The meaning of playing-related musculoskeletal disorders to classical musicians

In creating and performing music, musicians can experience health problems from the high physical and psychological demands of their profession. Musculoskeletal disorders related to playing are painful, chronic and disabling conditions which are prevalent among classical musicians. The widespread study of the prevalence, etiology, and management of playing-related musculoskeletal disorders (PRMDs) is a recent development known as performing arts medicine. Despite the rapid development of this new field, it is unclear how musicians identify themselves as injured, and how they make decisions about what, if anything, to do about these disabling injuries. The aims of our study were two-fold. First, we aimed to provide musicians with the opportunity to define a PRMD in their own words. Second, we sought to understand the subjective meaning of the PRMD experience to musicians. Two key informants identified 30 study participants in Ontario and Quebec, Canada. As a form of data triangulation, participants included 27 musicians and three health professionals. Data were collected in semi-structured interviews which lasted, on average, 40 min. Data were transcribed, and were manually coded and analyzed. Participants defined a PRMD as pain and other symptoms which are chronic, are beyond their control, and which interfere with their ability to play their instrument at their usual level. Participants distinguished between "normal", mild everyday aches and pains, and a PRMD. Although a PRMD is not a medically serious or life-threatening illness, it is devastating to musicians physically, emotionally, socially, and financially. The overall theme of suffering captures the meaning of these problems which threaten the identity of the musician. The findings of this study are consistent with other studies of the experience of work-related musculoskeletal disorders, and other illnesses.     

Musicians' playing-related musculoskeletal disorders: An examination of risk factors

Several studies have shown that playing-related musculoskeletal disorders (PRMDs) present a significant health problem for musicians. To examine physiological, psychological, and behavioral risk factors of musicians' PRMDs, data for a case-control analysis were collected from classically-trained professional and university student musicians in the Canadian province of Ontario in 1994. Two-hundred and eighty-one subjects completed a self-report questionnaire and hypermobility and hand-span measurements. Cases were identified according to an operational PRMD definition developed by musicians and health care professionals in a qualitative study. Logistic regression was used to compare data from 44 prevalent PRMD cases who had no previous history of a PRMD, and 90 controls who had never experienced a PRMD. Data from all subjects were analyzed to examine the role of a prior PRMD on the risk of a current PRMD. This study suggests that females and string players were at a higher PRMD risk. A number of other individual characteristics were also important determinants of the development of a PRMD. Warming up before and taking breaks during practice sessions protected the subject from a PRMD. Given the high proportion of musicians who experience PRMDs, prevention programs are warranted. Am. J. Ind. Med. 32:292-300, 1997. © 1997 Wiley-Liss, Inc.     

Health care professionals’ familiarity with non‐pharmacological strategies for managing cancer pain

Many studies have confirmed unnecessary suffering among cancer patients, due to the inadequate use of analgesic medication and other effective interventions. While pharmacological treatments are appropriately the central component of cancer pain management, the under‐utilization of effective nonpharmacological strategies (NPS) may contribute to the problem of pain and suffering among cancer patients. The purpose of this study was to determine health care professionals’ familiarity with, and perceptions regarding, NPS for managing cancer pain, and to assess their interest in learning more about NPS as adjuncts to pharmacological analgesics. Two‐hundred and fourteen health care professionals were surveyed at two cancer treatment centres in Ontario, Canada. The self‐report questionnaire included questions regarding 11 psychological strategies (e.g. imagery) and eight other NPS (e.g. acupuncture). The response rate was 67% (141/214). Subjects were found to be the least familiar with autogenic training, operant conditioning, and cognitive therapy. Other than radiation and surgery, subjects most commonly reported recommending support groups (67%), imagery (54%), music or art therapy (49%) and meditation (43%) for managing cancer pain. Participants were most interested in learning more about acupuncture, massage therapy, therapeutic touch, hypnosis, and biofeedback. Participants were somewhat familiar with most of the 19 NPS presented; however, they use or recommend few NPS for managing cancer pain. Health professionals’ interest in NPS has important implications for the supportive care of cancer patients. Copyright © 1999 John Wiley & Sons, Ltd.     

Sex Differences in the Management and 5-Year Outcome of Young Patients (<55 Years) with Acute Coronary Syndromes

Background

Young women are usually protected against coronary artery disease due to hormonal and risk-factor profile. Previous studies have suggested poorer outcome in women hospitalized with acute coronary syndrome as compared with men. However, when adjusted for age and other risk factors, this difference does not remain significant. We compared the risk profile and outcome between young (≤55 years) women and men admitted with acute coronary syndrome.

