bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of Developing Dementia at Older Ages in the United States
Authors: Fishman Ezra
Published: August 2017

Dementia is increasingly recognized as a major source of disease burden in the United States, yet little research has evaluated the lifecycle implications of dementia. To address this research gap, this article uses the Aging, Demographics, and Memory Study (ADAMS) to provide the first nationally representative, longitudinal estimates of the probability that a dementia-free person will develop dementia later in life. For the 1920 birth cohort, the average dementia-free 70-year-old male had an estimated 26.9 % (SE = 3.2 %) probability of developing dementia, and the average dementia-free 70-year-old female had an estimated 34.7 % (SE = 3.7 %) probability. These estimates of risk of dementia are higher for younger, lower-mortality cohorts and are substantially higher than those found in local epidemiological studies in the United States, suggesting a widespread need to prepare for a life stage with dementia.
Perceptions of Religious Hypocrisy: When Moral Claims Exceed Moral Action
Authors: Matthews Mark A. , Mazzocco Philip J.
Published: August 2017

In this study, we investigated perceptions of hypocrisy among Christian and non-Christian individuals. Specifically, participants (N = 121) were asked to evaluate people of different religious orientations in terms of perceptions of both claimed morality, actual behavior, and general hypocrisy. Across all designations, perceptions of moral hypocrisy were determined to be greater to the extent that moral claims exceeded actual behavior. Among non-Christian participants, perceptions of hypocrisy were highest with respect to “devout” and “evangelical” Christian targets. In contrast, among Christian participants, the highest ratings of hypocrisy were reserved for “casual” Christians (i.e., Christians who do not incorporate their faith into their daily life). Our findings have both theoretical implications regarding the nature of religious hypocrisy perceptions, as well as real-world implications for understanding inter-faith perceptions and interactions.
The number of active trigger points is associated with sensory and emotional aspects of health-related quality of life in tension type headache
Authors: Palacios-Ceña M. , Wang K. , Castaldo M. , Fuensalida-Novo S. , Ordás-Bandera C. , Guillem-Mesado A. , Arendt-Nielsen L. , Fernández-de-las-Peñas C.
Published: August 2017

Aims

Some evidence supports that referred pain elicited by active trigger points (TrPs) reproduces some features of tension type headache (TTH). Our aim was to investigate the association between the number of active TrPs and health-related quality of life TTH.

Methods

Patients with TTH diagnosed by experienced neurologists according to the last International Headache Classification (ICHD-III) were included. Exclusion criteria included other primary headaches, medication overuse headache, whiplash injury or fibromyalgia. TrPs were bilaterally explored within the masseter, temporalis, trapezius, sternocleidomastoid, splenius capitis, and suboccipital. Health-related quality of life was assessed with the SF-36 questionnaire including 8 domains: physical functioning, physical role, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Higher scores represent better quality of life. Spearman correlation coefficients were used to determine correlations between the active TrPs and SF-36.

Results

Two hundred and two patients (mean age: 45±12 years) with a headache frequency of 17±7 days/month participated. Each patient with TTH exhibited 4.7±2.9 active TrPs. The number of active TrPs showed moderate weak negative associations with bodily pain (r
s: −0.216; P =0.002), emotional role (r
s: -0.185; P = 0.008) and vitality (r
s: –0.161; P = 0.02), but not with the remaining domains: the higher the number of active TrPs, the worse the emotional role and vitality and the higher the pain interference with daily life. These results were similar in both frequent episodic and chronic TTH.

Conclusions

The number of active TrPs was associated with sensory and emotional aspects of quality of life in a cohort of subjects with TTH.
Chronic neuropathic pain following oxaliplatin and docetaxel: A 5-year follow-up questionnaire study
Authors: Bennedsgaard K.J. , Ventzel L. , Jensen A.B. , Jensen A.R. , Tankisi H. , Finnerup N.B.
Published: August 2017

Background

Adjuvant chemotherapy with docetaxel and oxaliplatin increases survival in patients with high-risk breast and colorectal cancer, respectively, but may induce acute and chronic neurotoxicity. This study is a 5-year follow-up of chronic chemotherapy-induced peripheral neuropathy (CIPN).

Methods

In 2011–2012, 74 patients with high-risk colorectal cancer and 100 patients with high-risk breast cancer answered a questionnaire before, during and one year after receiving adjuvant chemotherapy with oxaliplatin and docetaxel, respectively. In 2016, a 5-year follow-up with the same questionnaire was performed in survivors.

Results

Fifty-two (36.5% women) of 74 patients (91%) treated with oxaliplatin and 80 (100% women) of 100 patients (85%) treated with docetaxel answered the questionnaire. The most common symptoms of CIPN were tingling in the hands (44.2% in the oxaliplatin (CI 95% 30.5; 58.7) and 36.3% in the docetaxel group (CI 95% 25.8; 47.8)) and feet (52.0% in the oxaliplatin (CI 95% 37.6; 66.0) and 37.5% (CI 95% 29.9; 49.0) in the docetaxel group) and numbness in the feet (34.6% in the oxaliplatin (CI 95% 22.0; 49.1) and 17.5% (CI 95% 9.9; 27.6) in the docetaxel group). Pain was present in the hands or feet in 28.9% of patients treated with oxaliplatin (CI 95% 17.12; 43.0) and 31.3% of patients treated with docetaxel (CI 95% 21.3; 42.6).

