Pain Neuroscience Education for Physical Therapy Students.

AIMS: Current physical therapy curricula may not adequately address pain education. Pain Neuroscience Education (PNE) is an education tool that focuses on the influence of psychosocial pain triggers to help the patient gain better understanding of the pain experience. PNE is a potentially effective pain management intervention for sufferers of chronic pain. This research explored whether a single lecture/demonstration could produce evidence of enhanced understanding among Physical Therapist Assistant (PTA) and Doctor of Physical Therapy (DPT) students regarding chronic pain. METHODS: The Neuroscience Pain Questionnaire (NPQ) and Health Care Providers Pain and Impairment Relationship Scale (HC-Pairs) were both administered pre and post lecture. The NPQ was completed again at 6 months post lecture by subjects who were DPT students. Case vignettes were administered to the DPT students to assess their ability to apply their understanding of PNE. RESULTS: There was a significant improvement in scores from pre to post NPQ (knowledge of pain) and HC-Pairs (attitudes and beliefs). The DPT students were able to apply their understanding of chronic pain to effectively respond to clinical scenarios. The DPT students retained the knowledge gained in the instructional program as indicated by the results from the 6 month follow-up.

Association Between Personality Types and Predilection to Chronic Pain.

Chronic pain is a problem that has become common across communities. Currently there is no uniform approach for treating chronic pain. The purpose of this study was to explore whether an association exists between personality type and the predisposition to developing chronic pain. Using a personality profile tool, we surveyed 29 subjects suffering from chronic pain and found that 25 of the 29 approached their pain experience from a "feeling" or subjective perspective. Emotion, rather than logic, was more likely to drive these subjects' understanding of their chronic pain state. Considering this predilection toward emotion should be part of treating patients with chronic pain states. Educators who prepare future health professionals and those professionals currently in practice should appreciate the psychosocial nature of chronic pain and direct treatment, at least in part, toward the psychosocial component of the lived pain experience.

Visible light as an inhibitor of Campylobacter jejuni.

INTRODUCTION: Campylobacter jejuni is a Gram-negative, microaerophilic bacteria that is the leading cause of food-borne illnesses in the United States; it frequently causes severe diarrhoea. Campylobacter jejuni has recently demonstrated antibiotic resistance; therefore, alternative methods for treating these infections must be investigated. Visible light has proven to be an effective inhibitory agent for many medically significant species of bacteria and fungi. METHODS: Visible light in the blue range (405 nm and 464 nm) was administered to a suspension of Campylobacter jejuni. Brain-heart infusion agar was inoculated with the suspension of the organism following exposure to blue light at a dose of 24 Jcm2 for each wavelength. Inoculated plates were placed into a traditional Campy jar in order to mimic a 5% O2 atmosphere and incubated at 37 °C for 48 hours. Following incubation, colony forming units were counted and compared with controls to determine if the light energy had effectively inhibited the growth of the organism. RESULTS: Both 405 nm and 464 nm light at a dose of 24 Jcm2 were shown to be effective inhibitors of Campylobacter jejuni, with kill rates ranging from 82.4-98.9%. CONCLUSION: Blue light effectively inhibits Campylobacter jejuni.

Chronic musculoskeletal pain and function improve with a plant-based diet.

BACKGROUND: Chronic musculoskeletal pain, often debilitating, affects all genders, ethnicities, and age groups. Research suggests consumption of a plant-based diet may improve the status of persons with chronic pain. A diet rich in fruits, vegetables and whole grains has been shown to reduce chronic pain and disability associated with musculoskeletal conditions. OBJECTIVE: The purpose of this study was to examine the value of a plant-based diet in the management of chronic musculoskeletal pain and functional limitations. METHOD: Fourteen subjects participated in the eight-week study. Baseline evaluation included anthropometric measurements and completion of two self-reported outcome measures: Numeric Pain Rating Scale (NPRS) and the Short Form Health Survey (SF-36). A registered dietitian nutritionist provided a sample menu cycle and education on a plant-based diet. Subjects utilized a phone app to log food intake and receive support from the dietitian. Post data collection included a repeat of the baseline measures and the Patient Global Impression of Change Scale. The sample was small. Twenty subjects began, 14 completed. No comparison group was used. Results should be considered with caution. RESULTS: The diet intervention resulted in decreased pain and improvement in quality of life. Diet adherence by ten of fourteen subjects was 89% based on completion of food intake records and adherence to allowed foods. CONCLUSION: Consumption of a plant-based diet produced positive improvements in chronic pain and function. Interprofessional collaboration between physical therapists and registered dietitian nutritionists, along with other healthcare practitioners, can encourage and promote diet interventions that positively affect chronic pain.

