Differences in the Relationship Between Psychosocial Distress and Self-Reported Disability in Patients with Chronic Low Back Pain in Six Pain Rehabilitation Centers in the Netherlands
Introduction: In this study, the activation of different brain areas after an experimental surgical incision was assessed by functional magnetic resonance imaging, and the pathophysiological role of distinct brain activation patterns for pain perception after incision was analyzed. Methods: Thirty male volunteers (mean age ± SD, 25 ± 5 yr) received an experimental incision (4 mm) within the volar aspect of the right forearm using a ceramic scalper blade, and 14 volunteers (mean age ± SD, 25 ± 4 yr) received a sham procedure. Magnetic resonance images were taken before, during (0–2 min), and after incision or sham procedure (2–4.5, 4.5–10, 24–29, and 44–49 min) at a 3T scanner using a block design. Subjective pain ratings by a numerical pain scale were performed between the scans. Results: Functional magnetic resonance imaging analysis showed a distinct temporal profile of activity within specific brain regions during and after the injury. Lateralization (predominantly contralateral to the incision) and increased brain activity of the somatosensory cortex, frontal cortex, and limbic system were observed in subjects after incision, when compared with individuals receiving sham procedure. Peak brain activation occurred about 2 min after incision and decreased subsequently. A distinct correlation between evoked pain ratings and brain activity was observed for the anterior cingulate cortex, insular cortex, thalamus, frontal cortex, and somatosensory cortex. Conclusion: These findings show different and distinct cortical and subcortical activation patterns over a relevant time period after incision. Pain sensitivity hereby has an influence on the activity profile. This may have important implications for encoding ongoing pain after a tissue injury, for example, resting pain in postoperative patients. Reporting outcomes of back pain trials: A modified Delphi study European Journal of Pain, 05/25/2011 Froud R et al. – A group of back pain experts reached a high level of consensus on a statement recommending reporting methods for patient–reported outcomes in future low back pain trials. The statement has the potential to increase interpretability and improve patient care. Methods • Authors presented experts with clinicians’ views on different reporting methods and asked them to rate and comment on the suitability reporting methods for inclusion in a standardized set • Panellists developed a statement of recommendation over three online rounds. • Authors used a modified Delphi process and the RAND/UCLA appropriateness method as a formal framework for establishing appropriateness and quantifying panel disagreement. Results • A group of 63 experts from 14 countries participated. • Consensus was reached on a statement recommending that the continuous patient–reported outcomes commonly used in back pain trials, are reported using between–group mean differences (accompanied by minimally important difference (between–group/population–level) thresholds where these exist), the proportion of participants improving and deteriorating according to established and relevant minimally important change thresholds, and the number needed to treat; all with 95% confidence intervals. • Outcomes may additionally be reported using alternative approaches (e.g. relative risks, odds ratios, or standardized mean difference) according to the needs of a particular trial. A systematic review of instruments for the assessment of work-related psychosocial factors (Blue Flags) in individuals with non-specific low back pain Heather Graya , Abiodun T. Adefolarinb, Tracey E. Howea Received 4 January 2011; received in revised form 27 March 2011; accepted 11 April 2011. published online 16 May 2011. Corrected Proof Manual Therapy