Perioperative mortality: Analysis of 3 years of operative data across 7 general surgical projects of Médecins Sans Frontières in Democratic Republic of Congo, Central African Republic, and South Sudan.

Background: The African continent has the greatest burden of surgical disability-adjusted life years, yet the least is known about operative care here. This analysis describes the surgical patients admitted to 7 hospitals supported by the Médécins Sans Frontières (MSF) over 3 years in 3 conflict-affected countries-Eastern Democratic Republic of Congo, Central African Republic, and South Sudan.

Methods: A standardized operative data collection tool was used for routine collection of operative inpatient data between 2011 and 2013 at 7 MSF surgical facilities.

Radiating low back pain in general practice: incidence, prevalence, diagnosis, and long-term clinical course of illness.

Objective: The aim of this study was to calculate the incidence and prevalence of radiating low back pain, to explore the long-term clinical course of radiating low back pain including the influence of radiculopathy (in a subsample of the study population) and non-radiating low back pain thereon, and to describe general practitioners' (GPs') treatment strategies for radiating low back pain.

Design: A historic prospective cohort study.

Setting: Dutch general practice.

Epidural steroids for lumbosacral radicular syndrome compared to usual care: quality of life and cost utility in general practice.

Objective: To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice.

Design: A pragmatic randomized controlled trial. Results were analyzed using mixed models.

Steroid injections added to the usual treatment of lumbar radicular syndrome: a pragmatic randomized controlled trial in general practice.

Background: Lumbosacral radicular syndrome (LRS) is a self-limiting, benign, painful and impairing condition caused by lumbar disc herniation and inflammatory processes around the nerve root. Segmental epidural steroid injections (SESIs) are helpful to reduce radicular pain on a short-term basis. It is unknown whether SESIs are an effective addition to usual pain treatment of LRS in general practice.

Costs and cost-effectiveness of epidural steroids for acute lumbosacral radicular syndrome in general practice: an economic evaluation alongside a pragmatic randomized control trial.

Study Design: A pragmatic, randomized, controlled, single-blinded trial in Dutch general practice.

Objective: Assessing the costs and cost-effectiveness of adding segmental epidural steroid injections to care as usual in radiculopathy in general practice.

Summary Of Background Data: Lumbosacral radicular syndrome (radiculopathy) is a benign, generally self-limiting but painful condition caused by a herniated lumbar intervertebral disc, which results in an inflammatory process around the nerve root.

Do analgesics improve functioning in patients with chronic low back pain? An explorative triple-blinded RCT.

Purpose: TREATMENT of patients with chronic low back pain (CLBP) aims to reduce disability, improve functional capacity, and participation. Time contingent prescription of analgesics is a treatment modality in CLBP. The impact of analgesics on functional capacity is unknown.

Heart rate variability parameters do not correlate with pain intensity in healthy volunteers.

Objective: When patients cannot indicate pain, physiological parameters may be useful. We tested whether heart rate variability (HRV) parameters, as reflection of sympathetic and vagal tone, can be used to quantify pain intensity.

Design: Prospective study.

A novel magnetic stimulator increases experimental pain tolerance in healthy volunteers - a double-blind sham-controlled crossover study.

Unlabelled: The 'complex neural pulse'(TM) (CNP) is a neuromodulation protocol employing weak pulsed electromagnetic fields (PEMF). A pioneering paper reported an analgesic effect in healthy humans after 30 minutes of CNP-stimulation using three nested whole head coils. We aimed to devise and validate a stimulator with a novel design entailing a multitude of small coils at known anatomical positions on a head cap, to improve applicability.

Somatosensory profiles but not numbers of somatosensory abnormalities of neuropathic pain patients correspond with neuropathic pain grading.

Due to the lack of a specific diagnostic tool for neuropathic pain, a grading system to categorize pain as 'definite', 'probable', 'possible' and 'unlikely' neuropathic was proposed. Somatosensory abnormalities are common in neuropathic pain and it has been suggested that a greater number of abnormalities would be present in patients with 'probable' and 'definite' grades. To test this hypothesis, we investigated the presence of somatosensory abnormalities by means of Quantitative Sensory Testing (QST) in patients with a clinical diagnosis of neuropathic pain and correlated the number of sensory abnormalities and sensory profiles to the different grades.

