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Pain Hypersensitivity: A Bio-Psychological Explanation of Chronic Musculoskeletal Pain and Underpinning Theory  [PDF]
Zakir Uddin, Joy C. MacDermid
Pain Studies and Treatment (PST) , 2014, DOI: 10.4236/pst.2014.22007
Abstract:

Hypersensitivity is a phenomenon that has a dual role: adaptive (protective) and maladaptive (pathological) based on different aspects of the pain mechanism. The mechanism of hypersensitivity has not been fully defined. However, it is known that over-excitability (too much sensitivity) of neurons can arise in both peripheral and central components of the nervous system. Pain theories can be useful in helping to explain complex phenomenon like hypersensitivity. The Gate control theory and other more bio-psychological pain models may assist us to understand a mechanism of chronic musculoskeletal pain. This article discusses a mechanism based pain model.

Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? a systematic review
Qiyun Shi, Joy C MacDermid
Journal of Orthopaedic Surgery and Research , 2011, DOI: 10.1186/1749-799x-6-17
Abstract: We included all controlled trials written in English, attempting to compare any surgical interventions with any conservative therapies. We searched Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2010), MEDLINE (1980 to June 2010), EMBASE (1980 to June 2010), PEDro (searched in June 2010), international guidelines, computer searches based on key words and reference lists of articles. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Weighted mean differences and 95% confidence intervals for patient self-reported functional and symptom questionnaires were calculated. Relative risk (RR) and 95% confidence intervals for electrophysiological studies and complication were also calculated.We assessed seven studies in this review including 5 RCTs and 2 controlled trials. The methodological quality of the trials ranged from moderate to high. The weighted mean difference demonstrated a larger treatment benefit for surgical intervention compared to non surgical intervention at six months for functional status 0.35( 95% CI 0.22, 0.47) and symptom severity 0.43 (95% CI 0.29, 0.57). There were no statistically significant difference between the intervention options at 3 months but there was a benefit in favor of surgery in terms of function and symptom relief at 12 months ( 0.35, 95% CI 0.15, 0.55 and 0.37, 95% CI 0.19 to 0.56). The RR for secondary outcomes of normal nerve conduction studies was 2.3 (95% CI 1.2, 4.4), while RR was 2.03 (95% CI 1.28 to 3.22) for complication, both favoring surgery.Both surgical and conservative interventions had treatment benefit in carpal tunnel syndrome. Surgical treatment has a superior benefit, in symptoms and function, at six and twelve months. Patient underwent surgical release were two times more likely to have normal nerve conduction studies but also had complication and side effects as well. Given the treatment differential and pot
The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity
Joy C MacDermid, Patty Solomon, Kenneth Prkachin
BMC Musculoskeletal Disorders , 2006, DOI: 10.1186/1471-2474-7-12
Abstract: Community volunteers (n = 129) who self-identified as having shoulder pain were enrolled. Patients were examined by a physical therapist using a standardized assessment process to insure that their pain was musculoskeletal in nature. This included examination of pain reported during active and passive shoulder motion as reported on a visual analogue pain scale. Patients completed the SPADI, the Coping Strategies Questionnaire (CSQ) and the Sickness Impact Profile (SIP) at a baseline assessment and again 3 and 6 months later. Factor analysis with varimax rotation was used to assess subscale structure. Expectations regarding convergent and divergent subscales of CSQ and SIP were determined a priori and analysed using Pearson correlations. Constructed hypotheses that patients with a specific diagnosis or on pain medication would demonstrate higher SPADI scores were tested. Correlations between the observed changes recorded across different instruments were used to assess longitudinal validity.The internal consistencies of the SPADI subscales were high (α > 0.92). Factor analysis with varimax rotation indicated that the majority of items fell into 2 factors that represent pain and disability. Two difficult functional items tended to align with pain items. Higher pain and disability was correlated to passive or negative coping strategies, i.e., praying/hoping, catastrophizing on the CSQ. The correlations between subscales of the SPADI and SIP were low with divergent subscales and low to moderate with convergent subscales. Correlations, r > 0.60, were observed between the SPADI and pain reported on a VAS pain scale during active and passive movement. The two constructed validity hypotheses (on diagnosis and use of pain medications) were both supported (p < 0.01). The SPADI demonstrated significant changes over time, but these were poorly correlated to the SIP or CSQ suggesting that these scales measure different parameters.The SPADI is a valid measure to assess pain and d
