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Institute
Background: Pain in the thoracic spine is considered a debilitating pain in other parts of the spine and the consequences are similar to those of neck pain. Thoracic Spine Pain (TSP) is defined as pain experienced in the region between the first and 12th thoracic vertebrae on the posterior trunk, with possible radiation ventrally to the ribcage. The prevalence can be up to 30% depending on the population. Despite this, there is significantly less research in this area and therefore a lack of guidelines to enable clinicians to provide optimal care for this patient group. Thus, this systematic review aimed to find out the comparative effectiveness of manual therapy (MT), exercise therapy (ET), pharmacological intervention, or educational therapy on pain in adults with TSP. In addition, to verify the effect of the above therapies on physical functioning and emotional functioning.
Methods: A systematic review (SR) with meta-analysis was conducted. For this, a literature search of five electronic databases (Ovid Medline All, Embase, Cinahl, Scopus, and Cochrane Library Trials) was performed in October 2021 and updated in September 2023 by a professional librarian without restriction in terms of year of publication and language. It included randomized controlled trials (RCTs) with adults (>18 years old) suffering from TSP. The interventions investigated had to include at least one of these approaches: MT, ET, pharmacological intervention (PI), or education therapy. First (abstract and title) and second (full text) screening, data extraction, and risk of bias (Cochrane RoB-2 tool) assessments were performed by two independent reviewers and then checked by a third reviewer. The results were presented qualitatively and quantitatively. When possible, the data from the included studies were pooled in a meta-analysis. The certainty of evidence was assessed using the GRADE approach.
Results: Ten RCTs were included. MT was investigated in 7 studies,[1-7] ET in 3 studies,[1,5,8] and PI in 3 studies.[1,9,10] Four studies [2-4,6] compared MT vs placebo, but no statistically significant (NSS) difference at any time point was found (e.g., 3 months (SMD [95%CI] -0.01 [-0.36, 0.35]) follow-up). The comparison between two PI (local anesthetic vs local anesthetic plus steroids),[9,10] demonstrated NSS in pain intensity at any follow-up. One study [5] compared MT (spinal manipulation, manual pressure release) plus ET (stretching and strengthening) vs just ET, and found SS difference favoring the combined therapy (SMD [95%] 0.59 [0.07, 1.10]) after 3 weeks. No study compared the four treatments of interest against each other. One study was classified as low RoB, 3 studies as some concerns, and 6 studies as high RoB. All results presented a very low certainty of evidence according to the GRADE.
Conclusion: Although thoracic pain is considered a disabling pain, the best conservative treatment option to relieve pain has not been substantially explored to provide high evidence-level information. Based on the restricted data included in this review, just manual therapy was compared with placebo therapy, and the results demonstrated that this technique is not superior to a placebo treatment to relieve thoracic pain. The other modalities explored in this review (exercise, pharmacological, and education therapy) were just compared between the same classes of treatment. And no difference between them was found. Just when manual therapy was combined with exercise therapy and compared with exercise alone, the results showed a medium effect favoring the combined therapy. Thus, the combination of manual therapy and exercise could be a promising treatment to relieve thoracic pain. However, more studies with better quality and more homogeneity in treatments are needed for further conclusions.
Some Hydrangea macrophylla/Hydrangea macrophylla subsp. serrata cultivars contain high amounts of the dihydroisocoumarins (DHCs) phyllodulcin and hydrangenol predominantly in young leaves. Treatments with methyljasmonate increases the contents as confirmed by studies with plants grown under optimized conditions. The functions of the DHCs for the plant are presently unclear. Since phyllodulcin has weak bactericide and moderate antifungal properties, bacterial and fungal endophytes of young leaves were isolated and PCR methods were used for identification. Most of the bacteria belong to the genus Bacillus. Other endophytes may belong to the genera Patulibacter, Rhodococcus, Rhizobium, Agrobacterium, Shouchilla, Priesta, Aeribacillus and Peribacillus, which is presently under conclusive proof, as are the endophytic fungal species belonging to the Ascomycetes. Culturing of several endophytes in presence of the DHCs revealed that some of the bacteria (Priestia spec., Patulibacter spec., Bacillus thuringiensis) and two fungi were able to degrade hydrangenol but not phyllodulcin. Ongoing studies with bacterial cultures point to growth modulation of some species by phyllodulcin. It is therefore hypothesized that phyllodulcin may have allelopathic functions in endophyte colonization success, as well as growth and microbial interaction control in the young leaves.
Evaluation of neuropathic pain characteristics in persons with spine-related neck-arm pain (Poster)
(2024)
Background
Spine-related neck-arm pain is heterogenous in its clinical presentation and pain-types (nociceptive/neuropathic). A clinical-framework for spine-related pain differentiates between (i) somatic referred pain, ii) heightened nerve mechanosensitivity, both conditions are per definition nociceptive pain (NoP) and iii) radicular pain as well as iv) radiculopathy. Radicular pain with radiculopathy meets the criteria for neuropathic pain (NeP).