Conclusions

The results showed no major change in symptoms of neuropathy or pain from 1 to 5 years after chemotherapy. Symptoms of neuropathy were more common in patients treated with oxaliplatin.
Expression of α1 adrenergic receptor subtypes by afferent fibers that innervate rat masseter muscle
Authors: Cairns B.E. , Liu J. , Wong H.
Published: August 2017

Aims

In temporomandibular disorders sufferers, muscle pain is more severe in individuals who have undergone a traumatic stress. Why stress exacerbates masticatory muscle pain in these individuals is not known. One possibility is that under conditions of stress there is an interaction between the sympathetic and sensory nervous systems. This study investigated whether trigeminal ganglion neurons that innervate the masseter muscle express α1 adrenergic receptor subtypes to identify whether a direct interaction between the sympathetic and sensory nervous systems is feasible.

Methods

Masseter muscle ganglion neurons were identified by injection of the fluorescent dye fast blue into the masseter muscle of 4 Sprague Dawley rats (2 male, 2 female). Trigeminal ganglion sections were stained for α1a, α1b or α1d adrenergic receptors, as well as the transient receptor potential vanilloid 1 (TrpV1) receptor. Sections were examined with a Leica confocal microscope. The percent of masseter ganglion neurons expressing each receptor was calculated.

Results

Masseter muscle ganglion neurons expressed α1a(29 ± 9%), α1b (34 ± 4%) and α1d (19 ± 13%) adrenergic receptors. Expression of all three α1 receptor subtypes was higher in female rats than in male rats. Expression of α1b receptors was more commonly found on larger diameter masseter ganglion neurons. Overall 11±3% of masseter ganglion neurons expressed the TrpV1 receptor, which suggests they served a nociceptive function. The TrpV1 receptor was co-expressed by about ~10% of α1a and α1b receptor positive masseter ganglion neurons.

Conclusions

Afferent fibers that innervate the masseter muscle express all three α1 adrenergic receptor subtypes. Agonists at the α1 receptor have been previously shown to depolarize trigeminal ganglion neurons, which suggests that activation of these receptors on masseter muscle afferents would be excitatory. The expression of α1 receptors by putative nociceptors that innervate the masseter may permit a direct interaction between the sensory and sympathetic system that contributes to pain in this muscle.
Social stress, epigenetic changes and pain
Authors: Eriksen M.B. , Jacobsen D.P. , Gjerstad J.
Published: August 2017

Aims

Bullying is a prevalent issue in society, with adverse effects ranging from psychological symptoms to somatic ailments like chronic pain. The purpose of this study was to generate new knowledge about the underlying mechanisms behind this association. Using an animal model, we investigated the changes in microRNA expression in plasma, in the pituitary gland and the adrenal gland following social stress.

Methods

A resident-intruder paradigm where male Sprague Dawley rats (intruders) were exposed to male Long Evans rats (resident) 1 h daily for a week was used. Bodyweight was measured and blood samples were collected throughout the experiment. Changes in plasma microRNA expression was determined by qPCR.

Results

Rats exposed to social stress showed reduced weight gain compared to controls. Preliminary results suggested that social stress increased the plasma expression of miR-146a-5p, miR-30c- 5p and miR-223-3p.

Conclusions

The data showed that social stress gives reduced weight gain and increased expression of several circulating microRNAs. How this affects the development of persistent pain remains to be investigated.
Tramadol in postoperative pain – 1 mg/ml IV gave no pain reduction but more side effects in third molar surgery
Authors: Eriksson L. , Sand L. , Gordh T. , Tegelberg Å.
Published: August 2017

Aims

Does pre-emptive single dose intravenous tramadol produce a safe and effective postoperative analgesia?

Methods

Randomized, placebo controlled, single blinded clinical trial of pre-emptive intravenous tramadol 1 mg/kg in combination with IV midazolam in patients with dental fear. A “Pain diary” evaluates the efficacy. The safety is evaluated perioperative monitoring (SpO2 and BP).

Results

Pain scored by VAS showed no differences between the groups. It took longer time to first rescue pill in tramadol vs. control group (157 vs. 110 min, p = 0.049). Desaturation (SpO2 < 90%) was more commonly found in tramadol vs. placebo and control (p < 0.01). Increasing systolic blood pressure in the control group. Diastolic blood pressure decrease in tramadol and placebo groups. In the tramadol group, we saw more frequently mild side effects.

Conclusions

Tramadol gave no reduction in postoperative pain but an increased frequency of desaturation and side effects. Other drugs or other doses ought to be tried for this kind of postoperative pain management.
Tempo-spatial discrimination to non-noxious stimuli is better than for noxious stimuli
Authors: Frahm Ken Steffen , Mørch Carsten Dahl , Andersen Ole Kæseler
Published: August 2017

Aims

The exteroceptive sensory system is responsible for sensing external stimuli in relation to time and space. The aim of the study was to investigate the tempo-spatial properties of the exteroceptive system using laser heat and mechanical touch stimulation.

Methods

13 healthy subjects were stimulated in the volar forearm. Each subject was stimulated using two paradigms, a continuous stimulation along a continuous line on the skin, and a simultaneous 2-point stimulation. The line stimulations were delivered in both a distal and proximal direction with lengths of 25, 50, 75, and 100 mm. The 2-point stimulations were delivered with a point-to-point distance ranging from 10 to 100 mm, in steps of 10 mm. Both paradigms were delivered using painful heat (laser) stimulation and mechanical (touch) stimulation. Following each stimulation, subjects had to report the intensity (0–10 NRS, 3 being pain threshold) and either direction (line stimuli) or number of perceived points (2-point stimuli).

