ABSTRACT
There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.
Subject(s)
Chronic Pain , Fibromyalgia , Stress Disorders, Post-Traumatic , Comorbidity , Female , Fibromyalgia/complications , Fibromyalgia/epidemiology , Humans , Pain Threshold , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/epidemiologyABSTRACT
BACKGROUND: Three different types of manual therapy techniques for patients with neck pain and relationship with psychological factors has not been evaluated. AIM: To compare the effectiveness high velocity and low amplitude (HVLA) manipulation vs. posteroanterior mobilization (PA mob) vs. sustain appophyseal natural glide (SNAG) in the management of patients with neck pain and to evaluate the interaction with psychological factors. STUDY DESING: Randomized clinical trial. SETTING: Primary Health Care Center. POPULATION: Patients with history of chronic neck pain over the last 3 months were recruited. METHODS: Patients were randomly assigned to receive treatment with HVLA (N.=15), with PA mob (N.=16) or with SNAG (N.=17). One session was applied. Pain intensity of neck pain, pressure pain threshold over processus spinosus of C2 (PPT_C2) and cervical range of motion (CROM) were measured pre- and post-intervention. Pain catastrophizing, depression, anxiety and kinesiophobia were assessed in baseline. ANOVAs were performed, with main effects, two-way (treatment x time) and three-way interactions (treatment x psychological variable x time) were examined. RESULTS: Fourthy-eight patients (mean±SD age, 36.5±8.7 years; 87.5% female). A significant interaction treatment x time was observed for VAS-rest in HVLA and AP mob groups (P<0.05). With more pain relief to HVLA and AP mob groups than SNAG groups but all groups improve the same in CROM. Also, a significant three-way treatment x anxiety x time interaction for VAS in Flexion/Extension was identified (P<0.01), and a trend toward significance was observed for the three way treatment x anxiety x time interaction, with respect to CROM in Lateral-Flexion movement (P<0.05). CONCLUSION: The results suggest that an HVLA and PA mob groups relieved pain at rest more than SNAG in patients with Neck pain. Among psychological factors, only trait anxiety seems interact with Manual therapy, mainly high anxiety conditions interact with the Mobilization and SNAG effects but under low anxiety conditions interact with the HVLA effects. Significant mean differences can be observed both in VAS in Flexion/Extension and in CROM in lateral-flexion movement when using mobilization under high anxiety conditions CLINICAL REHABILITATION IMPACT: The findings provide preliminary evidence to support that three different techniques have similar immediate effects over neck pain and while under high anxiety levels a better outcome is expected after mobilization intervention, under low anxiety levels a better prognosis is expected after manipulation and SNAG intervention.
Subject(s)
Chronic Pain/rehabilitation , Musculoskeletal Manipulations/methods , Neck Pain/rehabilitation , Range of Motion, Articular/physiology , Adult , Aged , Aged, 80 and over , Analysis of Variance , Anxiety/complications , Anxiety/etiology , Catastrophization/psychology , Cervical Vertebrae/physiopathology , Chronic Pain/psychology , Depression/complications , Depression/etiology , Female , Humans , Male , Manipulation, Orthopedic/methods , Manipulation, Orthopedic/psychology , Manipulation, Spinal/methods , Manipulation, Spinal/psychology , Middle Aged , Musculoskeletal Manipulations/psychology , Neck Pain/psychology , Outcome and Process Assessment, Health Care/statistics & numerical data , Pain Measurement/methods , Physical Therapy Modalities , Spain , Zygapophyseal Joint/physiopathologySubject(s)
Anesthesia, Inhalation/adverse effects , Angelman Syndrome/diagnosis , Delayed Emergence from Anesthesia/etiology , Laryngostenosis/etiology , Receptors, GABA-A/drug effects , Retrognathia/etiology , Anesthesia, Inhalation/methods , Anesthetics, General/pharmacology , Angelman Syndrome/complications , Angelman Syndrome/pathology , Benzodiazepines/pharmacology , Brain/pathology , Child, Preschool , Contraindications , Diagnostic Errors , Humans , Incidental Findings , Intellectual Disability/etiology , Intubation, Intratracheal/adverse effects , Magnetic Resonance Imaging , Male , Methyl Ethers/pharmacokinetics , Mucopolysaccharidoses/diagnosis , Muscle Hypotonia/etiology , Receptors, GABA-A/deficiency , Receptors, GABA-A/genetics , SevofluraneABSTRACT
