Modification of induced ischaemic pain by placebo electrotherapy

Quantifying the analgesic effect of placebo electrotherapy is an important part of understanding the placebo response in physiotherapy. This repeated measures study of induced ischaemic pain compared reports of pain threshold, pain tolerance, and pain endurance under three conditions: control, placebo interferential, and placebo TENS. Both of the placebo conditions significantly delayed the report of pain threshold. Placebo interferential also delayed pain tolerance. Each placebo condition reduced pain intensity in the 6th minute. Only placebo TENS reduced pain at the 9th minute of ischaemic pain. The nature of pain reduction in the placebo conditions suggests that analgesia was due to learned expectancies and endogenous opioid release. Further research into the impact of positive expectancies of pain relief in our patients could clarify the efficacy of physiotherapy outcomes for pain.

Combined physiotherapy and education is efficacious for chronic low back pain

Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects, This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners, The dependent variables of interest were pain and disability. Assessors were blind to treatment group. Outcome data from 49 subjects (86%) showed a significant treatment effect. The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale (95% CI 0.7 to 2.3) and 3.9 points on the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8), respectively. The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.

Kinematics of oblique collision and ramping inferred from microstructures and strain in middle crustal rocks, central Southern Alps, New Zealand

The hanging wall of the Alpine Fault near Franz Josef Glacier has been exhumed during the past similar to2-3 m.y. providing a sample of the ductilely deformed middle crust of a modem obliquely convergent orogen. Presently exposed rocks of the Pacific Plate are inferred to have undergone several phases of ductile deformation as they moved westward above a mid-crustal detachment. Initially they were transpressed across the outboard part of the orogen, resulting in oblate fabrics with a down-dip stretch. Later, they encountered the Alpine Fault, experiencing an oblique-slip backshearing on vertical planes. This escalator-like deformation tilted and thinned the incoming crust onto that crustal-scale oblique ramp. This style of hanging wall deformation may affect only the most rapidly uplifting, central part of the Southern Alps because of the low flexural rigidity of the crust in that region and its displacement over a relatively sharp ramp-angle at depth. A 3D transpressive flow affected mylonites locally near the fault, but their shear direction remained parallel to plate motion, ruling out ductile 'extrusion' as an important process in this orogen. Outside the mylonite zone, late Cenozoic shortening is inferred to be modest (30-40%), as measured from deformation of younger biotite grains. Oblique collision is dominated by translation on the Alpine Fault, and rocks migrate rapidly through the deforming zone, preventing the accumulation of large finite strains. Transpression may play a minor role in oblique collision. (C) 2001 Elsevier Science Ltd. All rights reserved.

EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls

Abnormal patterns of trunk muscle activity could affect the biomechanics of spinal movements and result in back pain. The present study aimed to examine electromyographic (EMG) activity of abdominal and back muscles as well as triaxial torque output during isometric axial rotation at different exertion levels in back pain patients and matched controls. Twelve back pain patients and 12 matched controls performed isometric right and left axial rotation at 100%, 70%, 50%, and 30% maximum voluntary contractions in a standing position. Surface EMG activity of rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum and multifidus were recorded bilaterally. The primary torque in the transverse plane and the coupling torques in sagittal and coronal planes were measured. Results showed that there was a trend (P = 0.08) of higher flexion coupling torque during left axial rotation exertion in back pain patients. Higher activity for external oblique and lower activity for multifidus was shown during left axial rotation exertion in back pain group when compared to the control group. In right axial rotation, back pain patients exhibited lesser activity of rectus abdominis at higher levels of exertion when compared with matched controls. These findings demonstrated that decreased activation of one muscle may be compensated by overactivity in other muscles. The reduced levels of activity of the multifidus muscle during axial rotation exertion in back pain patients may indicate that spinal stability could be compromised. Future studies should consider these alternations in recruitment patterns in terms of spinal stability and internal loading. The findings also indicate the importance of training for coordination besides the strengthening of trunk muscles during rehabilitation process. (C) 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.

