David Zimmerman
While nociception’s role in pain generation is known and understood what is less certain are the processes that drive rapid and profound pain reduction or cessation, particularly when the physical ‘causes’ are reinstated where orthotic use has seen rapid and durable profound pain reduction. There is a balance between nociceptive and antinociceptive systems. This paper looks at unexpectedly rapid and yet durable reduction in pain suffered achieved using non-invasive therapy. Pain is by definition and neurologically is subject to thresholds, below which pain is not consciously perceived. Context is always relevant and enduring pain and/or impaired sleep poses a threat to health. Noting profound, rapid and durable loss of pain, either in terms of cognition or of afferent signaling there are great benefits clinically. The questions posed are whether the threshold of perceivable pain increases over time and with conditioning exposure, and secondly asks do pre-treatment thresholds remain high, even when the cause is removed? It is notable that such afferent supply, as demonstrated to be immediately reversible and switch back on, cannot be considered a neuropathic pain as there is no aberrant function of the receptors or nerves, nor is there a pathology associated with involved tissues such as cancer. The cited cases suffer from long term stimulation of these normal and healthy nerves but often misdiagnosed as chronic pain, neuropathic pain or allied to a disease process. Were this case reversal of motor-reflexes would not be related to position of an anatomical structure.
Shahul Hameed, Jinesh M. Shah, Simon Ting, Christopher Gabriel, Sze Yan Tay, Usanee Chotphoksap and Angela Liong
Background and Objectives: To study the effect of a creative dance movement programme on physical, social, psychological and overall well-being of dementia patients. Methods: A prospective, cohort study was performed outpatient, on ten community-dwelling patients with mildmoderate dementia, with their care-givers. All the study participants underwent a creative dance movement programme (Everyday Waltzes) by two dance therapists, weekly for six weeks. The Alzheimer’s disease Quality of Life Inventory (ADQoL) scores of both patients and their caregivers’ impression of the patient’s quality of life in each of the 13 items, and combinations of items to obtain physical, social and psychological domains, pre and post intervention were recorded in a numerical scale. Wilcoxon’s signed rank test was used to determine the statistical significance of any change in summated score of each of the domains and overall score, post intervention in both patients and caregivers. Results: Except for one of the items, all the items had improvements pre to post intervention ranging from 0 to 0.8 in patients and caregivers. For patients, the overall summated score was statistically significant for improvement post intervention with a p value of between 0.02 to 0.05. The improvements in the physical, psychological and social domains were not statistically significant. For caregivers, the improvement in post intervention was not statistically significant in neither the domains nor the overall score. Conclusion: A creative dance movement programme had a positive effect on overall well-being in patients with mild-moderate dementia in an Asian setting.
Meheroz H Rabadi and Paul M. Munden
Infective Endocarditis (IE) implies infection of the endocardial surface of the heart from the presence of microorganisms in the lesion. The variability in clinical presentation, heterogeneous patient population and microbiologic organisms makes the IE diagnosis challenging for clinicians.