Sensory Evaluation of Cucumbers Treated with Blue Light.

Blue light delivered at wavelengths of 405 to 470 nm has been demonstrated to inhibit growth of bacteria on foodstuffs. This study investigated the effect of a narrow band of visible light on the color, texture, and flavor (organoleptic) properties of cucumbers. Previous research in this area has focused on either broad-spectrum light or specifically the UV bands of energy. Two experiments were performed, a sensory evaluation and a discriminative test. in both experiments, half of the cucumbers were irradiated with 464 nm at 18 J/cm2 and half were left untreated. For the sensory evaluation, each evaluator received a treated cucumber slice and an untreated cucumber slice, then rated each slice based on organoleptic properties using a 9-item scoring sheet. For the two-out-of-five test, each evaluator received five slices, two slices of treated cucumber and three slices of untreated cucumber. The evaluators were asked to group the cucumber slices based on how the slices were prepared. Statistical analysis revealed that trained sensory evaluators were unable to distinguish between treated and untreated samples using sensory assessment. Blue light does not diminish the organoleptic qualities of the tested vegetables and appears to be at least as acceptable, from an organoleptic perspective, as other light decontamination methods.

In vitro fungicidal effects of methylene blue at 625-nm.

The aim of the study is to confirm the effectiveness of photodynamic therapy (PDT) as a significant inhibitor of Trichophyton rubrum (T. rubrum) and to determine the most appropriate dose and rate of delivery. Trichophyton rubrum is the most common dermatophyte worldwide, responsible for the majority of superficial fungal infections. The traditional treatment of T. rubrum has known adverse effects. An alternative treatment is warranted. Photosensitised T. rubrum specimens were treated with 625-nm light at doses of 3, 12, 24, 40 and 60 J/cm2 . Colony counts were performed and compared to untreated controls. Doses of 24, 40 and 60 J/cm2 all produced kill rates of over 94%. A lower rate of delivery (7.80 mW/cm2 ) was shown to be a greater inhibitor of T. rubrum than a higher rate of delivery (120 mW/cm2 ). Photodynamic therapy with methylene blue (MB) at 625 nm using a low rate of delivery at doses of 24, 40 and 60 J/cm2 is an effective inhibitor of T. rubrum. A rate of delivery of 7.80 mW/cm2 is a significantly greater inhibitor of T. rubrum than a rate of 120 mW/cm2 when applying 625-nm light in PDT using MB.

Susceptibility of Trichopyton mentagrophytes to Visible Light Wavelengths.

OBJECTIVE: To determine whether a blue light (405 nm) could inhibit the growth of Trichopyton mentagrophytes without using a photosensitizing material as part of the treatment protocol. DESIGN: Basic physiologic randomized trial using laboratory specimens (T mentagrophytes). INTERVENTIONS/METHODS: Plated on a growth medium, T mentagrophytes were exposed to 3 to 5 administrations of blue light at 20 J/cm over 28 hours. Following 7 days of incubation, colony-forming units were counted and compared with nonirradiated controls. RESULTS: The study found 3, 4, and 5 administrations of blue light produced significant inhibition of T mentagrophytes (P < .05); 4 and 5 applications produced the greatest inhibition of growth (84.7% and 93.6% kill rates, respectively). CONCLUSIONS: The application of 405-nm light at a dose of 20 J/cm is an effective in vitro inhibitor of T mentagrophytes. To give results similar to those seen when a photosensitizing material is included, 3 to 5 applications of this wavelength and dose condition delivered over 28 hours is likely needed.

Inactivation of Salmonella on tainted foods: using blue light to disinfect cucumbers and processed meat products.

