Randomised trial of long term effect of acupuncture for shoulder pain

Guerra de Hoyos JA, Andres Martin Mdel C, Bassas y Baena de Leon E, Vigara Lopez M, Molina Lopez T, Verdugo Morilla FA, Gonzalez Moreno MJ. Pain. 2004 Dec;112(3): 289-98.The objective of the study is to compare the efficacy of electro-acupuncture with placebo-acupuncture for the treatment of shoulder pain. This study comprised of a prospective, randomized, placebo controlled trial, with independent evaluator set in a Public primary care clinic in Spain. The participants are patients aged from 25 to 83 years with shoulder pain. Patients were randomly allocated to two treatments over eight weeks, with electro-acupuncture or skin non-penetrating placebo-acupuncture, both able to take diclofenac if needed for intense pain. Primary outcome measure was the difference between groups in pain intensity (visual analogue scale – VAS). Secondary outcomes were differences between groups in pain intensity measured by Lattinen index, in range of motion (goniometer), functional ability (SPADI), quality of life (COOP-WONCA charts), NSAIDS intake, credibility (Borkoveck and Nau scale) and global satisfaction (10 points analogue scale). Assessments were performed before, during and three and six months after treatment. At six month follow-up after treatment the acupuncture group showed a significantly greater improvement in pain intensity compared with the control group [VAS mean difference 2.0 (95 % CI 1.2–2.9)]. The acupuncture group had consistently better results in every secondary outcome measure than the control group. Acupuncture is an effective long-term treatment for patients with shoulder pain (from soft tissues lesions) in a primary care setting. q2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.     

Discrimination of idiopathic pain syndromes from neurogenic pain syndromes and healthy volunteers by means of clinical rating,personality traits,monoamine metabolites in CSF,serum cortisol,platelet MAO and urinary melatonin

Summary The aim of the present study was to investigate the discriminative power of a series of variables (including determination of depressive symptomatology by means of a visual analogue scale, determination of personality traits by means of the Karolinska Scales of Personality, determination of monoamine metabolites in CSF, platelet MAO activities, serum cortisol before and after dexamethasone suppression and urinary melatonin) in differentiating (a) chronic pain patients from healthy subjects, and (b) patients with idiopathic pain syndromes from patients with neurogenic pain syndromes. Separately each of the measures gave a significant but often low contribution to the discrimination, while a combination of several measures gave a complete discrimination both between healthy subjects and patients with chronic pain syndromes and between patients with idiopathic and neurogenic pain syndromes, respectively.Supported in part by grants from the Swedish Medical Research Council (grants no. 3371, 4145 and 5740) and by a grant from Stiftelsen Söderström-Königska Sjukhemmet     

Counterfactual (‘if only’) thinking in women with chronic widespread pain

The study explored the counterfactual thinking that women with chronic and widespread pain showed in response to what they themselves considered to be particularly stressful situations. Counterfactual thinking in 125 women sick‐listed due to chronic and widespread pain was investigated in terms of structure, function and control focus. The women were asked, for each of three types of problems that they indicated in a questionnaire to affect them most strongly, to describe a typical occurrence of it and to complete a counterfactual sentence in connection with it of the type ‘If only . . .’. The majority of counterfactuals pertained to predominantly somatic problems (e.g. musculo‐skeletal problems, pain and fatigue) classified as being affective rather than preparative and self‐focused rather than external, whereas in counterfactuals relating to predominantly psychological/psychosocial problems a preparative function and an external focus were more prominent. The numbers of problems listed and the numbers of situations responded to counterfactually were positively correlated. The counterfactuals, although often related to somatic problems, generally concerned psychological or psychosocial matters such as finances and paid or unpaid work. A contextual approach to elucidating counterfactual thinking based on subjects' own experiences is seen as providing valuable insight into what bothers them most. Copyright © 2006 John Wiley & Sons, Ltd.     

Correspondence analysis as a screening method for indicants for clinical diagnosis

In clinical diagnosis, a patient's symptoms are observed and the probabilities of various diseases are assessed. A widely used method of formalizing this approach is independent Bayes in which symptoms are assumed to be independent conditional on the disease category. Correspondence analysis provides a method for examining the dependence between symptoms and assists in the selection of a reduced set of symptoms for the application of the independent Bayes method. This approach is illustrated on two data sets concerned with patients attending Accident and Emergency departments with chest pain and acute abdominal pain, respectively.     