Purpose
The aim was to investigate if NeP-characteristics differ between the group somatic referred pain/heightened nerve mechanosensitivity (group A) and the group radicular pain/radiculopathy (group B), using the NeP screening tool painDETECT (PD-Q). For the purpose of this study, group A was defined as having NoP, and group B as having NeP.
Methods
One hundred and thirteen persons with unilateral spine-related neck-arm pain were clinically assessed using bedside neurological examination and classified into subgroups A and B. Maximal pain area (MPA), average pain severity during the last 4 weeks, sleep quality (numerical-rating-scale), symptom duration (weeks), neck disability index (NDI) and PD-Q were recorded. The PD-Q includes seven weighted sensory descriptors (burning, tingling/pricking, light touch, electric shocks, cold/heat pain, numbness, pressure). The lowest weight is 0 (no experience of the sensation) and the highest weight is 5 (sensation is felt very strongly). PD-Q classifies patients into 3 groups, unlikely (0-12), unclear (13-18) and likely NeP (19-38). For this study, a score ≤ 18 was defined as unlikely and >19 as likely NeP.
Results
Based on the clinical-framework, 52 persons were classified into group A (37 females; mean age 46,1 ± 11,8), of which 48 (91,3%) were classified by PD-Q as unlikely NeP. Sixty-one persons were clinically classified into group B (34 females, mean age 48,7 ± 11,3), of which PD-Q classified 14 (23%) as likely NeP. 84,6% in group A reported the neck as MPA. In group B 63,9% indicated the arm as MPA. There were significant differences in symptom duration (A: mean 207,8 ± 272,3; B: 64,2 ± 154,1, p=< 0,001) and the following PD-Q descriptors: burning (A: 15,6%, B: 38,% p=0,005), tingling/pricking (A: 39,1%, B: 79,6%, p= < 0,001) and numbness (A: 20,3%, B: 38,8% p=0,032). All other descriptors showed no statistically significant difference.
Conclusions
The majority of people in group A (75%) reported the neck as their MPA whereby the majority of persons in group B (61%) reported arm pain. Typical NeP characteristics were significantly more common in group B compared to group A, supporting the suggestion that the clinical presentations of radicular pain/radiculopathy are likely associated with the presence of NeP. The PD-Q identified 89.1% of the clinically classified NoP subjects as unlikely neuropathic, but only 24.5% of those in the radicular/radiculopathy group as having likely NeP, suggesting low diagnostic accuracy in this population.
Implications
It is important to know whether a person with spine-related arm pain has NeP, in order to implement appropriate treatment. The location of the MPA and reported pain descriptors may assist clinicians in the diagnostic work-up of persons with spine-related neck-arm pain.
Background
Pain radiating from the spine into the leg is commonly referred to as ‘sciatica’. ‘Sciatica’ is associated with reduced quality of life, significant suffering and socio-economic burden. The main challenges associated with a diagnosis of ‘sciatica’ relate to the inconsistent use of terminology for the diagnostic labels ‘sciatica’/radicular pain/painful radiculopathy, and the identification of neuropathic pain. These challenges hinder collective clinical and scientific understanding and clarity regarding these conditions, impact effective clinical communication and care planning, prevent clear interpretation of the scientific literature related to the condition, and ultimately may contribute to the limited efficacy and personalisation of care for people living with ‘sciatica’.
Aims
A working group commissioned by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain was tasked with the aims: (i) to revise the use of terminology for classifying spine-related leg pain, (ii) to propose a way forward on the identification of neuropathic pain in the context of spine-related leg pain.
Method
Three facilitators convened an international expert group (n=12; 6 physicians, 5 physiotherapists, 1 patient advocate; specialities in musculoskeletal health, neurology/pain specialist, general practice, neurosurgery) with diverse expertise in the area of ‘sciatica’. A literature review was conducted to propose recommendations on terminology, followed by the first virtual meeting. The second meeting entailed discussions on the application of the neuropathic pain grading system, including the use of patient case studies to test operationalisation of the system. The system had been developed to assist clinicians and researchers in determining whether patients have neuropathic pain and the level of confidence associated with that decision. Patients are classified as having no neuropathic pain, possible, probable or definite neuropathic pain. The working group members were briefed and updated about the progress before, between and after the meetings with summary papers outlining the objectives, tasks and outcomes of each workshop.
Results
The panel recommended discouraging the term ‘sciatica’ for use in clinical practice and research without further specification of what it entails. The term ‘spine-related leg pain’ is proposed as an umbrella term to include the case definitions of somatic referred pain and radicular pain with and without radiculopathy. Differences in the application of the grading system among panel members and uncertainties to the interpretation of the grading system in the context of spine-related leg pain highlighted the need for further clarifications. The panel proposed an adaptation of the neuropathic pain grading system to facilitate the identification of neuropathic pain in the context of spine-related leg pain. The application of the adapted grading system will be presented at the IFOMT conference.
