Relationship of neuroticism and laboratory pain in healthy children: Does anxiety sensitivity play a role?

Both neuroticism, a higher-order, stable personality trait, and anxiety sensitivity (AS), a lower-order pain-related construct, have been associated with pain, although no research exists examining the relationship of both these constructs to acute pain in children. In the current study, 99 healthy children (53 girls) completed self-report measures of neuroticism and AS before undergoing pain tasks involving cold and pressure pain. We hypothesized that both neuroticism and AS would be correlated with acute pain responses, but that AS would at least partially mediate the relationship between neuroticism and pain responses. Results indicated significant correlations between neuroticism, AS, and anticipatory anxiety, pain intensity and pain bother. Mediational models revealed that AS partially mediated relationships between neuroticism and pain intensity/bother, and fully mediated relationships between neuroticism and anticipatory anxiety. These data suggest that, at least in children, neuroticism may be best understood as a vulnerability factor for elevated pain responses, especially when coupled with a fear of bodily sensations.     

Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects?

OBJECTIVE: To determine whether body balance is perturbed more in low back pain patients than in healthy subjects, under the concept of posturo-kinetic capacity. DESIGN: Comparison of posturographic and respiratory parameters between low back pain and healthy subjects. BACKGROUND: It has been demonstrated that respiratory movements constitute a perturbation to posture, compensated by movements of the spine and of the hips, and that low back pain is frequently associated with a loss of back mobility. METHOD: Ten low back pain patients and ten healthy subjects performed five posturographic tests under three different respiratory rate conditions: quiet breathing (spontaneous), slow breathing (0.1 Hz) and fast breathing (0.5 Hz). RESULTS: Intergroup comparison showed that the mean displacements of the center of pressure were greater for the low back pain group, especially along the antero-posterior axis, where respiratory perturbation is primarily exerted. Inter-condition comparison showed that in slow and fast breathing relatively to quiet breathing, the mean displacement of the center of pressure along the antero-posterior axis was significantly increased only for the low back pain group. CONCLUSION: According to the results, respiration presented a greater disturbing effect on body balance in low back pain subjects. RELEVANCE: This study provides information on the causes of the impaired body balance associated with chronic low back pain, which could be used to improve treatment strategy.     

Does aerobic exercise improve pain perception and mood? A review of the evidence related to healthy and chronic pain subjects

Aerobic exercise can cause an acute improvement in mood as well as a reduction in the perception of pain from a painful stimulus. Regular exercise training also may offer some protection from depression, is clinically useful in treating certain psychiatric and chronic pain conditions, and may allow for an enhancement of the acute improvements in mood from a single exercise session. The utility of aerobic exercise training for improving mood disturbances and pain perception among patients with chronic pain requires further investigation.     

Does early medical intervention have a role in the management of intracerebral haemorrhage?

INTRODUCTION: An increasing amount of research is now being directed towards the medical treatment of patients who have suffered an intracerebral haemorrhage (ICH). Despite this, no routine drug treatment to date has been shown to be unequivocally effective in unselected patients. TREATMENTS/DISCUSSION: Approaches to treatment are based upon our understanding of the pathophysiological sequelae following ICH. Strategies to reduce haematoma growth, subsequent oedema formation and perihaematoma ischaemia are key targets for further research. Whether these therapies become valuable tools for the future is as yet unclear. Until then, the mainstay of the medical management of ICH remains individualised care. CONCLUSIONS: There is now a pressing need for large prospective randomised controlled trials to determine the effectiveness of pharmacological therapies for this condition.     

Parathyroid hormone. Does it have a role in the pathogenesis of osteoporosis?

Of the many functions that parathyroid hormone serves, none is more important than its role to maintain calcium homeostasis. Intrinsic to the aging process is changes in the synthesis, metabolism, and responsiveness of parathyroid hormone. This article explores whether the age-associated changes in parathyroid hormone are causally related to the age-associated changes in bone mass. On the other hand, some of the apparent changes in parathyroid hormone associated with aging may be adaptive, serving to protect the aging skeleton. More information is needed to sort out these diametrically opposite views.     

Do botulinum toxins have a role in the management of neuropathic pain?: a focused review

ABSTRACT: Botulinum neurotoxin (BoNT) is usually used in physiatric practice in the treatment of spasticity and dystonia. Research involving both animal and human subjects has emerged suggesting potential benefits in painful neuropathic conditions. The animal data strongly support the use of BoNT in the treatment of sensitized pain states. BoNT is probably effective at treating postherpetic neuralgia, probably or possibly effective at treating postoperative/posttraumatic neuropathic pain, and probably effective at treating painful diabetic neuropathy. BoNT's proposed mechanism of action is described as decreasing sensitized nociception in four ways by (1) inhibiting glutamate release in peripheral tissues, (2) decreasing calcitonin gene-related peptide release in peripheral tissue, (3) decreasing transient receptor potential cation channel subfamily V member 1 trafficking to peripheral neuron cell membrane, and (4) decreasing substance P release in peripheral tissue. This review discusses pertinent cellular/animal basic science research in conjunction with clinical research with regard to the role of BoNT in treating neuropathic pain.     

Does amyl nitrite have a role in the management of pre-hospital mass casualty cyanide poisoning?