Results

All four line lengths and both directions were reported correctly for all mechanical line stimulation (an accuracy of 100%). For laser line stimulation the directional discrimination threshold was 68.5 mm and 70.2 mm for distal and proximal directed stimuli, respectively. The 2-point discrimination threshold for heat stimulation (67.9 mm) was higher than for the mechanical stimulation (34.5 mm). NRS was significant higher for laser stimulations than for the mechanical stimulation for both line and 2-point stimulations. NRS increased both with line length and distance between the two points (ANOVA, p < 0.001). The average NRS was 3.15 and 0.91 for laser line and mechanical line stimulations, respectively. For 2-point stimulation the average NRS was 3.72 and 1.06 for laser and mechanical stimulations, respectively.

Conclusions

The findings indicate that the tempo-spatial acuity of the exteroceptive system is lower for noxious stimuli than for innoxious stimuli. This is possible due to the larger receptive fields of nociceptive neurons and/or less lateral inhibition.
Identification of pre-operative of risk factors associated with persistent post-operative pain by self-reporting tools in lower limb amputee patients – A feasibility study
Authors: Houlind M.B. , Rømer H. , Schmelling W. , Palsson T. , Petersen K.K.
Published: August 2017

Aims

The incidence of persistent post-operative pain (PPP) is 30–85% in lower limb amputee (LLA) patients and identification of preoperative risk factors are warranted. Preoperative levels of anxiety, depression, pain catastrophizing, neuropathic pain and severe preoperative pain have previously been linked with PPP but such screening tools are not used in the clinical hospital setting. The aim of this study was to assess feasibility of using questionnaires for anxiety, depression, pain catastrophizing, neuropathic pain and preoperative pain levels in a clinical preoperative setting.

Methods

Patients scheduled for non-traumatic amputation of the lower leg or femur were recruited from three Danish hospitals. Exclusion criteria were surgery 4-weeks prior to LLA, same leg re-amputation, or inability to participate. Pre-operative values of anxiety, depression and catastrophizing were assessed using the Hospital Anxiety (A) and Depression(D) Scale (HADS) (cutoff: 8) and Pain Catastrophizing Scale (PCS) (cutoff =32). Neuropathic pain was assessed preoperatively using Pain-Detect-Questionnaire (PD-Q) (cutoff: 19). The maximum preoperative pain intensity was assessed using the Numeric Rating Scale (NRS; 0: no pain and 10: worst imaginable pain). Scores are presented as median values with interquartile range (Q1–Q3).

Results

Eight of 18 patients (5 females) completed this pilot study: median age 71 (range 56–83), 6 femur and two lower leg amputees. Nine of ten excluded patients were unable to complete the questionnaires and one patient was operated acutely. Median pre-operative HADS-D and -A scores were 7 (3–9, 50% ≥ cutoff) and 4 (1–8, 25% ≥ cutoff), pre-operative PCS score was 24 (18–28, 13% ≥ cutoff), pre-operative PD-Q score was 16 (8–22, 50% ≥ cutoff) and NRS score was 9.5 (8–10).

Conclusions

This study indicates that it is possible to implement preoperative questionnaires in a clinical setting. However, more than 50% of the patients are unable to complete the questionnaires.
Effects of conditioned pain modulation on the withdrawal pattern to nociceptive stimulation in humans – Preliminary results
Authors: Jure F.A. , Arguissain F.G. , Biurrun Manresa J.A. , Andersen O.K.
Published: August 2017

Aims

Conditioned pain modulation (CPM) is a paradigm employed to assess descending control of spinal nociception. Previous studies have shown that CPM affects the nociceptive withdrawal reflex (NWR) threshold (RTh), typically assessed in one muscle. However, the NWR activates not one but a group of synergistic muscles, which are recruited by common neural commands to achieve the limb withdrawal. In this regard, synergy analysis can provide the minimum coordinated recruitment of groups of muscles with specific activation balances that describe a movement. The aim was to assess how CPM modulate the global withdrawal strategy of the lower limb expressed by synergy analysis.

Methods

Sixteen healthy subjects received electrical stimulation in the arch of the foot at 2 × RTh intensity assessed at the biceps femoris muscle, to elicit the NWR at three time points: before, during and after immersion of the hand in cold water at 2.6 ± 0.4° (cold pressor test, CPT) to trigger CPM. Electromyographic signals (EMG) were recorded from 2 distal muscles (tibialis anterior, soleus) and 2 proximal muscles (biceps femoris, rectus femoris). Muscle synergies were identified by a non-negative matrix factorization algorithm for the EMG envelope in the 60–180 ms post-stimulus interval. Data were analyzed by a point-by-point Wilcoxon test using a permutation strategy.

Results

The overall withdrawal pattern was explained by two main synergies (Syn1 and Syn2). Syn1 mainly contributes to EMG of distal muscles, whereas Syn2 contributes to EMG of proximal muscles. During CPT, the magnitude of Syn2 was reduced in the 160–180ms post-stimulus interval (p < 0.05), whereas no changes were found for Syn1.

Conclusions

At least two synergies are required to explain the NWR. Furthermore, results suggest that CPM might differentially affect proximal and distal muscles. Further analysis is needed to provide additional information about the behavior of the individual muscles.
The subjective sensation induced by various thermal pulse stimulation in healthy volunteers
Authors: Oono Y. , Kubo H. , Imamura T. , Matsumoto K. , Uchida S. , Takagi S. , Gazerani P. , Wang K. , Arendt-Nielsen L. , Kohase H.
Published: August 2017

Aims

Novel quantitative thermal stimulator devices (QTSDs) have been developed to deliver thermal pulse stimulation with regulated constant temperatures (0–45°C) with a Peltier element probe (16 cm2). The aim of this study was to investigate subjective sensation induced by the interaction between simultaneously applied painful cold and heat stimuli in various sites.

