[Visualisation of phantom- and backpain using imaging techniques. Implication for treatment]

[A functional approach to disorders of the loco-motor system-a way to a better understanding?]

BACKGROUND

Disorders of the loco-motor system are frequent and expensive. The current method of diagnosing and treating these disorders does not appear to be successful.

DIAGNOSTICS

A functional approach based on the model of the functional system incorporates all aspects relevant to disorders of the loco-motor system. Most disturbances the system can compensate. If compensating mechanisms are not sufficient, the system decompensates, and symptoms develop. It is important to search not only for structural changes but also for somatic dysfunction, psychosocial factors, and changes in neuromodulation. On this basis, treatment strategies can be developed. If there are complex disturbances on different levels, a multimodal interdisciplinary treatment is indicated. The model of the functional system highlights the important role of manual medicine in the diagnostics, treatment, prevention, and rehabilitation of disorders of the loco-motor system.

The effectiveness and cost evaluation of pain exposure physical therapy and conventional therapy in patients with complex regional pain syndrome type 1. Rationale and design of a randomized controlled trial

BACKGROUND

Pain Exposure Physical Therapy is a new treatment option for patients with Complex Regional Pain Syndrome type 1. It has been evaluated in retrospective as well as in prospective studies and proven to be safe and possibly effective. This indicates that Pain Exposure Physical Therapy is now ready for clinical evaluation. The results of an earlier performed pilot study with an n = 1 design, in which 20 patients with Complex Regional Pain Syndrome type 1 were treated with Pain Exposure Physical Therapy, were used for the design and power calculation of the present study.After completion and evaluation of this phase III study, a multi-centre implementation study will be conducted.The aim of this study is to determine whether Pain Exposure Physical Therapy can improve functional outcomes in patients with Complex Regional Pain Syndrome type 1.

METHODS/DESIGN

This study is designed as a single-blinded, randomized clinical trial. 62 patients will be randomized with a follow-up of 9 months to demonstrate the expected treatment effect. Complex Regional Pain Syndrome type 1 is diagnosed in accordance with the Bruehl/International Association for the Study of Pain criteria. Conventional therapy in accordance with the Dutch guideline will be compared with Pain Exposure Physical Therapy. Primary outcome measure is the Impairment level SumScore, restricted version.

DISCUSSION

This is the first randomized controlled study with single blinding that has ever been planned in patients with Complex Regional Pain Syndrome type 1 and does not focus on a single aspect of the pain syndrome but compares treatment strategies based on completely different pathophysiological and cognitive theories.

On-field management of emergent and urgent extremity conditions

Extremity injuries are common in many sporting events. Properly treating these injuries consists of initial evaluation to determine a presumptive diagnosis and provision of appropriate management to decrease the risk of long-term sequelae. Evaluation for and treatment of neurologic and vascular compromise should always occur in the field as expeditiously as possible, taking care not to make the injury worse. Radiographs may be impractical or unnecessary prior to reduction of many injuries. In general, in-line traction and reduction is usually safe and may alleviate complications. Following field treatment, appropriate splinting is necessary to relieve pain and prevent complications during transport. Proper field management and referral of extremity conditions provides the best primary opportunity to avoid complications.

Flagging the pain

Chronic pain represents a major public health problem that impacts negatively on quality-of-life issues and healthcare costs. Unrelieved acute post-traumatic and postoperative pains are risk factors in the development of chronic pain, although psychological and environmental factors are at work as well. Flagging pain (blue, yellow and red flags) helps to identify risk factors in acute pain that need attention to avoid the transition from acute postoperative pain to acute persistent and then on to chronic pain. This offers a unique opportunity for preventative medicine.