Foodborne illness resulting from infectious organisms occurring in vegetables and processed meat is a serious health concern in the United States. Improved and cost-effective techniques for disinfection are needed. Visible light in the blue range (405 nm) was administered to processed meat that had been inoculated with Escherichia coli. One application of light energy at doses of 10, 30, 60, and 100 J/cm2 was applied, in vitro. In the case of vegetables contaminated with Salmonella (cucumbers), 464 nm light was used at 6, 12, and 18 J/cm2. In both cases, after 20 hours of incubation, colony-forming units were counted and compared to controls to determine whether the light energy inhibited growth of E. coli or Salmonella. E. coli - 405 nm light at doses of 30, 60, and 100 J/cm2 were all effective inhibitors of the organism. Kill rates of 75.61 - 96.34% were achieved. Salmonella - 464 nm light at doses of 6, 12, and 18 J/cm2 produced significant inactivation of the organism. Kill rates of 80.23-100% were obtained. Blue light, delivered in the wavelength/dose combinations used in this study is an effective inhibitor of both E. coli and Salmonella on actual foodstuffs. Blue light should be considered as a potentially effective tool in the effort to protect humans from foodborne illnesses.

Using near infrared light to manage symptoms associated with restless legs syndrome.

The purpose of this study was to determine whether the application of near infrared (NIR) light could positively modulate symptoms associated with restless legs syndrome (RLS). Twenty-one subjects with RLS were treated with NIR three times weekly for four weeks. Baseline measures of: (1) international restless legs syndrome rating scale (IRLSRS) score; (2) Semmes Weinstein monofilament (SWM) test; (3) visual analog pain scale (VAS); (4) ankle-brachial index (ABI); and (5) sonographic imaging of the popliteal and posterior tibial arteries were compared to post-treatment values. NIR (850 nm) was delivered transcutaneously at 8 J/cm(2) to four locations on each leg and the plantar surface of each foot. A pre-test-post-test one group design was employed. Baseline and post-treatment measures were compared using either a dependent t-test when data were normal or the Wilcoxon signed rank test in the absence of normality. A significant improvement in IRLSRS scores was observed. Sensation improved from less than protective in 16.6% of sites tested at the baseline to 13.4% post-intervention. There was a significant improvement in ABI scores. VAS and sonographic imaging measures other than ABI remained unchanged. The use of NIR to modulate symptoms associated with RLS was supported by the data.

Inactivation of Candida albicans following exposure to 624-nanometer light from a supraluminous diode array.

OBJECTIVE: To determine the potential for visible light (405 or 624 nm) to produce an inhibitory effect on Candida albicans. In addition, the study sought to evaluate a series of doses in terms of their respective inhibiting capabilities. BACKGROUND DATA: The authors have studied the effect of blue light on Staphylococcus aureus and found that a bactericidal outcome can be obtained with low doses of blue light. METHODS: Candida albicans was tested because of its common appearance in human skin and mucous membrane infections. The organism was treated in vitro with 405-nm (blue) and with 624-nm (red) light emitted from a supraluminous diode array. Doses of 3, 9, 15, 30, and 60 J/cm(2) were used. Colony counts were performed and compared with untreated controls using Student t tests and 1-way analysis of variance with Tukey post hoc analysis. RESULTS: The results revealed no inhibition produced by 405 nm on C albicans (F4,20 = 0.901; P = .482). However, 624 nm did inhibit growth of C albicans at 3, 9, and 30 J/cm(2) (F4,20 = 6.064; P = .002). CONCLUSIONS: Appropriate doses of 624-nm light from a supraluminous diode array can inhibit the growth of C albicans in vitro. Three, 9, and 30 J/cm(2) are all effective dose levels.

Delaying the Onset of Resistance Formation: Effect of Manipulating Dose, Wavelength, and Rate of Energy Delivery of 405-, 464-, and 850-Nanometer Light for Staphylococcus aureus.