Content Analysis of Work Limitation, Stanford Presenteeism, and Work Instability Questionnaires Using International Classification of Functioning, Disability, and Health and Item Perspective Framework
Vanitha Arumugam,Joy C. MacDermid,Ruby Grewal
Rehabilitation Research and Practice , 2013, DOI: 10.1155/2013/614825
Abstract: Background. Presenteeism refers to reduced performance or productivity while at work due to health reasons. WLQ-26, SPS-6, and RA-WIS are the commonly used self-report presenteeism questionnaires. These questionnaires have acceptable psychometric properties but have not been subject to structured content analysis that would define their conceptual basis. Objective. To describe the conceptual basis of the three questionnaires using ICF and IPF and then compare the distribution and content of codes to those on the vocational rehabilitation core set. Methods. Two researchers independently linked the items of the WLQ-26, SPS-6, and RA-WIS to the ICF and IPF following the established linking rules. The percentage agreement on coding was calculated between the researchers. Results. WLQ-26 was linked to 62 ICF codes, SPS-6 was linked to 17 ICF codes, and RA-WIS was linked to 74 ICF codes. Most of these codes belonged to the activity and participation domains. All the concepts were classified by the IPF, and the most were rational appraisals within the social domain. Only 12% of codes of the core set for vocational rehabilitation were used in this study to code these questionnaires. Conclusion. The specific nature of work disability that was included in these three questionnaires was difficult to explain using ICF since many aspects of content were not confined. The core set for vocational rehabilitation covered very limited content of the WLQ-26, SPS-6, and RA-WIS. 1. Introduction Rehabilitation is based on an understanding that health and function extend beyond the presence or absence of disease to include the ability to participate in life activities and roles. Similarly, we now recognize that work functioning extends beyond the presence or absence of being at work to include the ability to engage in work activities and roles. Presenteeism refers to reduced performance or productivity while at work due to health reasons [1]. In a study conducted in Sweden where one-third of the surveyed labor force reported going to work two or more times in the past year in spite of their health being so bad that they should have taken leave [2]. Presenteeism is a complex issue that is affected by individual, work, workplace factors, health, and health behaviours. Previous studies have tried to identify determinants of presenteeism and have identified factors like low monthly income, psychological stress, initial health, time pressure, and finding a replacement, amongst others [1–8]. During rehabilitation, ability to return to work is often a major concern. Vocational
Risk Factors for Falls and Fragility Fractures in Community-Dwelling Seniors: A One-Year Prospective Study
Sacha Song,Joy C. MacDermid,Ruby Grewal
ISRN Rehabilitation , 2013, DOI: 10.1155/2013/935924
Abstract: Objective. To evaluate risk factors for falls and fragility fractures in healthy seniors. Methods. Assessing 50 ambulatory community-dwelling volunteers ≥65 for demographics, BMI, bone mineral density (BMD) (DEXA), fracture risk (FRAX), balance (Biodex), fear of falling (Modified Falls Efficacy Scale (MFES)), and activity level (RAPA). One-year followup was done through phone interviews. Results. Most participants (17 males, 33 females; mean age years) had normal BMD and were active with little to no fear of falling. Balance did not correlate with FRAX or fear of falling. Activity level did not correlate with FRAX, but the active group had less fear of falling. Most scored below age specific norms on balance testing. Fear of falling was not significantly different between genders but did correlate with FRAX, indicating that patients with higher fracture risk were also more afraid of falling. Individuals who fell after one year had increased fear of falling and decreased activity levels. Conclusions. Community-dwelling seniors with higher risk of future fractures were more afraid of falling. Although healthy and active, this cohort had poor balance compared to age matched norms. Further research on how to best assess fall risk and improve balance to prevent fractures is needed. 