Current concepts in central nervous system regeneration

A dictum long-held has stated that the adult mammalian brain and spinal cord are not capable of regeneration after injury. Recent discoveries have, however, challenged this dogma. In particular, a more complete understanding of developmental neurobiology has provided an insight into possible ways in which neuronal regeneration in the central nervous system may be encouraged. Knowledge of the role of neurotrophic factors has provided one set of strategies which may be useful in enhancing CNS regeneration. These factors can now even be delivered to injury sites by transplantation of genetically modified cells. Another strategy showing great promise is the discovery and isolation of neural stem cells from adult CNS tissue. It may become possible to grow such cells in the laboratory and use these to replace injured or dead neurons. The biological and cellular basis of neural injury is of special importance to neurosurgery, particularly as therapeutic options to treat a variety of CNS diseases becomes greater. (C) 2002 Published by Elsevier Science Ltd.

Assault-related admissions to hospital in Central Australia

Objective: To determine the number of assault-related admissions to hospital in the Central Australia region of the Northern Territory over a six-year period. Design and setting: Retrospective analysis of all patients admitted to Alice Springs Hospital (ASH) and Tennant Creek Hospital (TCH) from July 1995 to June 2001, where the primary cause of injury was assault. Main outcome measures: Frequency of assault-related admission to hospital; demographic characteristics of the victims. Results: in the six years, there were 2449 assault-related admissions to ASH and 545 to TCH. Adults aged 25-34 years were most frequently hospitalised for assault, in a proportion greater than their proportion in the NT population, Females represented 59.7% of people admitted to ASH and 54.7% to TCH, greater than their proportion in the NT population. Aboriginals comprised 95.2% of ASH and 89.0% of TCH admissions, and were admitted in a significantly greater proportion than their proportion in the NT population (P < 0.001). The age-adjusted hospital admission rate resulting from assault has increased (P = 0.002) at an average rate of 1.6 (SE, 0.2) per 10 000 people per year. The proportion of assault-related admissions associated with alcohol has also increased significantly (P < 0.001). Conclusion: The frequency of assault-related admissions to hospital, especially among the Aboriginal population, suggests that this major public health issue is escalating.

The Limits of Rational Choice: New Institutionalism in the Test Bed of Central Banking Politics in Australia

This paper tests the explanatory capacities of different versions of new institutionalism by examining the Australian case of a general transition in central banking practice and monetary politics: namely, the increased emphasis on low inflation and central bank independence. Standard versions of rational choice institutionalism largely dominate the literature on the politics of central banking, but this approach (here termed RC1) fails to account for Australian empirics. RC1 has a tendency to establish actor preferences exogenously to the analysis; actors' motives are also assumed a priori; actor's preferences are depicted in relatively static, ahistorical terms. And there is the tendency, even a methodological requirement, to assume relatively simple motives and preference sets among actors, in part because of the game theoretic nature of RC1 reasoning. It is possible to build a more accurate rational choice model by re-specifying and essentially updating the context, incentives and choice sets that have driven rational choice in this case. Enter RC2. However, this move subtly introduces methodological shifts and new theoretical challenges. By contrast, historical institutionalism uses an inductive methodology. Compared with deduction, it is arguably better able to deal with complexity and nuance. It also utilises a dynamic, historical approach, and specifies (dynamically) endogenous preference formation by interpretive actors. Historical institutionalism is also able to more easily incorporate a wider set of key explanatory variables and incorporate wider social aggregates. Hence, it is argued that historical institutionalism is the preferred explanatory theory and methodology in this case.

Comparison of lumbar range of movement and lumbar lordosis in back pain patients and matched controls

Inconclusive findings have been shown in previous studies comparing lumbar range of movement (LROM) and lumbar lordosis between back pain patients and healthy subjects. In these studies, confounding variables such as age, gender, height, obesity, and pain level were usually not well controlled. The present study aimed to compare LROM and lumbar lordosis between back pain patients and matched controls. Fifteen male back pain patients and 15 age-, height-, obesity-, and physical activity-matched male controls were investigated. To minimize the effect of pain on the measurements, only patients with minimal or no pain at the time of testing were included in the study. Inclinometer technique was used for the evaluation of LROM in flexion, extension and lateral flexion as well as lumbar lordosis. A lumbar rotameter was used for measuring axial rotation. Pelvic motion was limited by a pelvic restraint device during LROM measurements. Results showed that there were no significant differences between the back pain and control groups in flexion, extension, lateral flexion and axial rotation LROM and also in lumbar lordosis. This may indicate that when a back pain patient is not in pain, LROM and lumbar lordosis may not be the measures that distinguish between back pain patients and subjects without back pain.

