A new way to lose your nerve

Peripheral nerve damage results in loss of sensation in the affected region of the body. Oaklander and Brown now report that, in the rat, transection of a peripheral nerve in only one side of the body also results in profound loss of the innervation of the same region on the opposite side of the body. Peripheral nerve damage may also produce persistent (neuropathic) pain conditions that are presumed to arise from maladaptive reorganization of the central nervous system. Thus, the possibility that comparable bilateral changes occur in patients and that such changes contribute to neuropathic pain conditions must be considered.     

Diagnosis of cardiovascular disease in women

Cardiovascular disease (CVD, comprising coronary heart disease and stroke) is the leading cause of death in both sexes in developed countries. Although women are nine times more likely to die from CVD than they are from breast cancer, there is a general public belief that the most common cause of death is cancer. The symptoms of acute myocardial infarction and acute coronary syndromes differ between the sexes. Women are less likely to experience chest pain and may have non-specific symptoms. Normal or non-obstructive coronary disease, as detected by angiography, is more common in women. Scintigraphy improves the detection of coronary disease in women. There is an urgent need to increase awareness of both coronary heart disease in women and the limitations of commonly used diagnostic tools.     

Briefly Noted

Last month, the federal Food and Drug Administration (FDA) warned that combining gabapentin or pregabalin with central nervous system (CNS) depressants such as opioids could result in serious breathing problems for patients with underlying respiratory problems, or in the elderly. New labeling will be required on gabapentin and pregabalin, the FDA said. There is less evidence supporting such a risk in otherwise healthy people, the FDA said in the Dec. 19, 2019, warning. Gabapentin, first approved in 1993, is not a controlled substance. It is approved to treat various conditions, including seizures, nerve pain, fibromyalgia and restless legs syndrome. Pregabalin, first approved in 2004, is Schedule V on the Controlled Substances Act, the lowest‐risk category of controlled substance. “With the evolution of the opioid crisis, getting ahead of new concerns or addressing those that are already evident requires examining signs of misuse and abuse as soon as any signal emerges,” said Douglas Throckmorton, M.D., deputy director for regulatory programs in the FDA's Center for Drug Evaluation and Research, in announcing the warning. “Reports of gabapentinoid abuse alone, and with opioids, have emerged and there are serious consequences of this co‐use, including respiratory depression and increased risk of opioid overdose death. In response to these concerns, we are requiring updates to labeling of gabapentinoids to include new warnings of potential respiratory depressant effects.” Drug manufacturers are also being required to conduct clinical trials to evaluate the abuse potential of all gabapentinoids, particularly when combined with opioids, said Throckmorton. The downside is that prescribers could inadvertently increase opioid use by not using these medications, Throckmorton acknowledged, saying “we do not want to unintentionally increase opioid use by turning prescribers away from this class of pain medications.” For more information, go to https://www.fda.gov/drugs/drug‐safety‐and‐availability/fda‐warns‐about‐serious‐breathing‐problems‐seizure‐and‐nerve‐pain‐medicines‐gabapentin‐neurontin .     

Elites and popular nationalism

Much current theory concerning nationalism holds that elites commonly create or cause popular nationalism. In part, that thesis may be due to an overwhelming emphasis in research on nationalism on positive cases: cases where nationalism has appeared, ignoring cases where it has not. In this article, I challenge the thesis by showing numerous historical cases in which elites have promoted nationalisms that ordinary people have not adopted, or in which ordinary people have adopted a nationalism before it was taken up by elites. Even if elites do not create popular nationalism, however, they can and do shape its expression in a variety of ways, such as organizing it, providing relevant information, or providing opportunity or incentive for it. I show this through historical examples.     

The social construction of pain: an evaluation

Drawing upon the work of Hughes and Patterson, this paper addresses the issue of whether a socially constructed conception of pain is possible or desirable. Contrary to a number of postmodern inspired conceptions that pain exists exclusively at the level of discourse and linguistic construction, pain is viewed as a material barrier that exists beyond the politico-aesthetic level. The body is much more than a canvas upon which we can create appropriate discursive formation to incorporate within our preferred conception of 'self'. To recognize the existence of biologically based realities is not to accept biological dysfunction as the sole cause of disability or any other form of reactionary politics of disability.     

Preholiday grief. Facing it alone.