Context. Amyl nitrite has been recommended as a cyanide antidote for several decades. Its antidotal properties were initially attributed to induction of methemoglobin and later to a nitric oxide mediated hemodynamic effect. The ease of administration and alleged rapid clinical effect would recommend its wide use in the pre-hospital management of mass casualty cyanide poisoning; yet there are concerns regarding the use of amyl nitrite for this indication. Objective. Review the data on amyl nitrite in cyanide poisoning and evaluate its efficacy and safety in mass casualty cyanide poisoning. Methods. A literature search utilizing PubMed, Toxnet, textbooks in toxicology and pharmacology, and the bibliographies of the articles retrieved identified 17 experimental studies and human reports on the use of amyl nitrite in cyanide poisoning, and 40 additional articles on amyl nitrite's properties and adverse effects. One paper was excluded as it was a conference abstract with limited data. Mechanisms of action. The antidotal properties of amyl nitrite were attributed initially to induction of methemoglobinemia and later to nitric oxide mediated vasodilation. Efficacy: experimental studies. Animal studies on the use of amyl nitrite in cyanide poisoning are limited, and their results are inconsistent, which makes their extrapolation to humans questionable. Efficacy: human studies. Clinical reports are limited in number and the part played by amyl nitrite relative to the other treatments administered (e.g. life support, sodium nitrite, and sodium thiosulfate) is unclear. Adverse effects. Amyl nitrite can be associated with potentially serious adverse reactions such as hypotension, syncope, excessive methemoglobinemia, and hemolysis in G6PD deficient patients. These effects are more pronounced in young children, in the elderly, and in patients with cardiac and pulmonary disorders. Dose regimen. The method of administration of amyl nitrite (breaking pearls into gauze or a handkerchief and applying it intermittently to the victim's nose and mouth for a few minutes) is not easily controlled, might result in under- or over-dosing, can prevent the caregiver from administering life support, and possibly expose him/her to amyl nitrite's adverse effects. Conclusions. Administration of amyl nitrite in mass casualty cyanide poisoning can result in unnecessary morbidity and may interfere with the proper management of the incident and the required supportive treatment and rapid evacuation. In the authors' opinion these drawbacks make the use of amyl nitrite in pre-hospital mass casualty cyanide poisoning unwarranted.     

Does virtual colonoscopy have a major role in population-based screening?

In summary, technical advances in the performance of VC are occurring at a very rapid pace. These technical improvements will undoubtedly improve the polyp detection rate and reduce false-positive and false-negative examinations. The concept of VC is clearly attractive and the general public is enamored with everything that has an association with virtual reality. As other articles in this issue have revealed, there are many techniques in development to help stratify patients at risk for colon cancer. As we begin to focus our health care resources on those at highest risk, the less need there is for inexpensive, broadly based screening techniques. Clearly, those patients at high risk for having polyps are better served by colonoscopy because of its therapeutic potential. That being said, in the view of this author, if a virtual preparation can be achieved and the cost of VC can be kept relatively low, then this technique will become part of our mainstream clinical practice. If an immaculate colon preparation must be performed and if the costs reflect standard abdominal and pelvic CT rather than a special reduced cost for VC, then it is doubtful that there will be any significant impact from this technology     

Does speculum examination have a role in assessing bleeding in early pregnancy?

Objectives: To assess to what extent a speculum examination after a bimanual examination influences the accuracy of diagnosis and subsequent management of women with bleeding in early pregnancy in an accident and emergency (A&E) department.

Method: A prospective study over a five month period included women presenting to A&E with vaginal bleeding at <20/40. Exclusion criteria were haemodynamic instability or known cervical carcinoma. The clinician recorded a diagnosis and management plan on a standard questionnaire after bimanual examination and after subsequent speculum examination.

Results: 236 women were included in the study. Of these, a total of three (1.3%) had a change of management plan and 10 (4.2%) patients had a change of diagnosis after speculum examination.

Conclusion: The results suggest that speculum examination contributes to a minority of management decisions. The need for speculum examination should be assessed on a case by case basis depending on whether the findings on bimanual are conclusive.

     

The role of open learning in nurse education. Does it have a place?

A perceptible shift has begun, away from mass lectures towards more flexible, novel and adaptable methods of teaching and learning. A variety of terms (open, distance, flexible) have been used to describe such instructional methods, a key characteristic of which is that they do not require constant and/or synchronous contact between teacher and learner. This paper explores students' views of a distributed learning initiative within a University in the South of England. The initiatives were in response to increase in the number of students in each intake which was just one of the recent changes called for by the Government. This evaluation consisted of a longitudinal research project following two cohorts of nursing students (n=288) through the first two years of their education (and will continue in the final year). The study assessed the perceived influence of distributed learning (DL) on their academic education and professional training as well as their satisfaction with the workbooks. The evaluation used a mixture of qualitative and quantitative data collection, questionnaires and focus groups. DL was seen as a flexible way of studying for students. Students were able to study a topic area at their own pace and at a time convenient to them. The activities in the workbook stimulated discussions and triggered ideas and thoughts for both students and lecturers. With the commencement of the workbooks lecturers were given the opportunity to reflect on their teaching styles and were encouraged to utilise a number of different teaching and learning methodologies.