Best practice & research. Clinical rheumatology
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Best Pract Res Clin Rheumatol · Feb 2015
ReviewUpdate on the genetics of the fibromyalgia syndrome.
Fibromyalgia syndrome (FMS), a condition characterized by chronic widespread pain and tenderness, is a complex condition considered to represent a paradigm of centralized pain. FMS has demonstrated a clear familial aggregation, and hence it is considered to have a genetic background. ⋯ In addition, genome-wide sequencing scanning (genome-wide association study (GWAS)) is increasingly being harnessed for the study of chronic pain, including FMS. Micro RNAs are another novel field of research related to posttranscriptional inhibition of gene expression, which are currently regarding the pathogenesis of FMS.
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Chronic pain is an important public health problem, and there is a need to understand the mechanisms that lead to pain chronification. From a neurobiological perspective, the mechanisms contributing to the transition from acute to subacute and chronic pain are heterogeneous and are thought to take place at various levels of the peripheral and central nervous system. ⋯ This review summarizes important and recent findings in pain research using magnetic resonance tomography. Especially new developments in functional, structural and neurochemical imaging such as resting-state connectivity and γ-aminobutyric acid (GABA) spectroscopy, which have advanced our understanding of chronic pain and which can potentially be integrated in clinical practice, will be discussed.
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Best Pract Res Clin Rheumatol · Jun 2014
ReviewBurden of disability due to musculoskeletal (MSK) disorders.
This chapter summarises the global and regional prevalence, disability (Years Lived with Disability (YLDs)) and overall burden (Disability Adjusted Life Years (DALYs)) and costs for the common musculoskeletal disorders including low back and neck pain, hip and knee osteoarthritis, rheumatoid arthritis, gout, and a remaining combined group of other MSK conditions. The contribution of the role of pain in disability burden is introduced. Trends over time and predictions of increasing MSK disability with demographic changes are addressed and the particular challenges facing the developing world are highlighted.
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Best Pract Res Clin Rheumatol · Apr 2014
ReviewOverview of neurodevelopment and pain research, possible treatment targets.
Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. ⋯ Genotyping, sensory evaluation and neuroimaging may better characterize chronic musculoskeletal pain, identify high-risk groups and/or provide additional outcome measures to monitor disease and treatment progress. An integrated approach to management is required to effectively select and target interventions, reduce pain and disability and improve long-term outcome.
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Best Pract Res Clin Rheumatol · Apr 2014
ReviewAssessment and treatment of pain in children and adolescents.
Pain is one of the most common and distressing symptoms experienced by children and adolescents with juvenile idiopathic arthritis. Pain is known to negatively affect all aspects of health-related quality of life, including physical, emotional, social, and role functioning. The valid and reliable assessment of pain is the first critical step to developing an effective plan for pain management. This chapter will address the following key questions: (1) What is the prevalence and impact of pain in children and adolescents with arthritis? (2) Why is it important for clinicians to assess the multidimensional nature of pain and what are the practical issues that should be considered? (3) What tools are available to help clinicians to assess pain? (4) How can Internet and mobile technologies be used to improve the assessment of pain? (5) What are the recommended strategies for clinically managing pain, including pharmacological, physical, and psychological approaches?