Methods

Twenty healthy subjects (12 men and 8 women, age range: 25–45 years) participated. The intensity of cold pain (CP) and heat pain (HP) stimuli were assessed by visual analogue scale (VAS) and adjusted to elicit approximately 70/100 mm. Alternately pulse stimulations (pulse duration of 40 s; 0.025 Hz) which consisted of CP, HP, or neutral temperature (32°C) were applied. Four conditions were tested and subjective sensations were assessed: (1) one QTSD was applied to non-dominant forearm and cold-heat pulse stimulation was applied.

Two QTSDs were applied to (2) non-dominant ipsilateral forearm with 5 cm apart, (3) non-dominant and contralateral forearms, (4) non-dominant forearm and ipsilateral thigh, respectively. In conditions of (2)–(4), CP-neutral pulse stimulation (C-Neutral) and neutral-HP pulse stimulation (Neutral-H) were applied simultaneously with opposite phase, respectively.

Results

CP and HP were 3.9±1.0°C (mean±SD) and 43.6±0.9°C (mean±SD), respectively. The VAS values for CP and HP were 73.4±2.0 mm (mean±SD) and 76.4 ±4.8 mm (mean±SD), respectively. Some subjects could not discriminate cold or heat sensation and some felt cold as heat (paradoxical sensation). The number of subjects with such paradoxical sensation in (1), (2), (3), (4) were 9 (45%), 2 (10%), 0 (0%) and 3 (15%), respectively.

Conclusions

In healthy volunteers, simultaneous alternately cold-heat pulse stimulation on one site triggered paradoxical thermal sensation, which to a much less degree is triggered when C-Neutral and Neutral-H were applied to different dermatomes. This suggests that the mechanism is primarily triggered peripherally.
Assessing Offset Analgesia through electrical stimulations in healthy volunteers
Authors: Ligato D. , Petersen K.K. , Mørch C.D. , Arendt-Nielsen L.
Published: August 2017

Background and aims

Offset Analgesia (OA) is a disproportionally large decrease of pain perception evoked by a slight decrease of a painful cutaneous heat stimulus, resulting in a lower pain perception compared to a simple constant stimulus at the same temperature. This study aimed to investigate the possibility of evoking the same disproportional analgesic effect by applying electrical stimuli.

Methods

24 subjects underwent two control-trials of 30 s constant intensity by applying either heat stimulation at 48 °C or an electrical stimulation at 150% of the individual electrical Pain Detection (ePD) on the volar forearm. OA-trials consisted of a 30 s stimulation, divided into three periods: T1 (5 s), T2 (5 s), and T3 (20 s), with stimuli intensities of 48 °C, 49°C and 48°C or 150% of ePD, 180% of ePD, and 150% of ePD.

Subjects were asked to rate the pain intensity on an electronic Visual Analog Scale (VAS; 0: no pain; 10: worst imaginable pain), and were categorized as responders if they showed more than 30% lower VAS at heat OA-trials compared to heat control-trial. Repeated measures Analysis of Variance was applied to investigate the difference in pain intensity to the electrical OA-trials, compared with the electrical control-trials.

Results

Responders to the heat OA-trial also responded to the electrical OA-trial compared to the electrical control-trial, with an analgesic effect of 3.3±0.5 VAS points (P < 0.001). However, when analyzing all subjects, no difference was found comparing the electrical OA-trial (VAS 3.8±0.5) to the electrical control-trial (VAS 6.2±0.4; P > 0.5).

Conclusions

This study suggests that responders to the heat OA-paradigm also respond to the electrical OA-paradigm.
Metastatic lung cancer in patient with non-malignant neck pain: A case report
Authors: Pawlak W.Z. , Svensson L. , Jensen P.F.
Published: August 2017

Background

Symptoms from disseminated cancer can develop very slowly. This could be very difficult to distinguish those symptoms from chronic disabilities and nuisances in patients with chronic non-malignant pain.

Objective

In this report, the case of a woman with both nonmalignant pain and cancer is presented.

Case report

A 54 years old woman was referred by a general practitioner to Multidisciplinary Pain Center. The diagnosis was chronic non-malignant neck pain on the basis of degenerative columnar disease. The patient was also suffering from osteoporosis. During the first visit in the Center, the patient complained of shooting pains in the neck and had tingling sensations in the fingers – most of his right hand. Moreover, the patient experienced shooting pains in the hips, lower back and spine. The multidisciplinary treatment with medication, physical therapy, TENS and cognitive behavioral therapy was offered. Paracetamol together with gabapentin was used. The patient experienced relief of pain. The doses of gabapentin was escalated up to 2400 mg daily without significant side effects. Afterwards, the dose was gradually increased to 3600 mg daily and the patient experienced fatigue, mild headache and dizziness. These symptoms were initially interpreted as side effects of gabapentin. However, the tingling sensations in the fingers were almost disappeared. The doses of gabapentin was reduced, but without relief of symptoms. Within 2 weeks, the patient developed partial paresis of the right upper limb and aphasia. The patient was urgently referred to the neurologic inpatient clinic. CT- and MR-scans showed multiple cerebral metastases. Under the diagnostic workup the lung tumor was found. The biopsy showed pulmonary adenocarcinoma.

Conclusions

The symptoms of lung cancer with cerebral metastases can mimic side effects of gabapentin.
Oxycodone and macrogol 3350 treatment reduces anal sphincter relaxation compared to combined oxycodone and naloxone tablets
Authors: Poulsen Jakob Lykke , Brock Christina , Grønlund Debbie , Krogh Klaus , Drewes Asbjørn Mohr
Published: August 2017

Background

Opioid analgesics inhibit anal sphincter function and contribute to opioid-induced bowel dysfunction. However, it is unknown if the inhibition can be reduced by opioid antagonism with oral naloxone, and how this compares to osmotic laxative treatment.

