“When the Pain Won’t Wane It’s Mainly in the Brain”.

“When the pain won’t wane it’s mainly in the brain”.

Surg Neurol Int. 2013; 4(Suppl 5): S330-3
Pawl R

Chronic pain syndromes either have no underlying organic explanation, or include patients whose chronic pain complaints (without focal deficits or significant radiographic findings) were not alleviated by surgery (in 80% of cases). Patients with chronic pain typically “turn off” members of the medical community; they are often “written off” as malingerers or psychiatric cases. The Minnesota Multiphasic Personality Inventory often shows elevations on the hysteria and hypochondriasis scales; together these constitute somatization defined as patients converting emotional distress into bodily complaints. Depression, anxiety, and borderline personality disorders are also often encountered. Secondary gain also plays a critical role in patients with chronic pain syndromes (e.g., includes avoiding onerous tasks/work, or rewards opioid-seeking behaviors). Tertiary gain pertains to the physicians’ financial rewards for administering ineffective and repeated treatment of these patients, while validating for the patient that there is truly something organically wrong with them. Self-mutilation (part of Munchausen Syndrome/Fictitious Disorders) also brings these chronic pain patients to the attention of the medical community. They are also often involved in the legal system (e.g., workmen’s compensation or tort action) that in the United States, unfortunately financially rewards “pain and suffering.” The main purpose of this commentary is to reeducate spinal surgeons about the pitfalls of operating on patients with chronic pain syndromes in the absence of significant neurological deficits or radiographic findings, as such “last ditch surgery” invariably fails. HubMed – rehab

Serum dickkopf-1 level in postmenopausal females: correlation with bone mineral density and serum biochemical markers.

J Osteoporos. 2013; 2013: 460210
Ahmed SF, Fouda N, Abbas AA

Objective. To assess serum level of Dickkopf-1 in postmenopausal females and its correlation with bone mineral density and serum biochemical markers. Methods. Bone densitometry, serum Dickkopf-1, calcium, phosphorus, and alkaline phosphatase were done in sixty postmenopausal females. Patients were divided according to T score into osteoporosis (group I), osteopenia (group II), and normal bone mineral density that served as controls. Results. There was highly significant increase in serum Dickkopf-1 levels in postmenopausal females with abnormal T score versus controls (P < 0.001). Serum DKK-1 levels correlated negatively with both lumbar T score (r = -0.69, P < 0.001) and femur T score (r = -0.64, P < 0.001) and correlated positively with duration of menopause (r = 0.61, P < 0.001), while there was no significant correlation between serum levels of either calcium, phosphorus or alkaline phosphatase, and both serum Dickkopf-1 levels and the level of bone mineral density (P > 0.05). Conclusion. Postmenopausal females may suffer from osteoporosis as evidenced by bone densitometry. Postmenopausal women with significantly increased serum Dickkopf-1 had more significant osteoporosis. Prolonged duration of menopause and increased serum Dickkopf-1 are important risk factors for the development and severity of osteoporosis. HubMed – rehab

All-ceramic prosthetic rehabilitation of a worn dentition: Use of a distal cantilever. Two-year follow-up.

Dent Res J (Isfahan). 2013 Jan; 10(1): 126-31
Chekhani UN, Mikeli AA, Huettig FK

The rehabilitation of heavily abraded occlusion in patients with parafunctional habits is a restorative challenge to the dentist. Use of all-ceramic systems in such cases is widely considered, but uncertainty over their resistance hinders their broad use. The authors would like to illustrate a possible approach by mixing two all-ceramic systems based on zirconium dioxide and lithium disilicate. A 48-year-old female patient attended with reduced vertical dimension in a full dentition. She suffered from craniomandibular (CMD) pain and desired an esthetic rehabilitation. Prosthodontic treatment was started in a pain-free condition, after correction of the vertical dimension with an occlusal splint, over four months. Determination of the treatment was based on the clinical findings: IPS e.max(®) ZirCAD frameworks veneered with IPS e.max(®) Ceram were used for discolored retainers or subgingival finishing lines. All the rest received IPS e.max(®) Press crowns. A zirconia-based, single-tooth-retained distal cantilever reconstruction was used to replace a missing second molar. No technical or biological complication was observed 24 months after treatment. The patient was highly satisfied and pain-free. HubMed – rehab

A clinical survey of laryngectomy patients to detect presence of the false perception of an intact larynx or the “phantom larynx” phenomenon.

Indian J Med Paediatr Oncol. 2013 Jan; 34(1): 3-7
Chaturvedi P, Pawar PV, Syed S, Nair D, Dutta S, Chaukar D, D’Cruz AK

The Phantom larynx phenomenon (the false perception on an intact larynx in a laryngectomee) exists and is an important issue in the post-laryngectomy rehabilitation of such patients.The phantom limb phenomenon has been described after amputation of a limb or other parts of the body. Amputation or removal of any part is usually associated with a global feeling that the missing part is still present. We undertook this study to identify whether a phantom larynx phenomenon actually exists in laryngectomees. We also aimed to elicit its association with the duration following surgery.We did a clinical survey of 66 post-laryngectomy patients (30-80 years of age). Twenty-two of these patients were assessed within 6 months following surgery, whereas 44 patients were assessed at least 6 months later. A questionnaire containing 11 questions was served to these laryngectomees pertaining to false perception of persistent laryngeal functions and adaptation to the post-laryngectomy status.All patients showed an evidence of a phantom larynx phenomenon. In the majority of these patients, it persisted even after 6 months following surgery. There was no significant difference in the two groups (less than or more than 6 months) except for one question pertaining to occlusion of stoma for speech (77% vs. 29%). False perception of nasal breathing (59% and 43%) and olfactory sensation (63% in both groups) were the most common.Phantom larynx phenomenon following laryngectomy exists and may cause anxiety and poor rehabilitation among patients. Education and rehabilitation with regards to such a phenomenon is therefore needed in all patients. HubMed – rehab

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