These strategies for coping with the holidays following a loss can be shared not only in a group format such as a preholiday workshop, but also on a one-to-one basis by caring health professionals. To be effective in promoting adaptation to loss, it is vital that health-care professionals heighten their awareness of the needs and reactions of the grieving person. Their sensitivity to the anxiety and pain that can accompany the holiday season must increase. Only when awareness and sensitivity increase will there be an increase in the development of effective bereavement outreach programs. Through such programs the bereaved can experience positive encounters with caring professionals who can help them establish a new sense of hope, purpose, and renewed self-esteem.     

Erectile dysfunction is strongly linked with decreased libido in diabetic men

Erectile dysfunction frequently occurs with diabetes mellitus. A survey of diabetic men was conducted by anonymous questionnaire to investigate the associations of erectile dysfunction with various predictive factors. A total of 112 diabetic males without an obvious history of erectile dysfunction were available for analyses. The mean age and duration of diabetes were 53.7?±?12.2 years and 10.2?±?8.6 years (mean?±?standard deviation), respectively. The questionnaire included questions on the presence or absence of smoking, hypertension, libido and subjective symptoms of diabetic neuropathy that may be associated with erectile dysfunction. Analysis of the answers to the questionnaire revealed that 40% of the patients complained of erectile dysfunction (erection ‘always insufficient’). Erectile dysfunction was significantly correlated with age (p?=?0.005), but not with duration of diabetes (p?=?0.25), adjusted for age. Erectile dysfunction was also associated with sensory neuropathy and reduced libido, independently of age. The logistic regression analysis revealed that erectile dysfunction was positively associated with reduced libido and age. The odds ratio of erectile dysfunction for reduced compared to unreduced libido was 18.21, suggesting that psychogenic factors have a marked influence on erectile dysfunction. It is concluded that the presence of erectile dysfunction should be considered when symptoms related to diabetic neuropathy are observed; psychological approaches, such as sexual counseling, could be applied for the treatment of erectile dysfunction.     

Yoga for stress reduction and injury prevention at work

At work employees face numerous psychological stressors that can undermine their work performance. These stressors, stemming from a variety of possible causes, have enormous health and financial impacts on employees as well as employers. Stress has been shown to be one of the factors leading to musculo-skeletal disorders (MSDs) such as: include back pain, carpal tunnel syndrome, shoulder or neck tension, eye strain, or headaches. Yoga is an ancient form of exercise that can reduce stress and relieve muscular tension or pain. Practicing yoga at the workplace teaches employees to use relaxation techniques to reduce stress and risks of injury on the job. Yoga at the workplace is a convenient and practical outlet that improves work performance by relieving tension and job stress.     

Perineal Neurophysiological Assessment in 23 Patients Suffering from Persistent Genital Arousal Disorders: Evidence of Pudendal Neuropathy?

ABSTRACT

Objectives: Persistent genital arousal disorder (PGAD) is a rare condition. Our aim was to study whether or not the pudendal nerve is involved in PGAD, by means of electromyographic (EMG) testing. Methods: Twenty-three women who fulfilled the five criteria of PGAD were included in this study. After an in-depth interview and routine investigations, a perineal EMG assessment was performed. Concentric needle electromyography (EMG) testing with motor unit potential analysis of the pelvic floor muscles (bulbocavernosus muscle and striated external anal sphincter), study of the sacral reflex latency (SRL), and measurement of pudendal nerve terminal motor latency (PNTML) were performed. Results: Perineal ENMG demonstrated neurogenic changes in 14 (60.8%) of the patients. Denervation was found in all 14 patients with abnormal electrophysiological findings. Among them, 12 (85.7%) had altered PTNML and/or SRL. PTNML was delayed on the anal branch in 9 out of 14 (bilateral in 5 cases) and on the perineal branch in 9 out of 14 (bilateral in 6 cases). Conclusions: This study shows that pudendal neuropathy is frequent among women suffering from PGAD. However, due to the lack of a control group, involvement of pudendal neuropathy in the pathogenesis of PGAD remains unclear.     

An analysis of VDT monitor placement and daily hours of use for female bifocal users

A population of 72 bifocal wearers was studied to determine the relationship between VDT (video display terminal) placement for those who reported musculoskeletal pain and those who did not. The mean hours worked was 50.4 minutes (p=0.003) greater for those who reported head/neck pain versus those who did not and 48.6 minutes (p=0.004) greater for those who reported shoulder/arm pain that those who did not. There was no statistically significant difference between the means of monitor height, distance, or angle for those who reported pain symptoms versus those who did not. This study indicates that, self reported pain symptoms are correlated with hours of VDT work and that there appears to be a threshold at approximately five hours for pain symptoms among bifocal wearers. No such correlation can be made for monitor placement     

Low back pain disability and stay at work: contradiction or necessity?