Pain related potentials by electrical stimulation of skin for detection of small-fiber neuropathy in HIV

We compared the sensitivity of pain related evoked potentials (PREP), a novel electrophysiological technique, with standard nerve conduction (SNC) testing in the diagnosis of small fiber neuropathy in 47 patients with HIV infection and 31 age matched controls. SNC testing revealed a neuropathy in only 31%, whereas PREP was abnormal in 74% of symptomatic patients. This result hints that PREP is more sensitive in the detection of HIV-associated small fiber neuropathy than standard neurography. Received in revised form: 28 March 2006     

Quality in the provision of headache care. 1: systematic review of the literature and commentary

Widely accepted quality indicators for headache care would provide a basis not only for assessment of care but also, and more importantly, for its improvement. The objective of the study was to identify and summarize existing information on such indicators: specifically, did indicators exist, how had they been developed, what aspects of headache care did they relate to and how and with what utility were they being used? A systematic review of the medical literature was performed. A total of 32 articles met criteria for inclusion. We identified 55 existing headache quality indicators of which 37 evaluated processes of headache care. Most were relevant only to specific populations of patients and to care delivered in high-resource settings. Indicators had been used to describe overall quality of headache care at a national level, but not systematically applied to the evaluation and improvement of headache services in other settings. Some studies had evaluated the use of existing disability and quality of life instruments, but their findings had not been incorporated into quality indicators. Existing headache care quality indicators are incomplete and inadequate for purpose. They emphasize processes of care rather than structure or outcomes, and are not widely applicable to different levels and locations of headache care. Furthermore, they do not fully incorporate accepted evidence regarding optimal methods of care. There is a clear need for consensus-based indicators that fully reflect patients’ and public-health priorities. Ideally, these will be valid across cultures and health-care settings.

Electronic supplementary material

The online version of this article (doi:10.1007/s10194-012-0466-1) contains supplementary material, which is available to authorized users.     

Headache in Multiple Sclerosis

Pain, including headache, is a frequent complaint of individuals with multiple sclerosis (MS). Prevalence of headache in patients with MS was reported to be higher than 50%, but it is uncertain if this is different than what is seen in the general population. Nonetheless, it is possible that MS and headaches are comorbid. Case reports illustrated that isolated MS lesions (eg, in “strategic” regions like the midbrain) may cause severe headaches often resembling migraine. Furthermore, the role of MS disease-modifying agents needs to be taken into consideration. Mode of action and side effect profiles differ, and treatment per se may sometimes trigger headache in patients with MS. Thorough evaluation of headache in patients with MS is crucial to optimize patient management to help improve quality of life.     

From drug-induced headache to medication overuse headache. A short epidemiological review, with a focus on Latin American countries

Medication overuse headache (MOH) is a daily or almost-daily type of headache that results from the chronicization, usually migraine or tension-type headache, as a consequence of the progressive increase of intake of symptomatic drugs. MOH is now the third most frequent type of headache and affects a percentage of 1–1.4% of the general population. The currently available data on the impact of chronic headache associated with analgesic overuse in specialist headache centres confirm, beyond doubt, the existence of a serious health problem. Limited amount of data exists on the burden and impact of MOH in Latin American Countries. In this review, we summarise the reliable information from the literature on the epidemiological impact of MOH. COMOESTAS Consortium: C. Tassorelli (Project Manager), G. Sances, G. Sandrini, F. Blandini, P. Rossi (IRCCS “Neurological Institute C. Mondino” Foundation, University Centre for Headache and Adaptive Disorders, Pavia), R. Jensen (Region Hovedstaden, Glostrup Amtssygehuset), M. Lainez (Fundación de la Comunidad Valenciana para la Investigación Biomédica, la Docencia y la Cooperación Internacional y para el Desarrollo del Hospital Clínico Universitario de Valencia—Spain), D. Mueller (Universitaetsklinikum Essen), J. Leston, M.T. Goicoichea (Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infanzia, Buenos Aires—Argentina), R. Fadic (Pontificia Universidad Catolica de Chile, Santiago—Chile). COMOESTAS Project—EC contract number 215366 (COMOESTAS) FP7—Thematic priority ICT,