Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain.

This study examined whether subjects with chronic low back pain demonstrate exercise-induced analgesia to experimentally induced pressure pain. We employed a repeated measures design to study eight subjects with chronic low back pain (mean +/- standard deviation age = 40 +/- 10, duration of pain = 7 +/- 4 years). Pain ratings were measured immediately before and 2 minutes and 32 minutes after 25 minutes of cycle ergometry (5 minutes at 50% peak oxygen uptake, then 20 minutes at 70% peak oxygen uptake). We based the pain ratings on subject input on a visual analog scale at 10-second intervals during the 2-minute pressure pain stimulus to the nondominant index finger. Compared with preexercise values, pain ratings were significantly (p < 0.05) decreased after exercise at both 2 and 32 minutes postexercise. We conclude that pressure pain perception can be reduced for more than 30 minutes following aerobic exercise from leg cycling among people with chronic low back pain.

Thermal pain perception after aerobic exercise.

OBJECTIVE: To examine thermal pain perception before, 5 minutes after, and 30 minutes after 30 minutes of treadmill exercise at 75% of maximal oxygen uptake (V o 2 max). DESIGN: Repeated-measures. SETTING: Sports science laboratory. PARTICIPANTS: Convenience sample of 14 healthy male and female volunteers (mean age +/- standard deviation, 32+/-3y). INTERVENTIONS: Sensory thresholds, pain thresholds, and pain ratings to hot and cold stimuli were measured before and after 30 minutes of treadmill exercise at 75% of V o 2 max. The hot and cold stimuli were delivered by using a thermode placed on the thenar eminence of the nondominant hand. Thermal sensory and pain thresholds were determined during continuous ramps in temperature of the thermode. MAIN OUTCOME MEASURES: Pain ratings were measured on a visual analog scale at 10-second intervals over 2 minutes of thermal pain stimulation. RESULTS: There were no significant changes in thermal sensitivity, pain thresholds, or pain ratings for either heat or cold after 30 minutes of exercise at 75% of V o 2 max. CONCLUSIONS: Pain perception to thermal stimuli was unaltered after 30 minutes of exercise at 75% of V o 2 max, an intensity and duration of exercise previously shown to alter pain perception to electric and mechanical stimuli.

Health-related quality of life improves in children and adolescents with inflammatory bowel disease after attending a camp sponsored by the Crohn's and Colitis Foundation of America.

PURPOSE: To describe the reported health-related quality of life (HRQOL) in children and adolescents with inflammatory bowel disease (IBD) after attending an IBD summer camp. METHODS: A prospective analysis of quality of life was completed at an overnight camp that was exclusively for patients with IBD, which was sponsored by the Crohn's and Colitis Foundation of America. The IMPACT-II questionnaire (Canada and United States) and the State-Trait Anxiety Inventory for Children were administered to the campers at the beginning and at the end of a 1-week camp to assess HRQOL and anxiety. The IMPACT-II questionnaire consists of 35 questions measuring 6 quality-of-life domains (i.e., bowel domain, systemic symptoms, emotional functioning, social functioning, body image, and treatment/interventions). The State-Trait Anxiety Inventory for Children consists of 2 different 20-item sets of questions. One set assesses state anxiety, and the other, trait anxiety. A repeated-measures multivariate analysis of variance was performed to determine the differences between scores attained before and after camp on the IMPACT-II questionnaire and in each of its domains. Paired sample t tests were performed on state and trait anxiety before and after camp. RESULTS: A total of 125 individuals consented to participate, but 61 patients (50 girls and 11 boys; age range, 9 to 16 y) completed the IMPACT-II questionnaire in full. Of those 61 patients, 47 had Crohn's disease and 14 had ulcerative colitis. There was statistically significant improvement between the mean (+/-SD) precamp total score (172.95 +/- 36.61) and the mean postcamp total score (178.71 +/- 40.97; P = 0.035), bowel symptoms scores (P = 0.036), social functioning scores (P = 0.022), and treatment interventions scores (P = 0.012). No difference was found between anxiety scores before and after camp on either the state or trait anxiety inventories (n = 55; P > 0.05). CONCLUSIONS: Overall, HRQOL improved in children after attending IBD summer camp. This exploratory study suggests that contributing factors for these improvements may be an increase in social functioning, a better acceptance of IBD symptoms, and less distress regarding treatment interventions, suggesting that a camp that is specifically designed for children with IBD may normalize the chronic illness experience. However, future research using a multimodal measurement approach is warranted to support these conclusions.

Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain.

OBJECTIVE: To examine how exercise-induced analgesia is affected by the duration and intensity of aerobic exercise. DESIGN: Repeated-measures design. SETTING: Exercise science laboratory. PARTICIPANTS: Convenience sample of 12 healthy male and female volunteers (mean age +/- standard deviation, 32+/-9 y). INTERVENTIONS: Pain ratings were assessed before and at 5 and 30 minutes after treadmill exercise of 10 minutes at 75% maximal oxygen uptake (Vo(2)max), 30 minutes at 50% Vo(2)max, and 30 minutes at 75% Vo(2)max (randomized order and no less than 48 h between each bout). MAIN OUTCOME MEASURES: Pain ratings were measured on a visual analog scale at 10-second intervals during a 2-minute pressure-pain stimulus to the nondominant index finger. RESULTS: Pain ratings were significantly decreased (P<.05) from pre-exercise values 5 minutes after 30 minutes of exercise at 75% Vo(2)max but returned toward baseline by 30 minutes after exercise. There were no significant changes in pain ratings after 10 minutes of exercise or after exercise at 50% Vo(2)max. CONCLUSIONS: There are thresholds for both the intensity (>50% Vo(2)max) and duration (>10 min) of exercise required to elicit exercise analgesia.