The incidence of occupational diseases in the population is high and factors such as long working hours, poor posture, psychological and physical stress can contribute to its development. Among work-related musculoskeletal disorders, back pain has a high prevalence. The aim of the present study was to quantify and characterize pain complaints and to identify individuals with low back pain, in order to assess the degree of disability. Participated 226 employees of an institution of higher education. They answered a general questionnaire about location and quantification of pain complaints visual analog scale for pain and the Quebec Disability Questionnaire. Of all the workers, 69.60% had some type of musculoskeletal complaint; of those, 15.41% had low back pain. Considering workers who had back pain, 54.9% were female, 52.94% are under 30 years old and 43.14% between 1 and 5 years of work. As for the final score for the degree of disability, 41.17% had minimal disability and 37.25% moderate disability. The present study found large number of pain complaints and high prevalence of low back pain, resulting in individual's inability and difficulties in performing work activities.     

Computer use and ulnar neuropathy: results from a case-referent study

We aimed to evaluate associations between vocational computer use and 1) ulnar neuropathy, and 2) ulnar neuropathy- like symptoms as distinguished by electroneurography. We identified all patients aged 18-65 years, examined at the Department of Neurophysiology on suspicion of ulnar neuropathy, 2001-2007. We mailed a questionnaire to 546 patients with ulnar neuropathy, 633 patients with ulnar neuropathy-like symptoms, and three community referents per case, matched on sex, age, and primary care centre. From a Job Exposure Matrix we extracted estimates of daily hours of computer use. The analysis was performed by conditional logistic regression.There were a negative association between daily hours of computer use and the two outcomes of interest. Participants who reported their elbow to be in contact with their working table for 2 hours or more during the workday had an elevated risk for ulnar neuropathy (OR=2.16, 95 % CI; 1.06-4.44).The two outcomes were not associated with daily hours of computer use. Findings suggested specific effects of pressure on the elbow, and might be an explanation for the overweight of left-sided outcomes in this primarily right-handed group. Preventive efforts would then be straightforward by providing appropriate arm support for the left arm and elbow.     

Estimating Pain and Disability in Virtual Patients with Low Back Pain: The Contribution of Nonverbal Behaviors

It is well recognized that chronic low back pain (cLBP) can be estimated from nonverbal pain behaviors. However, only a few studies examined how clinicians rely on those when estimating specific outcomes, such as pain intensity and pain disability. Therefore, the present study examines (1) if facial expressions and guarding behaviors (including speed of the movement and lifting strategy) contribute to the prediction of pain intensity and disability in patients with cLBP; and (2) if these pain behaviors have been given the same importance according to the outcome. Twenty-five experienced clinicians and thirty-one novice clinicians were asked to estimate low back pain intensity and disability from a realistic virtual character performing a lifting lowering task. The studied pain behaviors were manipulated across different conditions. Pain intensity and disability were judged higher when the character moved more slowly and displayed painful facial expression. Speed of the movement and facial expressions explained a greater portion of variance when related to pain intensity assessment than to pain disability assessment. Results also showed a significant interaction between the lifting strategy, the speed of the movement and facial expressions, but only when estimating the character’s pain-related intensity. Novice clinicians rated pain disability higher than experienced clinicians did. Although pain-related concepts, pain intensity and related disability are not estimated through the same pain behaviors by clinicians. Clinical experience does not contribute to clinical judgments through the use of nonverbal pain behaviors when estimating pain outcomes but contributes to pain disability rating overall.     

Slaughterhouse workers exposed to cold: proposal of reference thermography values for hands

The cold environment is an indispensable for slaughtering and processing in the poultry industry In field studies it was observed that a large percentage of workers of this sector have hand contact with the cold chicken and / or frozen, have high complaints prevalence of pain and discomfort, mostly in the hands. The contact of human skin with a cold surface may cause pain, numbness and risk of skin damage. Currently, although the use of infrared thermal imaging has been useful in identifying normal and abnormal patterns of heat distribution on the surface of the body. However your use for work tasks and to assess the potential development of injuries related to it has been limited. Based on the physiological responses can be objectively evaluate the effects of the task demands of work and thus contribute to the development of effective strategies for ergonomic intervention. The methodology will be used to evaluate the subjective thermal sensation with analogue scale of ASHRAE and the infrared thermography in the dorsal and palmar hands. Thus the objective of this research is to propose reference values for thermographic hands within limits of comfort.     

