Contralateral Arm Pain as a Sign of Distress Regarding Symptoms.

BACKGROUND: Pain intensity and magnitude of incapability are associated with common unhelpful thoughts about symptoms such as catastrophic thinking and kinesiophobia. To determine whether reports of pain in the upper limb contralateral to a non-trauma condition were associated with unhelpful thoughts, we measured the relationship between pain intensity in the opposite limb and levels of unhelpful thinking. METHODS: In a cross-sectional study, 152 new and return patients seeking care of an upper-limb musculoskeletal condition completed measures of upper-extremity-specific magnitude of capability, pain intensity of the involved and contralateral arms, unhelpful thoughts regarding symptoms, symptoms of distress regarding symptoms, and general symptoms of depression. Factors associated with contralateral and ipsilateral pain intensity and upper-extremity-specific magnitude of capability were assessed using multivariable statistics. RESULTS: In bivariate analysis, contralateral arm pain was associated with symptoms of distress regarding pain, but not in multivariable analysis. Accounting for potential confounding in negative binominal regression analysis, greater pain intensity of the affected side was independently associated with greater feelings of distress regarding symptoms and no prior surgery. Greater upper-extremity-specific capability was independently associated with less distress regarding symptoms, married/partnered, men, and no prior surgery. CONCLUSIONS: The observation that greater pain intensity in the opposite arm was associated with greater distress regarding symptoms suggests that, in combination with other verbal and non-verbal signs of distress, patient concerns about pain in the contralateral limb can help direct patients and surgeons to evidence-based care strategies for alleviating stress regarding symptoms.

Top of the Basilar Syndrome: A Case Report of a Healthy Young Woman and Literature Review.

Top of the basilar syndrome (TBS) is defined as the presence of multiple ischemic lesions on magnetic resonance image (MRI) including more than two territories supplied by branches of the distal portion of the basilar artery, causing symptoms such as dizziness, diplopia, ataxia, and acute cognitive decline that can lead to quadriplegia and death. Diagnosing TBS is challenging because it can mimic other conditions such as thalamic hemorrhages or vertebrobasilar ischemia, and requires advanced imaging. Although the prognosis for these patients is poor, rehabilitation is essential for their recovery. This case describes a healthy 28-year-old woman who presented with headache, vomiting, and tonic-clonic seizures sent to the hospital with a stroke diagnosis.

Is there an association between sleep quality and magnitude of capability?

PURPOSE: Given the stigma surrounding mental health, a discussion of how symptoms interfere with sleep might be a useful first step to identify unhelpful thoughts or feelings of distress. We asked: 1) Does sleep quality have an association with magnitude of incapability and pain intensity independent of mental health? and 2) Are mental health factors associated with sleep quality? METHODS: We performed a cross-sectional study of one hundred and fifty-four patients seeking musculoskeletal care who completed measures of magnitude of capability, pain intensity, unhelpful thoughts regarding symptoms (catastrophic thinking, negative pain thoughts), distress (symptoms of anxiety and depression), and sleep disturbance. We tested factors associated with the magnitude of capability and pain intensity, accounting for sleep quality and mental health in multivariable models. RESULTS: Accounting for potential confounding in multivariable analysis, lower magnitude of capability was independently associated with greater sleep disturbance, more unhelpful thoughts about symptoms (negative pain thoughts), and older age. Greater pain intensity was independently associated with greater unhelpful thoughts about symptoms (catastrophic thinking) and not using of an electronic device before bed. Greater sleep disturbance was independently associated with use of sleep medication, greater symptoms of anxiety, and greater unhelpful thoughts regarding symptoms (PCS). CONCLUSION: Given the observation that sleep disturbance is associated with feelings of anxiety, clinicians can consider starting mental health discussions by focusing on sleep quality. App and web-based cognitive behavioral therapy-based treatments for sleep are readily available and have the potential to improve mental health.