Chloroquine or sulfadoxine-pyrimethamine for the treatment of uncomplicated, Plasmodium falciparum malaria during an epidemic in Central Java, Indonesia

A recent malaria epidemic in the Menoreh Hills of Central Java has increased concern about the re-emergence of endemic malaria on Java, which threatens the island's 120 million residents. A 28-day, in-vivo test of the efficacy of treatment of malaria with antimalarial drugs was conducted among 16 7 villagers in the Menoreh Hills. The treatments investigated, chloroquine (CQ) and sulfadoxine pyrimethamine (SP), constitute, respectively, the first- and second-line treatments for uncomplicated malaria in Indonesia. The prevalence of malaria among 1389 residents screened prior to enrollment was 33%. Treatment outcomes were assessed by microscopical diagnoses, PCR-based confirmation of the diagnoses, measurement of the whole-blood concentrations of CQ and desethylchloroquine (DCQ), and identification of the Plasmodium falciparum genotypes. The 28-day cumulative incidences of therapeutic failure for CQ and SP were, respectively, 47% (N = 36) and 22% (N = 50) in the treatment of P. falciparum, and 18% (N = 77) and 67% (N = 6) in the treatment of P. vivax. Chloroquine was thus an ineffective therapy for P. falciparum malaria, and the presence of CQ-resistant P. vivax and SP-resistant P. falciparum will further compromise efforts to control resurgent malaria on Java.

EMG activity normalization for trunk muscles in subjects with and without back pain

Purpose: The aims of the present study were to examine electromyographic (EMG) activity of six bilateral trunk muscles during maximal contraction in three cardinal planes, and to determine the direction of contraction that gives maximal activation for each muscle. both for healthy subjects and back-pain patients. Methods: Twenty-eight healthy subjects and 15 back-pain patients performed maximum voluntary contractions in three cardinal planes, Surface EMG signals were recorded from rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum, and multifidus bilaterally. Root mean square values of the EMG data were calculated to quantify I the amplitude of EMG signals. Results: For both healthy subjects and back-pain patients. one single direction of contraction was found to give the maximum EMG signals for most muscles. Rectus abdominis demonstrated maximal activity in trunk flexion, external oblique in lateral flexion. internal oblique in axial rotation, and multifidus in extension. For the latissimus dorsi and iliocostalis lumborum. maximal activity was demonstrated in more than one cardinal plane. Conclusion: This study has implications for future research involving normalization of muscle activity to maximal levels required in many trunk EMG studies. As the latissimus dorsi and iliocostalis lumborum demonstrate individual differences in the plane that gives maximal activity, these muscles may require testing in more than one plane.

Characterisation of chronic lateral epicondylalgia using the McGill pain questionnaire, visual analog scales, and quantitative sensory tests

Aims: To characterise chronic lateral epicondylalgia using the McGill Pain Questionnaire, Visual Analog Scales for pain and function, and Quantitative Sensory Tests; and to examine the relationship between these tests in a population with chronic lateral epicondylalgia. Method: Fifty-six patients (29 female, 27 male) diagnosed with unilateral lateral epicondylalgia of 18.7 months (mean) duration (range 1-300), with a mean age of 50.7 years (range 27-73) participated in this study. Each participant underwent assessment with the McGill Pain Questionnaire (MPQ), Visual Analog Scales (VAS) for pain and function. and Quantitative Sensory Tests (QST) including thermal and pressure pain thresholds, pain free grip strength, and neuromeningeal tissue testing via the upper limb tension test 2b (ULTT 2b). Results: Moderate correlation (r = .338-.514, p = .000-.013) was found between all indices of the MPQ and VAS for pain experienced in the previous 24 hours and week. Thermal pain threshold was found to be significantly higher in males. A significant poor to moderate correlation was found between the Pain Rating Index (PRI) in the sensory category of the MPQ and ULTT2b scores (r = .353, p = .038). There was no other significant correlation between MPQ and QST data. Pain free grip strength was poorly yet significantly correlated with duration of pathology (r = 318, p = .038). Conclusion: The findings of this study are in agreement with others (Melzack and Katz, 1994) regarding the multidimensional nature of pain, in a condition conventionally conceived as a musculoskeletal pain state. The findings also suggest that utilisation of only one pain measurement tool is unlikely to provide a thorough clinical picture of pain experienced with chronic lateral epicondylalgia.