1. Introduction Fractures resulting from a fall from standing height (fragility fractures) account for significant morbidity and health care expenses in older patients [1–3]. The 65-year and older age bracket is the fastest growing demographic around the world in both industrialized and developing countries [4, 5]. In industrialized countries, an estimated one-third of individuals ≥65 experience at least one fall each year [6, 7]. In 2008-2009, more than half of the cases of injurious falls were experienced by individuals 65, and within this age group, falls were responsible for 74% of major injuries suffered and approximately 10% to 15% resulted in fracture [8]. Regardless of whether a fracture occurs, falls can lead to a reduced quality of life and a functional decline for the individual [1, 7]. Falls in this age group are also more likely to result in longer and more expensive hospitalizations [1–3]. Annually, the cost to treat falls is 0.85% to 1.5% of the total health care expenditure [2, 3]. Fractures are the most costly result of falls; Stevens et al. found that although fractures accounted for only 35% of injuries sustained from falls, they were responsible for 61% of related health care costs [2]. Since a fracture event is determined both by risk of falling and bone
Is Casting for Non-Displaced Simple Scaphoid Waist Fracture Effective? A CT Based Assessment of Union
Joy C. MacDermid,Nina Suh,Ruby Grewal
- , 2016, DOI: 10.2174/1874325001610010431
Abstract: The purpose of this study is to report the union rate and time to union for acute non-displaced scaphoid waist fractures treated with a short arm thumb spica cast
The International Classification of Functioning as an explanatory model of health after distal radius fracture: A cohort study
Jocelyn E Harris, Joy C MacDermid, James Roth
Health and Quality of Life Outcomes , 2005, DOI: 10.1186/1477-7525-3-73
Abstract: This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome.Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE.The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.In 1980 the WHO [1] published a framework for classifying the consequences of disease. This classification system included the domains of impairment, disability, and handicap where a linear relationship was thought to exist between domains. This framework emphasized the multifaceted nature of health and led to changes in the measurement of health outcomes, specifically, the evaluation of disability, and handicap [2]. With increased application of the model it became apparent that the relationship between the domains was not linear and other relevant contributions to health (e.g., environmental, socio-demographic, and psychological has been ignored).The WHO updated the framework to reflect emerging understanding of health. In 2001 the International Classification of Functioning, Disability, and Heal
Pain and disability reported in the year following a distal radius fracture: A cohort study
Joy C MacDermid, James H Roth, Robert S Richards
BMC Musculoskeletal Disorders , 2003, DOI: 10.1186/1471-2474-4-24
Abstract: A prospective cohort study of 129 patients with a fracture of the distal radius was conducted. Patients completed a Patient-rated Wrist Evaluation at their baseline clinic visit and at 2, 3, 6 and 12 months following their fracture. The frequency/severity of pain and disabilities reported was described at each time point.The majority of patients experienced mild pain at rest and (very) severe high levels of pain with movement during the first two-months following distal radius fracture. This time is also associated with (very) severe difficulty in performing specific functional activities and moderate to severe difficulty in four domains of usual activity. The majority of recovery occurred within six-months, but symptoms persisted for a small minority of patients at one-year following fracture. Patients had the most difficulty with carrying ten pounds and pushing up from a chair. Resumption of usual personal care and household work preceded, and was more complete, than work and recreational participation.This study demonstrated that the normal course of recovery following a distal radius fracture is one where severe symptoms subside within the first two-months and the majority of patients can be expected to have minimal pain and disability by six-months following fracture. This information can be used when planning interventions and assessing whether the progress of a patient is typical of other patients.Distal radius fractures are common injuries that cause pain and disability. Despite this, few studies have described the disability experience of patients with this type of injury. A large number of studies, most frequently case series, have reported the impairments in specific clinical parameters resulting from a distal radius fracture. Usually these studies were conducted to describe the outcomes of a specific treatment intervention. Range of motion and grip strength scores are the most commonly reported impairments. A minority of studies on distal radius fracture
Effects of low power laser irradiation on bone healing in animals: a meta-analysis
Siamak Bashardoust Tajali, Joy C MacDermid, Pamela Houghton, Ruby Grewal
