How do pregnant women manage lumbopelvic pain? Pain management and their perceived effectiveness.

By London Spine
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How do pregnant women manage lumbopelvic pain? Pain management and their perceived effectiveness.

J Clin Nurs. 2015 Jan 26;

Authors: Chang HY, Jensen MP, Lai YH

Abstract
AIMS AND OBJECTIVES: This study aims to (1) investigate the pain management treatments used by pregnant women with lumbopelvic pain and their perceived effectiveness and (2) identify the predictors of pain treatment use.
BACKGROUND: A variety of treatments have been shown to be effective for reducing pregnancy-related lumbopelvic pain. However, the frequency of use of pain treatments and their perceived efficacy in pregnant women is still unknown. Knowledge regarding the use and perceived efficacy of these treatments would help guide clinical practice and inform future research.
DESIGN: A cross-sectional design with consecutive sampling.
METHODS: Participants were pregnant women in the 35th to 40th gestational week who reported lumbopelvic pain in an antenatal clinic of a medical centre in Taiwan. Questionnaires were administered assessing pain treatment use, pain relief associated with each treatment (e.g. perceived effectiveness), pain intensity, pain interference, pain endurance beliefs and demographic variables.
RESULTS: Among 295 participants with lumbopelvic pain, only 34 (12%) sought pain treatment. The pain management treatments used included mechanical treatments (80% = 27/34), herbal medicine (9% = 3/34), exercise (6% = 2/34) and medications (6% = 2/34). Average perceived effectiveness associated with the treatments was 55%. Use of pain management strategies was negatively associated with pain endurance beliefs, but not with pain intensity or pain interference.
CONCLUSIONS: Pregnant women with lumbopelvic pain are unlikely to seek or use pain management treatments for pain, suggesting a greater need for adopting effective pain treatment in clinical settings.
RELEVANCE TO CLINICAL PRACTICE: The study contributes new knowledge regarding how pregnant women cope with lumbopelvic pain and reveals very low rates in the use of pain treatments. Health professionals should assess pregnant women’s pain beliefs about pain endurance and emphasise the safety and effectiveness of interventions that have empirical support, to help minimise unnecessary pain during pregnancy.

PMID: 25620430 [PubMed – as supplied by publisher]

[Autophagy expression and its significance in chondrocytes from a degenerate model of human cervical endplate].

By London Spine
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[Autophagy expression and its significance in chondrocytes from a degenerate model of human cervical endplate].

Zhonghua Yi Xue Za Zhi. 2013 Aug 20;93(31):2474-7

Authors: Xiong SL, Xu HG, Wang H, Zhang M, Yu YF, Zhang W, Tu CD, Zhao QL, Lü K, Zhong M, Zhang MY

Abstract
OBJECTIVE: To explore the autophagy expression and examine its significance in chondrocytes in a degenerate model of human cervical vertebrae endplate.
METHODS: Cartilage endplates were obtained from 48 hospitalized patients with cervical vertebral fracture or dislocation at our hospital between February 2012 to August 2012. They were divided into cervical spondylosis group with cervical spondylotic myelopathy (n = 31) and control group (n = 17).Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro. The cells were stained with toluidine blue and hematoxylin and eosin; laser scanning confocal microscope and monodansyl cadaverine (MDC) were used to observe autophagy in endplate chondrocytes; reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the mRNA expression of typeIIcollagen and aggrecan and Western blot for the protein of LC3.
RESULTS: A degenerative cell model of human cervical endplate chondrocytes was established successfully in vitro. Compared with the common group, the cellular morphologies of degenerative group showed spindle changes. Autophagic body was stained with MDC.Intracellular and perinuclear LC3 protein was detected by laser confocal microscopy. Compared with the control group, the mRNA expressions of aggrecan (0.715 ± 0.194) and typeII collagen (0.628 ± 0.254) markedly decreased (0.845 ± 0.186,0.913 ± 0.254, P < 0.05) and LC3-II/LC3-Ideclined in cervical spondylosis group.
CONCLUSION: Autophagy plays an important pathogenic role in the process of human cervical disc degeneration. And regulating its expression may improve disc degeneration in endplate cartilage cells.

PMID: 24300268 [PubMed – in process]

Seatbelt use to save face: impact on drivers’ body region and nature of injury in motor vehicle crashes.

By London Spine
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Seatbelt use to save face: impact on drivers’ body region and nature of injury in motor vehicle crashes.

