Placebo

Agosto 3, 2017. No. 2769

Un condicionamiento clásico sin sugerencias verbales provoca analgesia placebo e hiperalgesia nocebo. A Classical conditioning without verbal suggestions elicits placebo analgesia and nocebo hyperalgesia. Bąbel P1, Bajcar EA1, Adamczyk W1,2, Kicman P1, Lisińska N1, Świder K1,3, Colloca L4,5. PLoS One. 2017 Jul 27;12(7):e0181856. doi: 10.1371/journal.pone.0181856. eCollection 2017. Abstract The aim of this study was to examine the relationships among classical conditioning, expectancy, and fear in placebo analgesia and nocebo hyperalgesia. A total of 42 healthy volunteers were randomly assigned to three groups: placebo, nocebo, and control. They received 96 electrical stimuli, preceded by either orange or blue lights. A hidden conditioning procedure, in which participants were not informed about the meaning of coloured lights, was performed in the placebo and nocebo groups. Light of one colour was paired with pain stimuli of moderate intensity (control stimuli), and light of the other colour was paired with either nonpainful stimuli (in the placebo group) or painful stimuli of high intensity (in the nocebo group). In the control group, both colour lights were followed by control stimuli of moderate intensity without any conditioning procedure. Participants rated pain intensity, expectancy of pain intensity, and fear. In the testing phase, when both of the coloured lights were followed by identical moderate pain stimuli, we found a significant analgesic effect in the placebo group, and a significant hyperalgesic effect in the nocebo group. Neither expectancy nor fear ratings predicted placebo analgesia or nocebo hyperalgesia. It appears that a hidden conditioning procedure, without any explicit verbal suggestions, elicits placebo and nocebo effects, however we found no evidence that these effects are predicted by either expectancy or fear. These results suggest that classical conditioning may be a distinct mechanism for placebo and nocebo effects. PDF Papel terapéutico del placebo: evolución de un nuevo paradigma en la comprensión de la investigación y la práctica clínica Therapeutic Role of Placebo: Evolution of a New Paradigm in Understanding Research and Clinical Practice. Manchikanti L1, Boswell MV2, Kaye AD3, Helm Ii S, Hirsch JA4. Pain Physician. 2017 Jul;20(5):363-386. Abstract Research into interventional techniques in managing chronic spinal pain continues to be challenging, mystifying, confusing, and biased. Insight, or lack thereof, into placebo and nocebo phenomena contributes mightily to these difficulties. Unfortunately, placebo-nocebo responses are the subject of numerous controversies and challenges from not only a research perspective, but also clinical perspective. While interventionalists consider the biggest threat to interventional pain management research is inappropriate and outdated interpretation of the data, a greater problem is the misuse of the placebo response in research, with the declaration that all and everything as a placebo effect: with a misinterpretation of the nature of the placebo the, associated conclusions can be inaccurate. Researchers have been aware of placeboand nocebo effects for decades, even though misunderstandings and misgivings continue to be seen in scientific studies. In simplistic terms, placebo and nocebo had been understood to indicate improving or worsening of symptoms that occur during treatment with placebo/nocebo drugs or modalities. However, research has demonstrated that such terminology does not necessarily reflect "true" placebo effect or nocebo response. These effects are based on numerous factors, including natural course of a disease, spontaneous remission, regression to the mean, and a multitude of other conceptual, explanatory, and moral challenges. In modern clinical research, a neutral substance called placebo has been mainly used as a comparison factor rather than being studied itself, while the nocebo response has only been minimally studied.A major misconception involves active placebo, a concept that has been extended beyond the administration of inert substances. The definition of active placebo of an active agent given to a patient, even though the pharmacologic action of the active agent is not known to be beneficial, has been converted to conveniently change many of the treatments which are effective on their own to be defined as placebos, often leading to conclusions that none of the interventions are effective. This review focuses on a multitude of controversies surrounding placebo and nocebo phenomena in research and clinical applications. The discussion includes a focus on unsolved, forgotten, and ignored features of placebo responses in medicine, and provides an appropriate understanding of placebo and nocebo phenomena in interventional pain management. To that effect, this review also describes therapeutic placebos, research with open placebos, and improvements in understanding clinical applications of present interventional pain management research. KEYWORDS: Placebo effect; active control trials active placebos.; interventional techniques; nocebo response; placebo analgesia PDF Los mecanismos moleculares de las respuestas al placebo en la analgesia PDF EL PODER CURATIVO DE LA MENTE: EL EFECTO PLACEBO Alberto Porras, Alberto del Arco, Gregorio Segovia y Rodrigo Martínez PDF El Comité Ejecutivo de la IASP insta a Venezuela a centrarse en el acceso a medicamentos para el dolor a la luz de escasez crítica IASP Executive Committee Urges Venezuela to Focus on Access to Pain Medications in Light of Critical Shortages As the leading global organization that brings together scientists, clinicians, health-care providers, and policymakers to stimulate and support the study of pain with the goal of improved pain relief worldwide, the International Association for the Study of Pain (IASP) has been made aware that difficult conditions in Venezuela have resulted in inadequate access to pain treatment. Declaración / Statement

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Resultados a largo plazo después de las fracturas de escafoides distales: un seguimiento de 10 años

http://www.clinicademano.com.mx/academia/resultados-a-largo-plazo-despues-de-las-fracturas-de-escafoides-distales-un-seguimiento-de-10-anos/

Long-Term Outcomes After Distal Scaphoid Fractures: A 10-Year Follow-Up

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28733100

http://www.jhandsurg.org/article/S0363-5023(16)30779-1/fulltext

De:

Clementson M1,Thomsen N2,Besjakov J3,Jørgsholm P2,Björkman A2.