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-1
Abstract: We searched five electronic databases (MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane Database of Randomised Clinical Trials) for studies in the area of laser and bone healing published from 1966 to October 2008. Included studies had to investigate fracture healing in any animal model, using any type of low power laser irradiation, and use at least one quantitative biomechanical measures of bone strength. There were 880 abstracts related to the laser irradiation and bone issues (healing, surgery and assessment). Five studies met our inclusion criteria and were critically appraised by two raters independently using a structured tool designed for rating the quality of animal research studies. After full text review, two articles were deemed ineligible for meta-analysis because of the type of injury method and biomechanical variables used, leaving three studies for meta-analysis. Maximum bone tolerance force before the point of fracture during the biomechanical test, 4 weeks after bone deficiency was our main biomechanical bone properties for the Meta analysis.Studies indicate that low power laser irradiation can enhance biomechanical properties of bone during fracture healing in animal models. Maximum bone tolerance was statistically improved following low level laser irradiation (average random effect size 0.726, 95% CI 0.08 - 1.37, p 0.028). While conclusions are limited by the low number of studies, there is concordance across limited evidence that laser improves the strength of bone tissue during the healing process in animal models.Bone and fracture healing is an important homeostatic process that depends on specialized cell activation and bone immobility during injury repair [1,2]. Fracture reduction and fixation are a prerequisite to healing but a variety of additional factors such as age, nutrition, and medical co-morbidities can mediate the healing process [3,4]. Different methods have been investigated in attempts to accelerate the bone-healing process. Most
“Push” versus “Pull” for mobilizing pain evidence into practice across different health professions: A protocol for a randomized trial
MacDermid Joy C,Law Mary,Buckley Norman,Haynes Robert
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-115
Abstract: Background Optimizing pain care requires ready access and use of best evidence within and across different disciplines and settings. The purpose of this randomized trial is to determine whether a technology-based “push” of new, high-quality pain research to physicians, nurses, and rehabilitation and psychology professionals results in better knowledge and clinical decision making around pain, when offered in addition to traditional “pull” evidence technology. A secondary objective is to identify disciplinary variations in response to evidence and differences in the patterns of accessing research evidence. Methods Physicians, nurses, occupational/physical therapists, and psychologists (n = 670) will be randomly allocated in a crossover design to receive a pain evidence resource in one of two different ways. Evidence is extracted from medical, nursing, psychology, and rehabilitation journals; appraised for quality/relevance; and sent out (PUSHed) to clinicians by email alerts or available for searches of the accumulated database (PULL). Participants are allocated to either PULL or PUSH + PULL in a randomized crossover design. The PULL intervention has a similar interface but does not send alerts; clinicians can only go to the site and enter search terms to retrieve evidence from the cumulative and continuously updated online database. Upon entry to the trial, there is three months of access to PULL, then random allocation. After six months, crossover takes place. The study ends with a final three months of access to PUSH + PULL. The primary outcomes are uptake and application of evidence. Uptake will be determined by embedded tracking of what research is accessed during use of the intervention. A random subset of 30 participants/ discipline will undergo chart-stimulated recall to assess the nature and depth of evidence utilization in actual case management at baseline and 9 months. A different random subset of 30 participants/ discipline will be tested for their skills in accessing evidence using a standardized simulation test (final 3 months). Secondary outcomes include usage and self-reported evidence-based practice attitudes and behaviors measured at baseline, 3, 9, 15 and 18 months. Discussion The trial will inform our understanding of information preferences and behaviors across disciplines/practice settings. If this intervention is effective, sustained support will be sought from professional/health system initiatives with an interest in optimizing pain management. Trial registration Registered as NCT01348802 on clinicaltrials.gov.
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