Articles: chronic.
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Whiplash-associated disorders (WAD) are common and incur substantial personal and economic costs. Research has shown that persistent posttraumatic stress reactions predict poorer functional recovery in WAD; however, the specific mechanism through which this occurs is unclear. The current study is the first to examine the direct impact of posttraumatic stress disorder (PTSD) symptoms in WAD using laboratory tested pain measures. ⋯ Findings from the current study highlight the negative impact of PTSD on both physical and psychological outcomes in chronic WAD. From a clinical perspective, data suggest that patients exposed to accident cues may experience arousal that lowers their threshold to certain pain stimuli. Further investigation of effective multidisciplinary interventions and in particular the treatment of PTSD in WAD is identified as an important area of further investigation.
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A 29-year-old woman presented with a 1-week history of fever, weakness, anorexia, darkened urine, and mild cough. The patient described her cough as nonproductive and without hemoptysis. ⋯ She reported regular cigarette smoking, but denied illicit or IV drug use or any recent travel or sick contacts. The patient also had no known pertinent family history.
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Pyogenic spondylodiskitis is an infection of intervertebral disks and spinal vertebral bodies. Various minimally invasive approaches to the infected disk spaces/abscesses have been described for management of early stages of the infection. Patients with chronic occurrence present with extensive infection, neurologic deficits, and bone destruction. Such patients commonly have substantial medical comorbidities. Despite the increased risks of complications, they often are treated with open surgical approaches without minimally invasive options. We describe a bilateral transpedicular approach to vertebral body abscess in a chronically infected patient with intraoperative contiguous irrigation. ⋯ Patients in poor health and with chronic vertebral osteomyelitis may benefit from minimally invasive percutaneous transpedicular drainage and irrigation of the abscess, representing a minimally invasive and effective treatment alternative for these patients.
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Randomized Controlled Trial
Brief Time-Based Activity Pacing Instruction as a Singular Behavioral Intervention was not Effective in Participants with Symptomatic Osteoarthritis.
Osteoarthritis (OA) of the lower extremities is a prevalent cause of disability in which symptoms interfere with mobility and activity participation. Behavioral self-management for OA symptomatology is commonly recommended; but these interventions are underutilized, unstandardized in application, and at times, unavailable in the context of clinical care. For people with chronic pain, rehabilitation professionals may select to apply activity pacing instruction as one behavioral strategy to manage symptoms. ⋯ Using linear mixed models, Western Ontario and McMaster Universities Osteoarthritis Index pain scores changed over time, decreasing the most in the general and usual care groups; only the usual care group had decreased pain over 6 months. The tailored and general activity pacing groups reported higher frequency of pacing behaviors than the usual care group at 10 weeks, but pacing was not sustained at 6 months. This trial does not support the use of time-based pacing as a singular behavioral strategy for people with knee or hip OA.