J Hand Surg Am.

2017 Jul 18. pii: S0363-5023(16)30779-1. doi: 10.1016/j.jhsa.2017.06.016. [Epub ahead of print]

Todos los derechos reservados para:

Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Abstract

PURPOSE:

The aim of this study was to evaluate the functional, clinical, and radiological outcome 10 years after distal scaphoid fractures.

CONCLUSIONS:

From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function as well as good wrist motion and strength. The risk for development of posttraumatic scaphotrapezium-trapezoid (STT) joint arthritis was low.

Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Arthritis; CT; classification; outcome; scaphoid fracture

Resumen

PROPÓSITO:
El objetivo de este estudio fue evaluar el resultado funcional, clínico y radiológico 10 años después de las fracturas distales del escafoides.

CONCLUSIONES:
Desde una perspectiva de 8 a 11 años, los pacientes con fracturas de escafoides distal informan de la función normal de la mano autoevaluada, así como el buen movimiento y la fuerza de la muñeca. El riesgo de desarrollar artritis en la articulación escafo-trapecio-trapezoidal (STT) postraumática fue bajo.

Copyright © 2017 Sociedad Americana de Cirugía de la Mano. Publicado por Elsevier Inc. Todos los derechos reservados.

PALABRAS CLAVE:
Artritis; Tomografía computada; clasificación; resultado; Fractura de escafoides

PMID:  28733100   DOI:  

10.1016/j.jhsa.2017.06.016

#artritis fractura#fractura#escafoides#articulación#escafo-trapecio-trapezoidal

Prevención, tratamiento y rehabilitación de lesiones del ligamento cruzado anterior en niños

http://www.ortopediapediatricaisunza.com.mx/academia/prevencion-tratamiento-y-rehabilitacion-de-lesiones-del-ligamento-cruzado-anterior-en-ninos/

Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28652828

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476725/

https://www.dovepress.com/prevention-treatment-and-rehabilitation-of-anterior-cruciate-ligament–peer-reviewed-article-OAJSM

De:

Lang PJ1,2,Sugimoto D1,2,3,Micheli LJ1,2,3

Open Access J Sports Med.

2017 Jun 12;8:133-141. doi: 10.2147/OAJSM.S133940. eCollection 2017.

Todos los derechos reservados para:

Copyright

© 2017 Lang et al. This work is published and licensed by Dove Medical Press LimitedThe full terms of this license are available at

https://www.dovepress.com/terms.php

and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Abstract

As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the “non-copers” who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries.

KEYWORDS:

neuromuscular training; physeal-sparing; skeletally immature; surgical techniques

Resumen

A medida que más niños y adolescentes participan en deportes organizados competitivos, ha habido un aumento en la incidencia reportada de lesiones del ligamento cruzado anterior (ACL) en estos grupos de edad. Las lesiones del LCA en atletas esqueléticos inmaduros presentan un desafío, ya que la reconstrucción debe preservar la fisis del fémur distal y de la tibia proximal para evitar trastornos del crecimiento. Históricamente, un atleta esqueleto inmaduro con una lesión de ACL se trató con una ortesis y la modificación de la actividad hasta la madurez esquelética, con la reconstrucción de LCA se realiza en ese momento en el “no copers” que experimentó la inestabilidad. Más recientemente, la evidencia ha demostrado que la reconstrucción tardía puede conducir a un mayor daño al menisco y cartílago articular. Como resultado, se favorece la reconstrucción temprana para proteger el menisco y permitir la actividad física continua. Mientras que los adolescentes en o cerca de la madurez esquelética pueden ser tratados con técnicas de reconstrucción estándar, pueden dar lugar a trastornos del crecimiento en atletas más jóvenes con un crecimiento significativo restante. En respuesta a la creciente necesidad de técnicas de reconstrucción de LCA en individuos esqueléticamente inmaduros, se han desarrollado técnicas de reconstrucción que salvan fósforo y que respetan fieles. Además de los avances en la técnica quirúrgica, ACL prevención de lesiones también ha ganado la atención. Este creciente interés en la prevención del LCA se relaciona en parte con el alto riesgo de re-rasgón del LCA, ya sea del injerto del ACL o del ACL contralateral, en niños y adolescentes. Informes recientes indican que los programas de entrenamiento neuromuscular bien diseñados pueden reducir el riesgo de lesiones primarias y posteriores del LCA.

PALABRAS CLAVE:
Entrenamiento neuromuscular; Preservación fisis; Esqueleto inmaduro; Técnicas quirúrgicas

PMID: 28652828   PMCID:  

PMC5476725  

DOI:  

10.2147/OAJSM.S133940

Free PMC Article

#Entrenamiento neuromuscular#fisis#esqueléto inmaduro#técnicas quirúrgicas