Orpheus wounded: The experience of pain in the professional worlds of the piano

Conclusions None of the three worlds within the field of professional piano playing has adequately confronted the problem of pain, partly because its causes and treatment could be easily assigned to another world. The medical world could blame pain on misuse; the virtuoso world on lack of genius or hard work; the pedagogical world on bad teaching or lack of talent. Each world, for its own reasons, has managed either to skirt the problem of pain outright or to develop techniques and languages that fail to offer general remedies, or worse, exacerbate the amount of pain pianists endure. In the meantime, market competition in a shrinking concert market has increased, together with audience dependence upon charismatic virtuosity. The more compact virtuoso world, populated by ever larger numbers of hopeful pianists, creates intense competition in which the causes stimulating pain multiply.A number of factors have inhibited both the private and public acknowledgment of pain. First, there are the demands of maintaining a professional career as a pianist. It has been difficult if not impossible for concert artists to admit they are in pain, because it would threaten their careers. Second, there is the romantic image of pain: the belief that pain is necessary and inevitable in order to be a virtuoso. This factor is related to a culture of mastery (or masculinity): the ideal of a stoical master in control of his body, able to surmount such mundane obstacles as pain. Third, the emotional identification of the young prodigy with their teacher; the belief that the teacher is giving the young pianist a precious skill, potential career as an artist, and would not allow unnecessary pain. Psychologically it is difficult to challenge teaching maxims that lead to discomfort. Instead, musicians in pain blame themselves.Complementary factors are leading to a growing ability to acknowledge pain. First, what might be called a culture of femininity emphasizing awareness of the body may be increasing. It is interesting to speculate whether women teachers are more likely than male teachers to emphasize that playing should be comfortable. Are women pianists less likely to suffer pain than male pianists because of less commitment to the ideal of control, power, and mastering pain?Second, the rise of the world of performing-arts medicine itself provides a refuge, a safe place where pain can be legitimately acknowledged. Medicalization takes pain out of the virtuoso world and neutralizes its emotional and professionally charged character, whether or not the doctors have solutions.Third, the diffusion of awareness that pain is not one's individual problem, as such examples as Gary Graffman and Leon Fleisher have become publicly acknowledged. However, once acknowledged, there may be a contagion effect. Is it possible that the reported incidence of pain is a result of a kind of mass hysteria? This possibility raises a knotty methodological issue: How much can we trust subjective reports of pain? Once people are asked if they have physical problems, they may become aware of them. Or, the individual may discover or remember an analog to parental or teacher abuse. Such an attempt to explain away the discovery of widespread pain as hysteria seems highly unlikely.If injuries to hand and arm can be shown to be caused by keyboards, not just pianos, but computers too, then legal institutions may get involved in this complex story. Here we are dealing with a future possibility, but an ominous one. Repetitive stress injury (RSI) has been charged by persons suffering pain after long hours on the computer, and more than 2,000 suits have been filed against makers of computer equipment. The U.S. Occupational Safety and Health Administration in October, 1994, announced a plan for rules that would make it harder for employers to claim they didn't know about the problem.... For the delicate muscles and tendons in the fingers and wrists, rapidly pushing buttons [or piano keys] thousands of times an hour can be just as stressful [as driving screws or slicing carcasses in a meat-processing plant]. The Time magazine article blithely explains the consequences of these stresses as creating tiny tears in the muscles and tendons, which become inflamed. If the tissues aren't given time to heal properly, scarring can occur. That the hand motions required for the piano and computer keyboards are essentially the same, in terms of body physiology, has been finally realized. A book giving concrete instructions on how to play both types of keyboards safely and efficiently was published in 1995, although the author, a concert pianist, focusses upon computers, with an accurate eye on a far bigger market for the book. It is curious in a society like ours that technical solutions have not been explored at all as a cure for pain. Interviews with members of manufacturing companies at the National Conference on Piano Pedagogy in October, 1994 indicated that there is practically no work being done in this area. Even though certain technological solutions readily present themselves (as they do in the computer industry, for example), having to with changing the physical arrangement of the keyboard, nothing has been seriously considered. Neither have pedagogical learning routines in electronic keyboards reached the sophistication that is now technically possible. This lack is fortunate (and perhaps not accidental) because Steinway and Baldwin might become subject to suits on exactly the same grounds as IBM has become liable.If pain is still slipping through the cracks among the various worlds constituting the field of professional piano playing, it is because in each of these worlds there are forces at work either producing pain or explaining it in individualistic terms. The pervasive experience of pain is an unintended consequence of the mutual actions of the institutions involved in creating and propagating piano music in our culture. Unintended consequences put stubborn difficulties in the path of change precisely because there are no concrete intentions or interests at stake that are producing the problem. As the examples above show, however, the mere recognition of pain as a reality pushes for a mutual opening up and interaction among these only partially overlapping worlds. If the issue of pain among pianists becomes forcibly raised - well beyond academic discourse and professional interest groups - in the broad community of piano playing and the even broader realm of the media, each of these institutional worlds faces deep challenges. At this moment it is impossible to know what might happen if the issue of pain is finally confronted as a joint problem for these social worlds. Within physiological limits, the issue is whether knowledge exists or can be acquired about how to play the piano in a way that will minimize the occurrence of pain. We have been concerned with the institutional and individual processes that both cause pain and stand in the way of obtaining a suitable cure for injured pianists. As we have shown, the institution with which pain is traditionally associated in our culture - medicine - plays only an accompanying part in this story. As David B. Morris notes in his recent work on the cultural embeddedness of pain. Certainly we can take comfort in assuming that pain obeys the general laws of human anatomy and physiology that govern our bodies ... however, the culture we live in and our deepest personal beliefs subtly or massively recast our experience of pain. The story of how our minds and our cultures continuously reconstruct the experience of pain demands that we look beyond the medicine cabinet. For the sociologist, what is most theoretically and substantively compelling about the relatively esoteric tribulations of pain-ridden performing artists is precisely how, within the experience of emotional and physical distress, deeply individual physical states and emotions cannot be separated from institutional pressures and constraints. And not only does the scourge of pain among pianists shatter the dichotomy of individual versus institution, it also provides a palpable example of how pain in our culture exists in the shadow of multiple social worlds.