Aims

To compare the effects of oxycodone and macrogol 3350 treatment (OX + PEG) versus combined oral oxycodone and naloxone (OXN) on anal sphincter function and gastrointestinal symptoms.

Methods

A randomised, double-blind, crossover trial was conducted in 20 healthy, male volunteers. Participants were randomised to five days treatment of OX + PEG or OXN. Anal resting pressure, anal canal distensibility, and rectoanal inhibitory reflex-induced sphincter relaxation were evaluated at baseline and on day 5. The Patient Assessment of Constipation questionnaire (PAC-SYM), stool frequency, and stool consistency were assed daily.

Results

Sphincter relaxation was reduced after OX + PEG treatment compared to OXN (difference = −17.6% [95% Cl;−25.2, −10.2]; P < 0.001). Anal resting pressure and anal canal distensibility did not differ between the treatments. PAC-SYM abdominal symptom subscale increased during OX + PEG compared to OXN (cumulated score: 3.2±2.3 vs. 0.2±1.8; P =0.002). Number of bowel movements was higher during OX + PEG vs. OXN (5.4±1.5 vs. 4.2±1.2; P = 0.035), but there was no difference in stool consistency (3.5±0.5 vs. 3.2±0.4; P = 0.14).

Conclusions

Sphincter relaxation was significantly reduced after OX + PEG compared to OXN. Evaluation of the rectoanal inhibitory reflex may serve as an important objective measure in future trials on treatment of opioid-induced bowel dysfunction.
Dissatisfaction and persistent post-operative pain following total knee replacement – A 5 year follow-up of all patients from a whole region
Authors: Salim T. , Pedersen P. , Østgaard S.E. , Kappel K. , Blom C.S. , Zinolabedinbik P. , Simonsen O.
Published: August 2017

Introduction

Total knee replacement (TKR) is the treatment of choice for the millions of individuals whose osteoarthritis related pain can no longer be managed through non-invasive methods. Although most patients report improvement in pain and functioning following TKR, up to 30% report after 1–2 years persistent pain that interferes with their daily function. Further knowledge on long term results are highly demanded. The present study is the first 5 year follow-up of all patients from a whole region.

Methods

Patients were interviewed by letter concerning pain, overall satisfaction and forgotten joint score (FJS). In 2011, 607 patients in the region of North Denmark had a primary TKR, of which 20 was bilateral. Still alive are 546 patients. A total of 498 answered by letter (91%) of which 13 were not able to answer detailed due to psychological reasons.

Results

A total of 290 (59%) patients were very satisfied with their TKR, 140 (30%) were satisfied and 58 (12%) dissatisfied. Pain free were 269 (55%). 163 patients (33%) experienced moderate pain and 55 (11%) had strong pain. Dissatisfaction and pain were highly correlated, especially pain at walking: Among patients reporting strong pain, 35 (64%) scored higher than 6 on the VAS-average pain last 24 h versus 46 (84%) that scored higher than 6 on the VAS-pain after 30 min’s walk.

Conclusions

Among an unselected series of patients having TKR, 12% were dissatisfied and 11% still had strong pain 5 years later. Dissatisfaction was especially correlated with pain when walking. Thus, the association between dissatisfaction, pain at activity and the individual expectations should be further focused.
Paradoxical differences in pain ratings of the same stimulus intensity
Authors: McPhee M.E. , Petersen K.K. , Hoegh M.S. , Graven-Nielsen T.
Published: August 2017

Aims

Stimulus intensity used for assessing temporal summation of pain (TSP) is commonly set at the participants’ pain tolerance. Yet pain ratings during TSP rarely reach that initial pain tolerance pain rating. This study aimed to explore the differences between baseline pain tolerance assessed by cuff algometry and subsequent pain ratings of the same stimulus intensity, and the reliability of these ratings over 2 sessions.

Methods

In two sessions, separated by one week, 24 healthy, pain-free males had their pressure pain detection (PDT) and tolerance threshold (PTT) recorded using a staircase inflation paradigm (5 kPa increments, 1sec-ON:4sec-OFF) with a cuff algometry system. The pain intensity was assessed during cuff stimulation using an electronic visual analogue scale (VAS, 0–10 cm). Three different inflation paradigms were then performed, using the PTT level as stimulation intensity, and a 1-s duration for each stimulus: PEAKS: 3 inflations at 0.17 Hz, SLOW: 10 inflations at 0.01 Hz, FAST: 10 inflations at 0.5 Hz). Approximately 5-min was kept between the staircase assessment and the first stimulation paradigm, and between each of the 3 inflation paradigms. The PTT and first inflation VAS rating from each paradigm was extracted.

Results

The VAS rating of PTT pressure was higher in the staircase (VAS: 8.5±2.1 cm) than the first PPT stimulus in any other paradigm (PEAKS: 5.4±2.0; SLOW: 4.6±2.1; FAST: 4.0±2.3, P < 0.05). VAS ratings were also lower in each subsequent paradigm (i.e. PEAKS > SLOW > FAST, P < 0.05). Intra-class coefficients demonstrated excellent reliability for each paradigm (all ICC > 0.79) between sessions.

