Articles: chronic.
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A 44-year-old woman with a history of dyslipidemia and chronic anemia from uterine fibroids was admitted to the general medicine department of a tertiary hospital for a prolonged fever of 2 months' duration. The patient reported multiple visits to her local general practitioner, with tympanic temperatures up to 38.2 °C, where she was treated with 2 courses of broad-spectrum antibiotics in view of associated sore throat, nonproductive cough, and generalized lethargy. Although her respiratory symptoms abated within a few days of her initial presentation, her fever and lethargy persisted. ⋯ Subsequent CT scan of the thorax, abdomen, and pelvis detected an enlarged subcarinal lymph node measuring 3.7 cm × 1.7 cm and a mildly enlarged pre-carinal lymph node measuring 2.0 × 1.5 cm, with a mean attenuation of 66-77 Hounsfield Units (HU), and no central necrosis or calcification. No significant abnormalities were detected in the abdomen or pelvis. The patient was then referred to the respiratory department for further evaluation.
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Evidence-based medicine is replete with studies assessing quality and bias, but few evaluating research integrity or trustworthiness. A recent Cochrane review of psychological interventions for chronic pain identified trials with a shared lead author with highly divergent results. We sought to systematically identify all similar trials from this author to explore their risk of bias, governance procedures, and trustworthiness. ⋯ We discuss the findings within the context of methods for establishing the trustworthiness of research findings generally. Important concerns regarding the trustworthiness of these trials reduce our confidence in them. They should probably not be used to inform the results and conclusions of systematic reviews, in clinical training, policy documents, or any relevant instruction regarding adult chronic pain management.
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Randomized Controlled Trial
The effects of pain science education plus exercise on pain and function in chronic Achilles tendinopathy: a blinded, placebo-controlled, explanatory, randomized trial.
Exercise is the standard of care for Achilles tendinopathy (AT), but 20% to 50% of patients continue to have pain following rehabilitation. The addition of pain science education (PSE) to an exercise program may enhance clinical outcomes, yet this has not been examined in patients with AT. Furthermore, little is known about how rehabilitation for AT alters the fear of movement and central nervous system nociceptive processing. ⋯ After rehabilitation, performance-based function improved (number of heel raises: 5.2 [1.6-8.8]), central nervous system nociceptive processing remained the same (conditioned pain modulation: -11.4% [0.2 to -17.3]), and fear of movement decreased (Tampa Scale of Kinesiophobia, TSK-17: -6.5 [-4.4 to -8.6]). Linear regression models indicated that baseline levels of pain and function along with improvements in self-efficacy and knowledge gain were associated with a greater improvement in pain and function, respectively. Thus, acquiring skills for symptom self-management and the process of learning may be more important than the specific educational approach for short-term clinical outcomes in patients with AT.