A randomized clinical trial of living donor nephrectomy: a plea for a differentiated appraisal of mini-open muscle splitting incision and hand-assisted laparoscopic donor nephrectomy.

A randomized controlled trial was designed to compare various outcome variables of the retroperitoneal mini-open muscle splitting incision (MSI) technique and the transperitoneal hand-assisted laparoscopic technique (HAL) in performing living donor nephrectomies. Fifty living kidney donors were randomized to MSI or HAL. Primary endpoint was pain experience scored on a visual analogue scale (VAS).

Bilateral sensory abnormalities in patients with unilateral neuropathic pain; a quantitative sensory testing (QST) study.

In patients who experience unilateral chronic pain, abnormal sensory perception at the non-painful side has been reported. Contralateral sensory changes in these patients have been given little attention, possibly because they are regarded as clinically irrelevant. Still, bilateral sensory changes in these patients could become clinically relevant if they challenge the correct identification of their sensory dysfunction in terms of hyperalgesia and allodynia.

Fear of movement in pre-operative patients with a lumbar stenosis and or herniated disc: factor structure of the Tampa scale for kinesiophobia.

The presence of fear of movement is related to higher disability rates in several patient groups. The purpose of this study was first to analyze fear of movement and the relation with pain and disability in pre-operative patients with low back pain and radiculopathy and secondly to analyze the factor structure of the Dutch version of the Tampa Scale for Kinesiophobia (TSK). The TSK and Pain Disability Index (PDI) were assessed in 128 patients.

Chronic pain and severe disuse syndrome: long-term outcome of an inpatient multidisciplinary cognitive behavioural programme.

Objective: Patients with chronic pain and severe disuse syndrome have pain with physiological, psychological and social adaptations. The duration and severity of complaints, combined with previously failed treatments, makes them unsuitable for treatment in primary care.

Design: A prospective waiting list controlled study.

Illness perceptions in patients with fibromyalgia and their relationship to quality of life and catastrophizing.

Objective: In the last decade, illness perceptions have been identified as important in the treatment of fibromyalgia (FM). The aim of the present study was to examine illness perceptions and use of the revised Illness Perception Questionnaire in patients with FM (IPQ-R-FM) and their relationship to quality of life and catastrophizing.

Methods: A domain with specific causal attributions related to FM was added to the IPQ-R-FM.

Quantitative sensory testing with Von Frey monofilaments in patients with allodynia: what are we quantifying?

The International Association for the Study of Pain defines allodynia as pain due to a stimulus that does not normally provoke pain and hyperalgesia as an increased response to a stimulus, which is normally painful. However, does "normally painful" mean "any stimulation of nociceptors" or "the subjective pain response?" We argue that "normally painful" should not mean "any stimulation of nociceptors," as Von Frey monofilaments may evoke a pricking sensation--which implies the involvement of nociceptors--without necessarily leading to a subjective pain perception. In this paper, we propose that the diagnosis of either allodynia or hyperalgesia should be based on the patient's report, that is, painful versus not painful, rather than on the (sub) type of afferent fiber involved.

Patients' use of the Internet for pain-related medical information.

Objective: Patients increasingly use the Internet for medical information. For doctor-patient communication it is important to gain insight into the use and impact of medical Internet searches of patients. This study aims to evaluate patients' use of the Internet for information about their pain problem.

Quantifying allodynia in patients suffering from unilateral neuropathic pain using von frey monofilaments.

Objectives: The aim of this study is to investigate whether quantitative sensory testing with Von Frey monofilaments (VFMs) can be used for the quantification of allodynia in patients with chronic neuropathic pain, and how the pain threshold of affected skin differs from healthy skin.

Methods: Using VFMs, we aimed to determine the pain threshold in 22 patients suffering from allodynia as a consequence of a chronic unilateral neuropathic pain syndrome. We performed quantitative sensory testing according to the Method of Limits protocol.

Barriers integrating dedicated software for quality management in pain centres.

Objectives: Explore the feasibility of integrating a dedicated pain centre information system as part of a quality management network with a number of different Hospital Information Systems.

Material & Methods: A systematic approach integrating and implementing the system in 15 selected hospital organisations (a nationwide 15% non-random sample).

Results: Hospitals have widely varying policies on integration and implementation of additional clinically required 3rd party software.