Conclusions

PTT, as assessed with the staircase inflation paradigm, was rated more painful during baseline assessment than when the identical stimulus profile (PPT intensity for 1-s) was applied afterwards and this finding is considered reliable.
Are we using Placebo effects in specialized Palliative Care?
Authors: Sigaard Jarl , Dinesen Birthe
Published: August 2017

Background

Placebo effects are positive treatment effects that occur because of the psycho-social context around the therapy. Such effects are well documented in pain treatment, as well as in the treatment of other common symptoms. Specialized Palliative Care focuses on the relief of pain and other symptoms in terminally ill cancer patients.

Aims

The aim of this study was to explore whether and/or how a Specialized Palliative Care Team might contribute to the creation of placebo effects.

Methods

The study was conducted as a qualitative study using a phenomenological/hermeneutic approach. A literature review was carried out to identify state-of-the-art knowledge about placebo effects. A triangulation of data collection techniques was used, including participant observations (n = 8.6 h) and a focus group interview with 7 members of the Specialized Palliative Care Team. Observations from six cases were also included. Data was analyzed using NVivo 11.0.

Findings

This study identified work routines and situation of the Specialized Palliative Care Team that had a potential for eliciting placebo effects. The value of patient collaboration for the creation of placebo effects was identified by members of the Specialized Palliative Care Team. The team’s knowledge and attitudes concerning placebo reflect the confusion that exists in general in this area.

Conclusions

This study found several work routines, already in use by the Specialized Palliative Care Team, well known for creating placebo effects. Increased knowledge and focus on this phenomenon may benefit patients.
Preoperative synovitis in knee osteoarthritis is predictive for pain 1 year after total knee arthroplasty
Authors: Vela Jonathan , Kjær Petersen Kristian , Arendt-Nielsen Lars , Meyer Andersen Mikkel , Simonsen Ole
Published: August 2017

Background

Knee osteoarthritis (KOA) was previously considered a degenerative joint disease due to wear and tear. After total Knee replacement (TKR) 13–38% of patients develop persistent post-operative pain. Emerging evidence has shown that the etiology of pain in KOA is multifaceted and may involve different structures including the synovial membrane, musculotendinous structures and neuronal tissue. Current preoperative assessment does not take these into account, thus the current study examines the role of preoperative synovitis on patient reported outcomes one-year post surgery.

Material and methods

40 patients with end-stage KOA answered the KOOS questionnaire prior to receiving total knee replacement surgery. During the procedure synovitis was scored systematically at six sites where synovial excision biopsies were obtained. Macro scoring was based on three parameters (hypertrophy, vascularity and synovitis) on a 0–4 point scale. Micro biopsies where also graded based on three parameters (synovial hyperplasia, inflammatory infiltration and activation of synovial stroma) but on a 0–3 point scale. Patients received a follow up KOOS questionnaire one-year post surgery.

Results

33 patients completed the KOOS questionnaire at follow-up. A high correlation between the micro mean, micro max, macro mean, and macro max was found. The micro mean was chosen as a proxy for the amount of synovitis. A multiple linear regression analysis, correcting for baseline values of BMI, age, smoking, point pressure thresholds (PPTs) and KOOS pain, showed that the synovitis measurement at baseline was significant for the change in KOOS pain with an effect of 22.22 (p = 0.0498). Hence, the more synovitis at baseline, the higher the follow-up KOOS Pain was compared to baseline KOOS Pain (an improvement). The standard deviation (SD) of the synovitis measure was 0.42, hence a change of 1 SD in synovitis gave an increase of 9 in KOOS Pain at follow-up compared to at baseline.

Conclusions

These preliminary results indicate that the synovitis score attained during operation is positively correlated with improvement in KOOS-pain post operatively.
PainData: A clinical pain registry in Denmark
Authors: Vægter H.B. , Høybye M.T. , Larsen S.K. , Hansen O.B. , Pedersen C.B. , Jensen P.B.F. , Handberg G.
Published: August 2017

Aims

Chronic pain is a significant clinical problem with few effective therapies. Objectives of this clinical registry are (1) to assist clinical decision-making, and (2) facilitate quality assurance and research projects to improve understanding and optimize treatment of patients with chronic pain.

Methods

PainData is an electronic software system developed for online data capture and clinical reporting, currently implemented in public pain clinics in Odense, Silkeborg, Aalborg, Næstved, Køge and Holbæk. The system captures patient-specific information across several bio-psychosocial domains of pain before the first consultation at the pain clinic as well as immediately after treatment, and 12 months after treatment. The registry also includes information from clinicians (e.g. pain diagnosis, and standardized pain sensitivity testing). PainData is registered as a clinical and research database with the Danish Data Protection Agency (16/39398, 14/44319).

Results

Since February 1st 2015 more than 3000 patients have completed questionnaires in PainData. The current completion rate at baseline is >80% and at follow-up is close to 50%. Pain-related data (e.g. pain-distribution, psychological distress and use of analgesics) from the registry will be presented on the poster.

Conclusions

The clinical pain registry contains data from a large cohort of consecutively referred chronic pain patients attending public pain clinics for multidisciplinary assessment and treatment. It contains detailed baseline and outcome data on a broad range of bio-psychosocial factors. The database has significant clinical relevance as it will contribute to an increased understanding of chronic pain conditions as well as contribute to substantial knowledge on how various psychological factors influence the experience of pain and disability in patients with chronic pain. In addition, early prediction of treatment efficacy and future stratification of patients with chronic pain has the potential to optimize treatment outcome. This will be of great interest to both the individual patient and to society.
The potential use of a serious game to help patients learn about post-operative pain management – An evaluation study
Authors: Ingadóttir B. , Zoëga S. , Blöndal K. , Thue D. , Thylen I. , Jaarsmaa T.
Published: August 2017

Aims

To describe the evaluation of a serious computer game designed for patients to learn about post-operative pain management.

