Quantitative Sensory Testing Changes in the Successful Management of Chronic Low Back Pain.

Quantitative sensory testing changes in the successful management of chronic low back pain.

Filed under: Rehab Centers

J Man Manip Ther. 2012 Feb; 20(1): 16-22
Geletka BJ, O’Hearn MA, Courtney CA

Individuals with chronic low back pain (LBP) represent a significant percentage of patients in physical therapy practice. The clinical pattern often includes diffuse pain and a variety of sensory complaints, making categorization difficult and leading to diagnoses such as non-specific LBP. Objective measures of sensory changes through quantitative sensory testing may help identify central sensitization of nociceptive pathways in this population. Identification of these somatosensory changes may contribute to clinical decision making and patient management. The purpose of this case report is to present objective evaluation findings, including altered somatosensation, in a patient with a 2-year history of LBP, and to describe changes in function and quantitative sensory testing with successful management.
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Acupuncture transcutaneous electrical nerve stimulation reduces discomfort associated with barostat-induced rectal distension: A randomized-controlled study.

Filed under: Rehab Centers

World J Gastroenterol. 2013 Jan 21; 19(3): 381-388
Leung WW, Jones AY, Ng SS, Wong CY, Lee JF

AIM: To explore the effectiveness of acupuncture transcutaneous electrical nerve stimulation (Acu-TENS), a non-invasive modality in reduction of rectal discomfort during barostat-induced rectal distension.METHODS: Forty healthy subjects were randomized to receive 45 min of either Acu-TENS or placebo-TENS (no electrical output) over acupuncture points Hegu (large-intestine 4), Neiguan (pericardium 6) and Zusanli (stomach 36). A balloon catheter attached to a dual-drive barostat machine was then inserted into the subjects’ rectum. A step-wise (4 mmHg) increase in balloon pressure was induced until maximal tolerable or 48 mmHg. Visual analogue scale and a 5-point subjective discomfort scale (no perception, first perception of distension, urge to defecate, discomfort/pain and extreme pain) were used to assess rectal discomfort at each distension pressure. Blood beta-endorphin levels were measured before, immediately after intervention, at 24 mmHg and at maximal tolerable distension pressure.RESULTS: There was no difference in the demographic data and baseline plasma beta-endorphin levels between the two groups. Perception threshold levels were higher in the Acu-TENS group when compared to the placebo group, but the difference reached statistical significance only at the sensations “urge to defecate” and “pain”. The distension pressures recorded at the “urge to defecate” sensation for the Acu-TENS and placebo-TENS groups were 28.0 ± 4.5 mmHg and 24.6 ± 5.7 mmHg, respectively (P = 0.043); and the pressures recorded for the “pain” sensation for these two groups were 36.0 ± 4.2 mmHg and 30.5 ± 4.3 mmHg respectively (P = 0.002). Compared to the placebo group, a higher number of participants in the Acu-TENS group tolerated higher distension pressures (> 40 mmHg) (65% in Acu-TENS vs 25% in placebo, P = 0.02). The plasma beta-endorphin levels of the Acu-TENS group were significantly higher than that of the placebo group at barostat inflation pressure of 24 mmHg (1.31 ± 0.40 ng/mL vs 1.04 ± 0.43 ng/mL, P = 0.044) and at maximal inflation pressure (1.46 ± 0.53 ng/mL vs 0.95 ± 0.38 ng/mL, P = 0.003).CONCLUSION: Acu-TENS reduced rectal discomfort during barostat-induced rectal distension and concurrently associated with a rise in beta-endorphin level.
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Mechanisms of striated muscle dysfunction during acute exacerbations of COPD.

Filed under: Rehab Centers

J Appl Physiol. 2013 Jan 31;
Gayan-Ramirez G, Decramer M

During acute exacerbations of COPD, limb and respiratory muscle dysfunction develops rapidly and functional recovery is partial and slow. The mechanisms leading to this muscle dysfunction are not yet fully established. However, recent evidence has shown that several pathways involved in muscle catabolism, apoptosis and oxidative stress are activated in the vastus lateralis muscle of COPD patients during acute exacerbations while those implicated in mitochondrial function were downregulated. These pathways may be targeted in different ways by factors related to exacerbations. These factors include enhanced systemic inflammation, oxidative stress, impaired energy balance, hypoxia, hypercapnia and acidosis, corticosteroid treatment and physical inactivity. Data on the respiratory muscles are limited but these muscles are undoubtedly overloaded during exacerbations. While they are also subjected to the same systemic elements as the limb muscles (except for inactivity), they have also to face a specific mechanical disadvantage caused by changes in lung volume during exacerbation. The latter will affect the ability to generate force by the foreshortening of the muscle (especially for the diaphragm) but also by altering rib orientation and motion (especially for the parasternal intercostals and the external intercostals). Because acute exacerbations of COPD are associated with an increase in both prevalence and severity of generalized muscle dysfunction and both remain present even while recovering, early interventions to minimize muscle dysfunction during exacerbation are warranted. While rehabilitation may be promising, also other therapeutic strategies such as counterbalancing the adverse effects of exacerbations on skeletal muscle pathways may be used.
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Use of Complementary and Alternative Medicine in Children With Autism and Other Developmental Disabilities: Associations With Ethnicity, Child Comorbid Symptoms, and Parental Stress.

Filed under: Rehab Centers

J Child Neurol. 2013 Jan 30;
Valicenti-McDermott M, Burrows B, Bernstein L, Hottinger K, Lawson K, Seijo R, Schechtman M, Shulman L, Shinnar S

The use of complementary and alternative medicine by children with autism and the association of its use with child comorbid symptoms and parental stress was studied in an ethnically diverse population, in a cross-sectional study with structured interviews. The sample included 50 families of children with autism and 50 families of children with other developmental disabilities, matched by age/gender. Interview included the Complementary and Alternative Medicine Questionnaire, Gastrointestinal Questionnaire, Children’s Sleep Habits Questionnaire, Aberrant Behavior Checklist, and Parenting Stress Index. In this ethnically diverse sample, the use of complementary and alternative medicine was significantly higher for the autism group. In the autism group, use was significantly related to child’s irritability, hyperactivity, food allergies, and parental stress; in the developmental disabilities group, there was no association with child comorbid symptoms or parental stress. The results contribute information to health care providers about families of children with autism who are more likely to use complementary and alternative medicine.
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