No disponible
Subject(s)
Humans , Male , Child, Preschool , Angelman Syndrome/diagnosis , Angelman Syndrome/drug therapy , Angelman Syndrome/epidemiology , Anesthesia, General/methods , Midazolam/therapeutic use , Atropine/therapeutic use , Angelman Syndrome/metabolism , Angelman Syndrome/surgery , Propofol/therapeutic use , Methylprednisolone/therapeutic use , gamma-Aminobutyric Acid/adverse effects , gamma-Aminobutyric Acid/metabolismABSTRACT
OBJECTIVE: To analyse medical care for terminal cancer patients (TCP) in a health district. DESIGN: A descriptive, crossover study. SETTING: primary care in an urban environment. PATIENTS: 227 patients who died of cancer between January 1994 and June 1995 and who came under the nine primary care teams (PCT) studied. MEASUREMENTS AND MAIN RESULTS: Information bases: mortality records and clinical histories from the PCT. VARIABLES STUDIED: age, sex, type of tumour, date of diagnosis of terminal illness, whether treated or not with morphine and (if so) the doses, place of death and the care activity engendered. Univariant analysis with standard means and deviations for the quantitative variables, frequencies for the qualitative ones and the Chi squared test for comparison. 64% were male. Most common neoplasias were, in order: lung, colon and stomach. 78 patients (49%) received morphine treatment, datum related to age. Average morphine dose was 80 mg in 24 hours. CONCLUSIONS: Patient treatment was inadequate because morphine, the lodestone of terminal cancer care, was insufficiently used. In contradiction with WHO recommendations, most patients died in hospital. Specific training programmes should be created for PC professionals with the aim of improving their handling of terminal cancer patients.
Subject(s)
Neoplasms/therapy , Primary Health Care , Terminal Care , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/administration & dosage , Chi-Square Distribution , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Morphine/administration & dosage , Neoplasms/mortality , Primary Health Care/statistics & numerical data , Spain/epidemiology , Terminal Care/statistics & numerical dataABSTRACT
We present a cervical thymic cyst clinically manifest as a lateral neck mass and studied preoperatively with ultrasound. We point to the sonographic findings that allow us to include the cervical thymic cyst as one of the diagnostic possibilities.
Subject(s)
Cysts/physiopathology , Thymus Gland/physiopathology , Adult , Cysts/diagnosis , Cysts/diagnostic imaging , Cysts/ultrastructure , Diagnosis, Differential , Female , Humans , Respiratory Tract Diseases/diagnosis , Thyroid Diseases/diagnosis , Thyroid Diseases/physiopathology , UltrasonographyABSTRACT
Two cases of jejunojejunal intussusception in whom diagnosis was reached preoperatively by ultrasonography and small bowel follow-through meal are presented. We review the sonographic patterns of intussusception that allow the differential diagnosis with miscellaneous gastrointestinal abnormalities detected by ultrasound.
Subject(s)
Intussusception/diagnostic imaging , Jejunal Diseases/diagnostic imaging , Adult , Female , Humans , Male , Middle Aged , UltrasonographyABSTRACT
We report on a 50-year-old male patient who presented with a scrotal mass which he had noted two years earlier. Ultrasound revealed a well-defined, regular, paratesticular mass. Pathological examination of the surgical specimen revealed abundant lipoblasts and a stroma with myxoid changes, prompting a diagnosis of myxoid liposarcoma of the spermatic cord. Liposarcoma is a rare tumor of the spermatic cord which frequently metastasizes to the lumbar retroperitoneal lymph nodes. The foregoing characteristic and the histologic features of the tumor type influence treatment.