Is an abbreviated Pediatric Crohn's Disease Activity Index better than the original?

OBJECTIVE: The Pediatric Crohn's Disease Activity Index (PCDAI) is a validated measure of disease activity comprised of historical, laboratory and physical examination parameters. It has been suggested that an abbreviated PCDAI may be of similar utility without requiring laboratory evaluations or calculated height velocity. The aim of this study was to compare an abbreviated PCDAI and the original PCDAI and also compare the abbreviated PCDAI and a quality-of-life measurement. METHODS: The authors prospectively analyzed quality of life and disease activity, using the IMPACT-35 Questionnaire, the PCDAI and an abbreviated PCDAI consisting of three historical items (abdominal pain, stools and patient functioning) and three physical examination items (weight, abdomen and perirectal disease). RESULTS: Forty subjects aged 5-24 years (22 males) were included in analysis. Correlations were performed between the original PCDAI, an abbreviated PCDAI and the IMPACT-35. There was a significant, strong correlation between the PCDAI and the abbreviated PCDAI (n = 40, r = 0.849, p <0.001), a significant, moderate correlation between PCDAI and IMPACT-35 (n = 29, r = -0.547, p = 0.002) and a significant, moderate correlation between the abbreviated PCDAI and IMPACT-35 (n = 29, r = -0.579, p <0.001). CONCLUSIONS: An abbreviated PCDAI predicted disease activity as well as the full PCDAI. The IMPACT-35 correlated well with disease activity based on both PCDAI and an abbreviated PCDAI. An abbreviated PCDAI may offer advantages over the original PCDAI and should be prospectively validated in future studies.

Laparoscopic-assisted bowel resection offers advantages over open surgery for treatment of segmental Crohn's disease in children.

BACKGROUND/PURPOSE: Minimally invasive approaches have been shown to decrease hospital length of stay (LOS), decrease postoperative pain, and speed return to normal activity for a number of intraabdominal procedures. In this study, laparoscopic (LAP)-assisted bowel resection is compared with an open technique for patients undergoing an initial bowel resection. METHODS: A retrospective review was conducted of 28 patients (12 LAP, 16 open) undergoing initial bowel resection for segmental Crohn's disease. RESULTS: Patients in the LAP group had decrease LOS (5.5 days v 11.5 days) decreased days of parenteral narcotics (3 days v 5 days) and more rapid return to regular diet (3 days v 5 days). CONCLUSIONS: The data suggest that the laparoscopic approach may offer advantages to pediatric patients undergoing an initial bowel resection for segmental Crohn's disease.

Safety and steroid-sparing experience using infliximab for Crohn's disease at a pediatric inflammatory bowel disease center.

OBJECTIVES: The published experience using infliximab (Remicade, Centocor, Malvern, PA) for the treatment of pediatric Crohn's disease is limited but suggests utility in the treatment of refractory disease. Experience using infliximab at a large pediatric center is reviewed. METHODS: A retrospective review of all infliximab infusions administered to patients with Crohn's disease (CD) was undertaken. Data were obtained from database and pharmacy records. Chart review and interviews with physicians, patients, and families were used to obtain missing data. RESULTS: A total of 432 infusions were administered to 82 patients (34 female and 48 male) with CD. The number of infusions each patient received ranged from one to 18, with a mean of 5.3 (SD 4.6) and median of 3. Of 33 patients, 19 (57.6%) became independent and remained free of corticosteroids. There was a statistically significant difference in the steroid dose between 0 and 4 wk and 0 and 8 wk. In all, 23 infusion reactions occurred (5.3%). Three patients developed herpes zoster, and one developed Listeria monocytogenes meningitis. No patients were documented to have delayed hypersensitivity reactions or malignancies. CONCLUSIONS: Infliximab is safe and effective for treating pediatric patients with CD. A steroid-sparing effect was demonstrated. The most common adverse reaction to infliximab was infusion reaction. These reactions did not preclude further use of the agent. Serious infections were seen in a small number of patients.

Preliminary investigation: the impact of the NCAA Wrestling Weight Certification Program on weight cutting.

Historically, wrestling is a sport dependent on weight. Three tragic deaths in late 1997 prompted the National Collegiate Athletic Association (NCAA) to make a Wrestling Weight Certification Program (WWCP) mandatory to foster a safe competitive environment. One institution examined the impact of this program on weight cutting. Thirty-two NCAA Division I wrestlers completed the WWCP in the 1998-1999 season and 29 in 1999-2000. Eighteen (56%) of 32 wrestlers in 1998-1999 weighed in 10 or more pounds above the previous year's competition weight. Whereas, 28% weighed in 20 or more pounds above the previous year's competition weight. Weekly weight loss for the wrestlers in 1998-1999 revealed a substantial loss during the first week, possibly demonstrating the use of time-tested techniques for weight loss. However, in 1999-2000, the first week weight loss was less pronounced, with 65.8% of the weight being lost during the second half of the WWCP. Therefore, these wrestlers may be breaking the sport historic cycle of weight fluctuations through the WWCP.