Muscular activation patterns of healthy persons and low back pain patients performing a functional capacity evaluation test

The results of most reported studies show differences between the muscular activity of low back pain patients and healthy subjects, but the focus has usually been on trunk muscles only, and they have not involved work-related tests or exercises. The reintegration of chronic low back pain patients to job market is a common problem. Therefore assessment systems like the functional capacity evaluation (FCE) according to Isernhagen [S.J. Isernhagen, Work Injury: Management and Prevention, Aspen Publishers Inc., Gaithersburg, MD, 1988] are often used tools to determine the physical abilities and deficits of long-time incapacitated persons. The aim of the present study was to compare the healthy persons and chronic low back pain patients in performing a FCE-test and to analyse their muscular activation and motion patterns. The results indicate differences in the activation patterns of the groups in the test task “floor to waist lift” common in many occupations.     

胶质细胞活化对慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)大鼠脊髓背角P物质的影响

目的探讨胶质细胞活化对慢性前列腺炎/慢性盆腔疼痛综合征（chronic prostatitis/chronic pelvic pain syndromes,CP/CPPS）大鼠脊髓背角P物质的影响。方法完全福氏佐剂和3%角叉菜胶前列腺内注射造成CP/CPPS模型,脊髓插管给药胶质细胞活化抑制剂Propentofylline干扰CP/CPPS模型大鼠,免疫组织化学方法观察正常组、疼痛模型组、药物干扰组脊髓节段（L6和S1）背角的胶质细胞的活化和P物质的定性定位,并用放射免疫的方法观察三组脊髓背角P物质的变化。结果脊髓背角胶质细胞活化阳性细胞数疼痛组明显增加,药物干扰组明显减少;P物质主要表达于脊髓背角且疼痛模型组明显增多,药物干扰组明显减少。结论胶质细胞活化是CP/CPPS大鼠脊髓背角P物质变化的重要原因,胶质细胞活化抑制剂的应用将是治疗CP/CPPS的新亮点。     

Acute diverticulitis – clinical presentation and differential diagnostics

Objective To describe the clinical presentation of acute diverticulitis in an emergency department and to characterize the natural history of diverticulitis in the short perspective. Comparisons are made with an important differential diagnosis, nonspecific abdominal pain (NSAP). Method Patients admitted to our hospital with abdominal pain of up to 7 days’ duration were registered prospectively using a detailed schedule for history, symptoms and signs, from 1 February 1997 to 1 June 2000. Of 3349 patients initially included, 3073 (92%) were eligible for follow up after 1–3 years. Results Acute diverticulitis was the final diagnosis in 145 patients and NSAP in 1142 patients. The incidence of hospitalized patients with diverticulitis was 47 per year and 100 000 population, with a mean hospital stay of 3.3 days. Patients with diverticulitis, more frequently than NSAP, had a longer history and laboratory signs of inflammatory activity. Isolated left abdominal tenderness was more common in diverticulitis, whereas isolated right abdominal tenderness was more common in NSAP. Duration of symptoms on arrival was independent of age and was not correlated to C‐reactive protein, leucocytes or body temperature. Sensitivity of diverticulitis as primary diagnosis was 64% and specificity 97%. Corresponding figures for NSAP were 43% and 90% respectively. Age and gender did not influence diagnostic accuracy or risk of surgery. Conclusion Diverticulitis differs significantly from NSAP in clinical presentation and laboratory parameters. Sensitivity of primary diagnosis for diverticulitis and NSAP was low.     

不同疗法对肌筋膜疼痛病人的自主神经功能的影响

目的：本研究的目的是观察注射疗法及复合小针刀疗法治疗肌筋膜疼痛综合征对自主神经系统功能的影响。方法：选择40例诊断明确的肌筋膜疼痛病人，随机分为两组，每组20例。Ⅰ组：采用注射疗法治疗；IS组：采用注射疗法加小针刀治疗。观察两组病人治疗前后心率变异（HRV）的频域变化，低频LF、超低频LLF、高频HF、低高频比LF／HF及心率变异指数HR-Ⅵ；用视觉模拟评分法（VAS）评定治疗前后疗效并随访观察其远期疗效。结果：①HRV频域指标组内比较：LF、LLF、HF以及HRVI治疗前舆治疗后1min比较有显着性差异（P〈0．05），与5min、10min比较有非常显着性差异（P〈0．01）。LF／HF治疗前与治疗后5min、10min比较有显着性差异（P〈0．05）。组间治疗后1、5、10min，两两比较无显着性差异。②组间比较：病人治疗后临床症状、VAS评分均较治疗前降低．治疗前后IS组有非常显着性差异（P〈0．01）。两组VAS降低率有非常显着性差异（P〈0．01）。③回访病例中，两组治疗有效率比较有显着性差异（P〈0．05）。结论：注射疗法以及复合小针刀疗法均可有效改善肌筋膜疼痛病人的自主神经功能，其机制可能是通过调节、稳定自主神经系统功能达到缓解疼痛。注射疗法复合小针刀疗法的远期疗效优于单纯注射疗法。