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Consequences of Pain in Early Life and its Remedy: Maternal Responsibility

ABSTRACT

Neonatal and childhood pain experience is an unavoidable consequence of modern-day medical practice. Repeated exposure to noxious stimuli is not free from adverse consequences in adult life. Therefore it is important to minimize pain if unavoidable in early life. Parents need to be aware of the various measures available to minimize pain in infants and children. They need to be educated about the analgesic efficacy of nonpharmacological agents such as sucrose. Judicious use of these substances is advised to prevent the immediate and late consequences of early pain experience.     

Female sexual pain disorders and cognitive behavioral therapy

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive-behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.     

Batch sampling to improve power in a community trial. Experience from the Pawtucket Heart Health Program

Experiments involving large social units, such as schools, work sites, or whole cities, are commonly limited in statistical power because the number of randomized units is small, leaving few degrees of freedom for residual (between-unit) error. The authors describe a method for increasing residual degrees of freedom in a community experiment without substantially increasing cost or difficulty. In brief, they propose that the experimental units should be divided into random subsamples (batches). Batch sampling can improve statistical power if the community endpoint means are stable over time or if their temporal variation is comparable in period to the batch-sampling schedule. The authors demonstrate the theoretical advantages of the batch system and illustrate its use with data from the Pawtucket Heart Health Program, in which such a design was implemented.     

Event‐Related Attributes Affecting Donation Intention of Special Event Attendees

The practice of increasing donations through special events has significant financial implications for charitable organizations. However, little is known about how such events can be organized to increase individuals’ donation intention beyond their event attendance. In this case study, a post‐event survey was conducted with attendees of a professional golf tournament operating as a special event to identify event‐related attributes that affected their intention to donate to the cause supported by the event. The results indicate that attendees’ donation intention was positively associated with their event satisfaction, perceived contributions of the event to the cause, and sense of camaraderie at the event. Furthermore, the effects of event satisfaction and camaraderie were stronger for attendees whose primary motivation for attending the event was unrelated to cause support. These results support hypotheses drawn from social exchange theory and provide implications for charitable organizations engaging in special events.