Conclusion
The working group recommends discouraging use of the term ‘sciatica’ in clinical practice and research; instead, accurate case definitions should be used. The panel proposed an adaptation of the neuropathic pain grading system in the context of spine-related leg pain, to facilitate the identification of neuropathic pain.
Implications
These recommendations will facilitate common language in clinical practice and research and assist the initiation of more specific management for this patient population.
Funding acknowledgements:
IASP NeuPSIG commissioned Working Group
Background and Aims
With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment, there is a call to support innovative models of care1, including the timely evaluation and expansion of workforce models supporting advanced practice skills in allied health.
An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2 full time equivalent) examine patients referred with spinal pathology from the Neurosurgery waitlist for their suitability for spinal surgery and instigate work-up where required, and for evaluation by a Neurosurgeon or appropriate non-surgical management. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. The ASPs work autonomously and they discuss patient cases with a neurosurgery consultant on a weekly basis, as required. The aim of this project was to evaluate the ASP service in the year 2022 and 2023.
Method
A retrospective descriptive analysis of patient data captured in 2022 and 2023 was performed.
Results
• Patient Management: In 2022, 1337 new patients were managed along with 267 follow-ups. Most patients received their initial appointment within the recommended wait times (Category 1 within 1 months, Category 2 within 3 months, category 3 within 12 months).
• ASP Autonomy: Of the new referrals, 849 (64%) did not require discussion with a consultant, emphasizing ASP's capacity for independent clinical decision-making.
• Patient Outcomes: Of the 1317 patients assessed by ASPs, 57% were discharged immediately post-assessment, while outcomes for 290 patients (22%) were pending as of January 2023.
• Neurosurgeon Referrals: Only 281 (22%) of patients assessed by ASPs were referred to a neurosurgeon, of which 103 (45%) were offered surgery.
• Further detailed outcomes will be analysed and presented in 2024, incorporating 2023 data.
Conclusion
Only 17% of the 1604 patients managed by the ASPs needed to see a Neurosurgeon. The conversion rate to surgery of 45% compares well with an estimated 5%-10% in a non-triaged Neurosurgeon clinic and highlights the benefits of triage work-up and screening prior to review by the surgeon.
The ASP model of care has proved invaluable to (i) provide timely access of patient care within the recommended wait times (ii) optimize Neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management, (iv) reduce the inconvenience and cost of travel for patients in remote areas using telehealth.
References
Sustainable Health Review (2019). Sustainable Health Review: Final report to the Western Australian Government of Health, Western Australia
Musiker leiden häufig an Einklemmunbgsneuropathie wie zum Beispiel Karpaltunnelsyndrom. In dem Vortrag und Workshop wird ein diagnostischer Ansatz für KTS und andere Nerveneinklemmungsprobleme bei MusikerInnen vorgestellt und ein Ausblick in das Management von MusikerInnen mit Einklemmungsneuropathien gegeben.
To convey perceptual experiences, cognitive agents employ various verbal strategies. This paper’s primary focus is on how olfactory perceptions are expressed when describing perfumes. Examining online communities that review perfumes reveals an intriguing approach to understanding scent perception. In addition to the technical jargon commonly employed, which follows a structured format of notes at three scent layers, one occasionally encounters narrations that aim to capture the essence of the perfume’s perceptual experience. It is argued that the narrativization of scent perception exemplifies a cognitive inclination to contextualize sensory inputs within a conceptual framework, facilitating the comprehension of non-linguistic experiences. This paper suggests a shift from a non-narrative mode of consciousness to a narrative mode as a means to elucidate the process of making sense of the seemingly nonsensical.
Die allgegenwärtigen komplexen gesellschaftlichen Herausforderungen (VUCA-Welt), die digitale Transformation weiter Arbeits- und Lebensbereiche sowie eine veränderte Erwartungshaltung der aktuellen und zukünftigen Studierendengeneration (Gen Z) erfordern eine kritische Betrachtung unseres gegenwärtigen (Hochschul-)Bildungssystems. Wissenschaftspolitische Empfehlungen raten zu einem Paradigmenwechsel in der Gestaltung unserer Lehr- und Lernprozesse sowie dem damit einhergehenden Rollenverständnis der handelnden Menschen. In zahlreichen Bereichen der Arbeitswelt wird von New Work geredet und Agilität ist in aller Munde. Ende 2022 werden durch die Verfügbarkeit von generativen Text-Chatbots KI-System Hochschulen vor neue Herausforderungen gestellt. Zwangsläufig ergeben sich daraus Anforderung an Hochschulen für ein New Learning. Was kann oder soll das Verständnis von New Learning aber sein?