Traffic Inj Prev. 2015 Feb 11;:0

Authors: Han GM, Newmyer A, Qu M

Abstract
Background. Seatbelt use is the single most effective way to save lives and reduce injuries in motor vehicle crashes. However, some case reports described seatbelt use as a double-edged sword because some injuries are related to seatbelt use in motor vehicle crashes. To comprehensively understand the effects of seatbelt use, we systemically investigated the association between seatbelt use and injuries based on anatomic body region and type of injury in drivers who involved in motor vehicle crashes. Methods. The injury information was obtained by linking crash reports with hospital discharge data and categorized by using the diagnosis codes based on the Barell injury diagnosis matrix. 10,479 drivers (≥15 years) in passenger vehicles involved in motor vehicle crashes from 2006 to 2011 were included in this study. Results. Seatbelt use significantly reduced the proportions of traumatic brain injury (10.4% non-seatbelt; 4.1% seatbelt) and other head, face, and neck injury (29.3% non-seatbelt; 16.6% seatbelt), while increased the proportion of spine: thoracic to coccyx injury (17.9% non-seatbelt; 35.5% seatbelt). Although the proportion of spine: thoracic to coccyx injury was increased in drivers with seatbelt use, the severity of injury was decreased, such as fracture (4.2% with seatbelt use; 22.0% without seatbelt use). Furthermore, the total medical charges decreased due to the change of injury profiles in drivers with seatbelt use from higher percent of fracture (average cost for per case $26,352) to higher percent of sprains or/and strains ($1,897) with spine: thoracic to coccyx injury. Conclusion. This study provide a comprehensive picture for understanding the protective effect of seatbelt use on injuries based on anatomic body region and type of injury in drivers who involved in motor vehicle crashes.

PMID: 25671580 [PubMed – as supplied by publisher]

[Evaluation and analysis of pain in chronic hemodialysis.]

By London Spine
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[Evaluation and analysis of pain in chronic hemodialysis.]

Nephrol Ther. 2014 Oct 29;

Authors: El Harraqui R, Abda N, Bentata Y, Haddiya I

Abstract
AIM: Pain is an unpleasant experience that deeply affects patients’ quality of life and emotional state. Pain’s epidemiology and characteristics in chronic hemodialysis are not well known and insufficiently analysed. The aim of our study was to assess the prevalence, characteristics, impact and treatment of pain in our hemodialysis patients and determine its related associated factors.
METHODS: We performed a cross-sectional study including 93 chronic hemodialysis patients. We collected demographic data as well as the aspects of the reported pain on the basis of the concise pain questionnaire, and finally inferred the risk factors related to pain occurrence. Chronic pain was defined as a pain that has existed for over three months.
RESULTS: The prevalence of pain was 70.9% (n=66), mean age 55.3±13.3 years, sex ratio 30 males/36 females, mean duration of hemodialysis 82.4±57.29 (6-252) months. This pain was permanent, daily, intermittent and rare in respectively 9%, 28.7%, 48.4% and 13.6% of cases. It was mild, moderate, severe or unbearable in respectively 42.8%, 23.8%, 19% and 14.2% of cases. Pain was multifocal in 57.4% of cases. The most frequently reported pain sites were: shoulders (47.2%), head (41.2%), knee (34.5%) and back (20%). Thus, 53.8% of patients reported using analgesics, with a daily intake, frequent or rare in respectively 28%, 44% and 28% of cases. The comparison between the group of patients reporting pain to the one without pain complaints in univariate statistical analysis found that age, Charlson’s score, interdialytic weight gain and the rate of two dialysis sessions per week were linked to pain occurrence. However, in multivariate analysis, only age remained as a pain-associated factor.
CONCLUSION: Pain in chronic hemodialysis patients is a very common complaint. Therefore, it is necessary to assess it regularly, using a suitable questionnaire.

PMID: 25449761 [PubMed – as supplied by publisher]

Adjacent-level biomechanics after single versus multilevel cervical spine fusion.

By London Spine
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Adjacent-level biomechanics after single versus multilevel cervical spine fusion.

J Neurosurg Spine. 2012 Feb;16(2):172-7

Authors: Prasarn ML, Baria D, Milne E, Latta L, Sukovich W

Abstract
OBJECT: Previous studies have demonstrated that patients with spinal fusion are at greater risk for adjacent-segment disease and require additional surgery. It has been postulated that excessive motion of a given motion segment unit (MSU) leads to an increased risk of disc degeneration. It is the authors’ hypothesis that a greater increase in adjacent-segment motion will be observed following a 2-level versus a single-level anterior cervical discectomy and instrumented fusion (ACDF). Therefore, they undertook this study to determine the effect of single-level versus 2-level ACDF on the biomechanics of adjacent MSUs.
METHODS: Ten fresh-frozen human cervical spines were used in this study. The specimens were potted at C-4 and T-1 and tested in flexion and extension. Range of motion (ROM) was 30° of flexion and 15° of extension at a maximum load of 50 N. The specimens were tested intact and then were randomized into 2 groups of 5 specimens each. Group 1 underwent a single-level ACDF at the C5-6 level first, and Group 2 underwent the procedure at the C6-7 level. After testing, both groups had the fusion extended to include the C5-7 levels, and the testing was repeated. Changes in overall ROM, stiffness, and segmental motion were calculated and statistically analyzed using a paired Student t-test.
RESULTS: An increase in sagittal ROM of 31.30% above (p = 0.012) and 33.88% below (p = 0.066) the fused MSU was found comparing a 2-level with a 1-level ACDF. The overall stiffness of the entire spinal construct increased 37.34% (p = 0.051) in extension and 30.59% (p = 0.013) in flexion as the second fusion level was added. As expected, the overall sagittal ROM of the entire spinal construct decreased by 13.68% (p = 0.0014) with a 2-level compared with a 1-level fusion.
CONCLUSIONS: This study has shown that the biomechanics at adjacent levels to a cervical spine fusion are altered and that there is increased adjacent-segment motion at the levels above and below, after a 2-level compared with a 1-level ACDF.

PMID: 22136389 [PubMed – indexed for MEDLINE]