Methods

This was a usability and evaluation study. The sample consisted of 20 people, recruited from the public. The computer game was developed by an interdisciplinary team. In the game, the player controls the actions of a virtual human character who has been discharged home after surgery. The player needs to make decisions about the character’s daily activities, such as common household tasks and self-care, including pain management. The player observes how his decisions influence the character’s recovery. The usability and efficacy of the game were evaluated in one session with semi-structured interviews and questionnaires on knowledge acquisition and usability. The playing session was video recorded to assess if technical problems arose and how often the player needed assistance.

Results

The mean age of participants was 48 years (SD = 14), 11 were women. Participants described the usability of the game as high (range 3–5 on a 0–5 scale) and expressed satisfaction with this novel method of learning, despite some technological challenges. Ease of use was confirmed by observation. Knowledge of pain medications and pain management strategies improved after playing the game. The number of correct answers increased from 54%, before playing, to 71% after playing the game (p = 0.001).

Conclusions

Playing an educational computer came has the potential to improve knowledge regarding post-operative pain management. The game was well received by participants. Serious computer games can be a useful tool in enhancing patient education. The game needs to be tested with surgical patients.
Choice of rat strain in pre-clinical pain-research – Does it make a difference for translation from animal model to human condition?
Authors: Hestehave S. , Munro G. , Brønnum-Pedersen T. , Heegaard A.M. , Abelson K.S.P.
Published: August 2017

Aims

Translating preclinical drug-efficacy of analgesics from animal models to humans has proven challenging with many failures. Reasons are likely multifaceted, but lack of sufficiently rigorous study design, and phenotypical relevant animal models may be part of the explanation. Chronic pain is often associated with substantial comorbid burden, consisting of changes in affective state and cognitive impairment amongst other behavioral disturbances. Accordingly, many preclinical pain research activities have started to include assessment of comorbidity as a possible experimental outcome measure, but surprisingly, little consideration has been paid to the influence of animal-related factors to pain models. To address this essential issue, we have embarked on several comparative experiments in different pain-models, comparing Sprague Dawley’s (SD) from two different vendors with different inbred rat strains (Lewis (LEW), Fisher (F344) and Wistar Kyoto (WKY)) selected based on reported stress, depression, inflammatory and pain phenotypes.

Methods

Male rats were characterized in acute (hot-plate), inflammatory (Complete Freund’s Adjuvant (CFA)) and neuropathic (Spared Nerve Injury (SNI)) pain models, with dose-response to morphine (0.3–6.0 mg/kg) in hot-plate, CFA-induced hyperalgesia, and a locomotor motility-assay (LMA).

Results

F344 and SD’s were sensitive to morphine in hotplate and CFA (Minimum Effective Dose (MED) = 3.0 mg/kg). WKY rats developed a less robust mechanical hypersensitivity after CFA injection, and were less sensitive to morphine in both pain-tests (MED = 6.0 mg/kg). LEW rats were completely insensitive to morphine in the hot plate, in contrast to reversal of CFA-induced hyperalgesia (MED = 3.0 mg/kg). Additionally, neuropathic sensitivity developed with a later onset and less robustly in this strain after SNI. All strains tested in LMA exhibited sedative effects at 3.0 mg/kg.

Conclusions

Sensory phenotyping in response to acute, inflammatory and neuropathic pain, and sensitivity to morphine in these strains indicates that different pathophysiological mechanisms are engaged after injury. This could have profound implications for translating preclinical drug discovery efforts into pain-patients.
Initial development of a free-surface wall jet at moderate Reynolds number
Authors: Khayat Roger E.
Published: August 2017

The steady laminar flow of a moderately inertial wall jet is examined theoretically near the exit of a channel. The free-surface jet emerges asymmetrically from the channel as it adheres to an infinite (upper) wall subject to a pressure gradient. The problem is solved using the method of matched asymptotic expansions. The small parameter involved in the expansions is the inverse cubic power of the Reynolds number. The flow field is obtained by matching the inviscid rotational core flow separately with the free-surface and the two wall layers. The upstream influence is examined as well as the break in the symmetry between the two wall layers. The wall jet exhibits a contraction near the channel exit that is independent of inertia, and eventually expands for any Reynolds number. Unlike the flow of a wall jet emerging into the same ambient fluid, the free-surface jet experiences a limited weakening in shear stress along the infinite wall, suggesting the possibility of separation for a jet with relatively low inertia. Significant shearing and elongation ensue at the exit, accompanied by flattening of the velocity profile near the upper wall.
Oscillatory and streaming flow between two spheres due to combined oscillations
Authors: Kong Dejuan , Penkova Anita , Sadhal Satwindar Singh
Published: August 2017

The flow induced by the combined torsional and transverse oscillations of a sphere with amplitude ratio $\unicode[STIX]{x1D6FC}$ and phase difference $\unicode[STIX]{x1D6FD}$ in a concentric spherical container is examined. Analytical solutions of the leading-order flow field and shear stress profiles have been obtained. Steady streaming flows are also analysed not only for the case of unrestricted Womersley number $|M|$, but also in the low-frequency $(|M|\ll 1)$ and high-frequency ($|M|\gg 1$) limits. At high frequency, the flow field has been divided into three regions: two boundary layers and the outer region. The streaming flow field is determined for the limiting case of the streaming Reynolds number $R_{s}\ll 1$. The results are compared with those of single torsional or transverse oscillation, and found to match very well. The amplitude ratio $\unicode[STIX]{x1D6FC}$ and phase difference $\unicode[STIX]{x1D6FD}$, in determining the streaming, are also discussed. The number and direction of steady streaming recirculation on the $r$–$\unicode[STIX]{x1D703}$ plane depend on value of the amplitude ratio $\unicode[STIX]{x1D6FC}$. The phase difference $\unicode[STIX]{x1D6FD}$ plays a dominant role in the azimuthal velocity $u_{1\unicode[STIX]{x1D719}}^{(s)}$ of steady streaming. When $\unicode[STIX]{x1D6FD}$ is approximately $(2n+1)\unicode[STIX]{x03C0}/2$, $u_{1\unicode[STIX]{x1D719}}^{(s)}$ vanishes under low-frequency oscillation, while steady streaming has a recirculation on the $r$–$\unicode[STIX]{x1D719}$ plane under higher-frequency oscillation.
Dating Reassembled Collagen from Fossil Bones
Authors: Goldenberg Larisa , Regev Lior , Mintz Eugenia , Boaretto Elisabetta
Published: August 2017