OBJECTIVE: To determine whether manipulation of dose, wavelength, and rate of energy delivery could delay the onset of previously demonstrated Staphylococcus aureus resistance to blue light. METHODS: The organism was treated in vitro with 405 nm, 464 nm, and combined 464 nm and with 850 nm light emitted from a supraluminous diode (SLD) array. Doses of 9 J/cm2 and 30 J/cm2 were used. Rates of energy delivery were also varied from 10 mW/cm2 to 125 mW/cm2. Seven stages were employed to test for resistance formation. Colony counts were performed and compared to untreated controls using Student t tests and one-way ANOVA with Tukey post hoc analysis. RESULTS: A best dose, wavelength, and rate of delivery combination was determined at each stage and it did produce a significant kill rate (P ≤ 0.05) at each stage. Analysis of variance demonstrated that no loss of effectiveness (formation of resistance) occurred over the 7 stages. CONCLUSIONS: Appropriate combinations of dose, wavelength, and rate of energy delivery can delay resistance formation to light as a bactericidal agent for S. aureus. .

Evidence of resistance development by Staphylococcus aureus to an in vitro, multiple stage application of 405 nm light from a supraluminous diode array.

OBJECTIVE: The aim of this study was to determine whether Staphylococcus aureus could develop a resistance to 405 nm light. BACKGROUND DATA: Research indicates that certain wavelengths and treatment parameters of light promote growth of bacteria; however, our earlier work indicated that blue light effectively inactivates growth of S. aureus in vitro. METHODS: S. aureus was tested because of its frequent isolation from skin infections and wounds. The organism was treated with 405 nm light from supraluminous diodes at a dose of 9 J/cm(2). RESULTS: As anticipated, blue light produced a significant (p≤0.05) inactivation of S. aureus growth. Subsequent applications of blue light to subcultured generations of S. aureus were increasingly effective through four stages (generations). Beginning with stage five, a decrease in effectiveness (resistance) was observed. CONCLUSIONS: Appropriate doses of 405-nm blue light inhibit the growth of S. aureus in vitro. This research does suggest that S. aureus may be capable of developing resistance to blue light irradiation.

Inactivation of mycobacterium smegmatis following exposure to 405-nanometer light from a supraluminous diode array.

OBJECTIVE: To determine the potential for blue light (405 nm) to produce a bactericidal effect on Mycobacterium smegmatis. Additionally, the study sought to evaluate a series of doses in terms of their respective bactericidal capabilities. BACKGROUND DATA: The effect of blue light on Staphylococcus aureus has been studied and it was found that a bactericidal outcome can be obtained with low doses of blue light. METHODS: M. smegmatis was tested because of the recent appearance of the Mycobacterium family of organisms as a public health threat among persons receiving tattoos. The organism was treated in vitro with 405 nm light emitted from a supraluminous diode (SLD) array. Doses of 60 Jcm-2, 90 Jcm-2, 120 Jcm-2, 150 Jcm-2, 180 Jcm-2, 215 Jcm-2, and 250 Jcm-2 were used. Colony counts were performed and compared to untreated controls using Student t tests and one-way ANOVA with Tukey post hoc analysis. RESULTS: The results revealed statistically significant bactericidal effects of the blue light on M. smegmatis (F6, 28 = 50.518, P = 0.000). The treatment reduced the number of bacterial colonies at all doses, but 60 Jcm-2 did not produce a statistically significant kill rate. All other doses produced a significant kill rate with 120 Jcm-2, 150 Jcm-2, and 215 Jcm-2, demonstrating the most effective kill rates of 98.3%, 96.7%, and 100%, respectively. CONCLUSIONS: Appropriate doses of 405 nm light from an SLD array can kill M. smegmatis in vitro. A dose of at least 100 Jcm-2 dose is needed for the most effective inactivation of the organism. The dose response for this organism to blue light is not linear. Some degree of effectiveness is lost at 180 Jcm-2 and 250 Jcm-2. .

Effects of combined 405-nm and 880-nm light on Staphylococcus aureus and Pseudomonas aeruginosa in vitro.

