Articulación Temporomandibular/tratamiento farmacológico , Resultado del Tratamiento , Adulto Joven
17.
J Headache Pain ; 22(1): 4, 2021 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413090

RESUMEN

BACKGROUND: The moment-to-moment variability of resting-state brain activity has been suggested to play an active role in chronic pain. Here, we investigated the regional blood-oxygen-level-dependent signal variability (BOLDSV) and inter-regional dynamic functional connectivity (dFC) in the interictal phase of migraine and its relationship with the attack severity. METHODS: We acquired resting-state functional magnetic resonance imaging from 20 migraine patients and 26 healthy controls (HC). We calculated the standard deviation (SD) of the BOLD time-series at each voxel as a measure of the BOLD signal variability (BOLDSV) and performed a whole-brain voxel-wise group comparison. The brain regions showing significant group differences in BOLDSV were used to define the regions of interest (ROIs). The SD and mean of the dynamic conditional correlation between those ROIs were calculated to measure the variability and strength of the dFC. Furthermore, patients' experimental pain thresholds and headache pain area/intensity levels during the migraine ictal-phase were assessed for clinical correlations. RESULTS: We found that migraineurs, compared to HCs, displayed greater BOLDSV in the ascending trigeminal spinal-thalamo-cortical pathways, including the spinal trigeminal nucleus, pulvinar/ventral posteromedial (VPM) nuclei of the thalamus, primary somatosensory cortex (S1), and posterior insula. Conversely, migraine patients exhibited lower BOLDSV in the top-down modulatory pathways, including the dorsolateral prefrontal (dlPFC) and inferior parietal (IPC) cortices compared to HCs. Importantly, abnormal interictal BOLDSV in the ascending trigeminal spinal-thalamo-cortical and frontoparietal pathways were associated with the patient's headache severity and thermal pain sensitivity during the migraine attack. Migraineurs also had significantly lower variability and greater strength of dFC within the thalamo-cortical pathway (VPM-S1) than HCs. In contrast, migraine patients showed greater variability and lower strength of dFC within the frontoparietal pathway (dlPFC-IPC). CONCLUSIONS: Migraine is associated with alterations in temporal signal variability in the ascending trigeminal somatosensory and top-down modulatory pathways, which may explain migraine-related pain and allodynia. Contrasting patterns of time-varying connectivity within the thalamo-cortical and frontoparietal pathways could be linked to abnormal network integrity and instability for pain transmission and modulation.


Asunto(s)
Imagen por Resonancia Magnética , Trastornos Migrañosos , Encéfalo/diagnóstico por imagen , Humanos , Hiperalgesia , Trastornos Migrañosos/diagnóstico por imagen , Vías Nerviosas/diagnóstico por imagen , Dolor
18.
Am Fam Physician ; 103(2): 81-89, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33448767

RESUMEN

Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.


Asunto(s)
Lesiones de la Cadera/diagnóstico , Enfermedades Musculoesqueléticas/diagnóstico , Dolor/etiología , Adulto , Nalgas , Diagnóstico Diferencial , Medicina Familiar y Comunitaria/métodos , Femenino , Cadera , Articulación de la Cadera , Humanos , Masculino , Dolor/diagnóstico
20.
Science ; 371(6525): 122-123, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33414207
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