Insoluble bone collagen is one of the most common materials used for high-resolution radiocarbon (14C) dating. Unfortunately, in some bones, poor preservation of the insoluble collagen excludes the possibility of dating. During the burial of the bone the collagen sometimes degrades into peptides. These peptides are soluble in the acid used to dissolve the bone mineral. It is known that under appropriate conditions, collagen has the ability to self-assemble. Here we exploit this capability and present a method for reassembling the soluble collagen peptides in archaeological bones and dating them. We treated the acid fraction generated during the demineralization of the bone by desalting and neutralizing the solution by dialysis. During the dialysis, the soluble collagen peptides reassemble and precipitate in the dialysis bag. We used FTIR spectroscopy to determine that the precipitated material is indeed collagen. The14C dates obtained from the reassembled collagen were compared to the dates of “standard” insoluble collagen, extracted in parallel from the same bone. Although there are some divergences of the dates, 3 out of 10 samples could have been dated only by the reassembled collagen. This shows that collagen peptides reassembly can be a valuable tool for dating bones with little or no insoluble collagen.
Does a better adherence to dietary guidelines reduce mortality risk and environmental impact in the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition?
Authors: Biesbroek Sander , Verschuren W. M. Monique , Boer Jolanda M. A. , van de Kamp Mirjam E. , van der Schouw Yvonne T. , Geelen Anouk , Looman Moniek , Temme Elisabeth H. M.
Published: August 2017

Guidelines for a healthy diet aim to decrease the risk of chronic diseases. It is unclear as to what extent a healthy diet is also an environmentally friendly diet. In the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition, the diet was assessed with a 178-item FFQ of 40 011 participants aged 20–70 years between 1993 and 1997. The WHO’s Healthy Diet Indicator (HDI), the Dietary Approaches to Stop Hypertension (DASH) score and the Dutch Healthy Diet index 2015 (DHD15-index) were investigated in relation to greenhouse gas (GHG) emissions, land use and all-cause mortality risk. GHG emissions were associated with HDI scores (−3·7 % per sd increase (95 % CI −3·4, −4·0) for men and −1·9 % (95 % CI −0·4, −3·4) for women), with DASH scores in women only (1·1 % per sd increase, 95 % CI 0·9, 1·3) and with DHD15-index scores (−2·5 % per sd increase (95 % CI −2·2, −2·8) for men and −2·0 % (95 % CI −1·9, −2·2) for women). For all indices, higher scores were associated with less land use (ranging from −1·3 to −3·1 %). Mortality risk decreased with increasing scores for all indices. Per sd increase of the indices, hazard ratios for mortality ranged from 0·88 (95 % CI 0·82, 0·95) to 0·96 (95 % CI 0·92, 0·99). Our results showed that adhering to the WHO and Dutch dietary guidelines will lower the risk of all-cause mortality and moderately lower the environmental impact. The DASH diet was associated with lower mortality and land use, but because of high dairy product consumption in the Netherlands it was also associated with higher GHG emissions.
Tree hole mosquito species composition and relative abundances differ between urban and adjacent forest habitats in northwestern Argentina
Authors: Mangudo C. , Aparicio J.P. , Rossi G.C. , Gleiser R.M.
Published: August 2017

Water-holding tree holes are main larval habitats for many pathogen vectors, especially mosquitoes (Diptera: Culicidae). Along 3 years, the diversity and composition of mosquito species in tree holes of two neighbouring but completely different environments, a city and its adjacent forest, were compared using generalized linear mixed models, PERMANOVA, SIMPER and species association indexes. The city area (Northwest Argentina) is highly relevant epidemiologically due to the presence of Aedes aegypti L. (main dengue vector) and occurrence of dengue outbreaks; the Yungas rainforests are highly biologically diverse. In total seven mosquito species were recorded, in descending order of abundance: Ae. aegypti, Haemagogus spegazzinii Brèthes, Sabethes purpureus (Theobald), Toxorhynchites guadeloupensis Dyar and Knab, Aedes terrens Walker, Haemagogus leucocelaenus Dyar & Shannon and Sabethes petrocchiae (Shannon and Del Ponte). The seven mosquito species were recorded in both city sites and forested areas; however, their mosquito communities significantly diverged because of marked differences in the frequency and relative abundance of some species: Tx. guadeloupensis and Ae. aegypti were significantly more abundant in forest and urban areas, respectively. Positive significant associations were detected between Ae. aegypti, Hg. spegazzinii and Hg. leucocelaenus. The combined presence of Ae. aegypti, Haemagogus and Sabethes in the area also highlight a potential risk of yellow fever epidemics. Overall results show an impoverished tree hole mosquito fauna in urban environments, reflecting negative effects of urbanization on mosquito diversity.