Brain activity modifications following spinal cord stimulation for chronic neuropathic pain: A systematic review.

BACKGROUND AND OBJECTIVE: Spinal cord stimulation (SCS) is believed to exert supraspinal effects; however, these mechanisms are still far from fully elucidated. This systematic review aims to assess existing neurophysiological and functional neuroimaging literature to reveal current knowledge regarding the effects of SCS for chronic neuropathic pain on brain activity, to identify gaps in knowledge, and to suggest directions for future research. DATABASES AND DATA TREATMENT: Electronic databases and hand-search of reference lists were employed to identify publications investigating brain activity associated with SCS in patients with chronic neuropathic pain, using neurophysiological and functional neuroimaging techniques (fMRI, PET, MEG, EEG). Studies investigating patients with SCS for chronic neuropathic pain and studying brain activity related to SCS were included. Demographic data (age, gender), study factors (imaging modality, patient diagnoses, pain area, duration of SCS at recording, stimulus used) and brain areas activated were extracted from the included studies. RESULTS: Twenty-four studies were included. Thirteen studies used neuroelectrical imaging techniques, eight studies used haemodynamic imaging techniques, two studies employed both neuroelectrical and haemodynamic techniques separately, and one study investigated cerebral neurobiology. CONCLUSIONS: The limited available evidence regarding supraspinal mechanisms of SCS does not allow us to develop any conclusive theories. However, the studies included appear to show an inhibitory effect of SCS on somatosensory evoked potentials, as well as identifying the thalamus and anterior cingulate cortex as potential mediators of the pain experience. The lack of substantial evidence in this area highlights the need for large-scale controlled studies of this kind.

Therapeutic touch for healing acute wounds.

BACKGROUND: Therapeutic Touch (TT) as a treatment modality has increased in popularity over the past two decades. Its efficacy in relation to the healing of wounds has been expounded in anecdotal publications. To date however there has been no systematic review. OBJECTIVES: To identify and review all relevant data to determine the effectiveness of TT in the promotion of wound healing. SEARCH STRATEGY: The Cochrane Wounds Group Specialised Trials Register and the Cochrane Central Register of Controlled Trials were searched in May 2003. The Cochrane Complementary Medicine field database was searched in September 2002. In addition the Sigma Theta Tau International Registry of Nursing Research (1983 to 2002) was also searched in September 2002. Furthermore searches of MEDLINE (1966 to 2003) were conducted in 1997 and May 2003, CINAHL (1982 to 2002) in September 2002 and dissertation abstracts in September 2002. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials, which compared the effect of TT with a placebo, another treatment, or no treatment control were considered. Studies which used TT as a stand-alone treatment, or as an adjunct to other therapies, were eligible. DATA COLLECTION AND ANALYSIS: One reviewer (DO) determined the eligibility for inclusion of all trials. Both reviewers conducted data extraction and evaluation of each trial's quality independently. Each trial was analysed based on predetermined criteria and a narrative of each trial's main conclusions was produced. MAIN RESULTS: Four trials in people with experimental wounds were eligible for inclusion. The effect of TT on wound healing in these studies was variable. Two of the studies (n = 44 & 24) demonstrated a significant effect of TT. However the results of the two other trials favoured the control group (n = 15 & 38), one of these trials demonstrated a significant effect in favour of the control group. REVIEWER'S CONCLUSIONS: There is insufficient evidence that TT promotes healing of acute wounds.

An in-vitro study of the pressure-relieving properties of four wound dressings for foot ulcers.

This in-vitro study reports on a selection of mechanical tests on four wound dressings: Allevyn (Smith and Nephew), Biatain (Coloplast), Lyofoam (Seton Scholl) and Tielle (Johnson and Johnson). The aim of the study was to investigate these dressings in the laboratory by subjecting them to dry and wet compression tests, shearing tests and a cyclical test. As predicted, all dressings performed differently in the range of tests, with Lyofoam deforming the most when subjected to compression testing (5.6 mm). During wet compression, differences in the physical properties of all the materials tested were identified. During shearing testin, Allevyn and Tielle withstood the greatest shear deflection before failure, but Biatain withstood the greatest force before failing. During the cyclical testing, Lyofoam only reduced by 1% of its original thickness, while Biatain reduced by 30%. No one dressing performed better in all the tests. However, as an all-round 'pressure-relieving' dressing, Allevyn consistently outperformed the others in the study.

The influence of four wound dressings on the kinetics of human walking.

OBJECTIVES: This in vivo study (the second phase of a research project first described in the February issue of Journal of Wound Care) reports on the influence of various wound dressings on the dynamics of human walking. Allevyn (Smith and Nephew), Biatain (Coloplast), Lyofoam (Seton Scholl) and Tielle (Johnson and Johnson) were used in this study. The investigation aimed to assess the ground reaction forces in the foot while the dressings were applied to the plantar surface of the foot. METHOD: A strain gauge force plate system was used. Six subjects with 'normal' gait patterns and no foot pathology were recruited into the study. Eight trials were recorded for each subject. The peak push-off force, in the vertical component of the ground reaction force, and the maximum braking and propulsive forces in the medial-lateral component of the ground reaction force were estimated and reported. RESULTS: Among the various dressings tested, Allevyn performed closest to barefoot in the peak push-off force and demonstrated an increased braking force at the deceleration point in the gait cycle. CONCLUSION: These findings may have implications for clinicians selecting wound dressings for the treatment of certain foot ulcerations. However, further clinical research is warranted in this area.

Conservative podiatric medicine and disability in elderly people.

A survey was conducted of 248 noninstitutionalized people aged 75 years and older, residing in a designated geographical area. The effect of dependency and physical disability on the receipt of conservative podiatric medicine was examined, and, in addition, the prevalence of medical and podiatric conditions was determined.