OBJECTIVE: The aim of this study was to determine the effect of a combination of 405-nm blue light and 880-nm infrared light on Staphylococcus aureus and Pseudomonas aeruginosa in vitro. BACKGROUND DATA: Reports indicate that certain wavelengths and treatment parameters of light promote the growth of bacteria, but our earlier study indicates that light at specific wavelengths and intensities are bactericidal for specific organisms (1). METHODS: Two common aerobes, Staphylococcus aureus and Pseudomonas aeruginosa were tested because of their frequent isolation from skin infections and wounds. Each organism was treated simultaneously with a combination of 405-nm and 880-nm light emitted by a cluster of Super Luminous Diodes (SLDs). Doses of 1, 3, 5, 10, and 20 Jcm2 were used. Colony counts were performed and compared to untreated controls using Student t tests and one-way ANOVA with Tukey and Scheffe post hoc analyses. RESULTS: The results revealed significant dose-dependent bactericidal effects of the combined blue and infrared light on Staphylococcus aureus (F 4,94 = 5.38, p = 0.001) and Pseudomonas aeruginosa (F 4,95 = 21.35, p < 0.001). With P. aeruginosa, the treatment reduced the number of bacteria colonies at all doses, achieving statistical significance at 1, 3, and 20 J cm2 doses and reducing bacterial colony by as much as 93.8%; the most effective dose being 20 J cm2. Irradiation of S. aureus resulted in statistically significant decreases in bacterial colonies at all dose levels; the most decrease, 72%, was also achieved with 20 Jcm2. CONCLUSION: Appropriate doses of combined 405-nm and 880-nm phototherapy can kill Staphylococcus aureus and Pseudomonas aeruginosa in vitro, suggesting that a similar effect may be produced in clinical cases of bacterial infection.

In vitro bactericidal effects of 405-nm and 470-nm blue light.

OBJECTIVE: The aim of this study was to determine the bactericidal effect of 405- and 470-nm light on two bacteria, Staphylococcus aureus and Pseudomonas aeruginosa, in vitro. BACKGROUND DATA: It is well-known that UV light kills bacteria, but the bactericidal effects of UV may not be unique since recent studies indicate that blue light produces a somewhat similar effect. The effects of blue light seem varied depending on wavelength, dose and the nature of the bacteria, hence this study. METHODS: Two common aerobes, Staphylococcus aureus and Pseudomonas aeruginosa, and anaerobic Propionibacterium acnes were tested. Each organism was treated with Super Luminous Diode probes with peak emission at 405 and 470 nm. Treatment was timed to yield 1, 3, 5, 10, and 15 Jcm2 doses. Colony counts were performed and compared to untreated controls. RESULTS: The 405-nm light produced a dose dependent bactericidal effect on Pseudomonas aeruginosa and Staphylococcus aureus (p < .05), achieving as much as 95.1% and nearly 90% kill rate for each, respectively. The 470-nm light effectively killed Pseudomonas aeruginosa at all dose levels, but only killed Staphylococcus aureus at 10 and 15 J cm2. With this wavelength, as much as 96.5% and 62% reduction of Pseudomonas aeruginosa and Staphylococcus aureus was achieved, respectively. Neither of the two wavelengths proved bactericidal with anaerobic Propionibacterium acnes. CONCLUSION: The results indicate that, in vitro, 405- and 470-nm blue light produce dose dependent bactericidal effects on Pseudomonas aeruginosa and Staphylococcus aureus but not Propionibacterium acnes.

An evaluation of the usefulness of noncognitive variables as predictors of scores on the national physical therapy licensing examination.

This study employed a correlational design to develop a model to assess the predictive nature of noncognitive variables with regard to the physical therapy licensing examination. Fifty-seven graduates of an accredited physical therapy education program completed the Non-Cognitive Questionnaire-Revised (NCQ-R) and provided their scores from the licensing examination. Regression analysis was used to explore combinations of the eight domains of the NCQ-R as predictors of licensing examination scores. A model combining four of the NCQ-R domains (long-range goals, leadership, community ties, and academic familiarity) was constructed that would account for 21.3% of the variance in licensing examination scores. Some of the NCQ-R domains were related inversely, however, to higher scores on the licensing examination. The authors concluded that although noncognitive variables might be used by admissions committees as indicators of potential future success on the licensing examination, the NCQ-R as it is currently constructed may not be the best tool for measuring noncognitive variables to predict scores on the physical therapy licensing examination. Other health disciplines (e.g., occupational therapy, speech pathology, clinical laboratory science) could consider examining the predictive values of noncognitive variables when making admissions and advising decisions.

Patient compliance: its relevance to the management of a patient with Charcot's foot.

This case report discusses the challenges related to the management of a diabetic patient with Charcot's foot and a neuropathic foot ulcer. The patient received good coordinated care including foot pressure measurements. The case is an example demonstrating that patient compliance is a determinant of treatment outcome.