9 research outputs found
Évaluation de l efficacité de l analgésie continue cicatricielle dans la chirurgie du rachis
No full textLa chirurgie du rachis est responsable de douleurs importantes qui peuvent être traitées, dans le cadre d une stratégie d analgésie multimodale, par l association d antalgiques systémiques et de techniques d anesthésie loco-régionale. L infiltration continue cicatricielle est simple, comporte peu d effets secondaires et a prouvé son efficacité. Très peu d études ont été réalisées dans la chirurgie du rachis pour évaluer son intérêt. Notre essai randomisé, contrôlé, en double aveugle a pour objectif d évaluer l efficacité de l analgésie continue cicatricielle après arthrodèse rachidienne par voie postérieure. Après obtention d un consentement écrit, un cathéter multiperforé est placé par le chirurgien sous les plans musculaires à la fin de l intervention chirurgicale. Les patients sont randomisés selon 2 groupes : un groupe traité qui reçoit de la ropivacaine 0,2% (bolus de 10 mL puis diffusion continue à 8mL/h pendant 48 heures) et un groupe contrôle qui reçoit selon le même protocole du sérum physiologique. Les 2 groupes bénéficient d une analgésie par PCA morphine et antalgiques non morphiniques. Pour une puissance statistique suffisante, 60 patients doivent être inclus. A ce jour, nous avons inclus 30 patients répartis entre la neurochirurgie (15) et l orthopédie (15). La consommation moyenne de morphine est de 22,4 mg à H24et 21,9 mg à H48. La médiane des EN à H24 est de 3, à H48 de 2 et à H72 de 1. Nous n avons pas levé l aveugle afin d éviter tout biais méthodologique dans les résultats définitifs. Nous poursuivons nos inclusions jusqu en 2012. L objectif global est une amélioration de la prise en charge postopératoire et de la satisfaction du patient.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF
Electroencephalographic Insights into Placebo and Nocebo Effects on Sports Performance: A Scoping Review
No full textPlacebo and nocebo effects are psychobiological responses to purported beneficial or harmful interventions, substances, or actions (Hurst et al., 2017; Beedie et al., 2018). They are shaped by expectations, prior experiences, conditioning, social constructs/learning, acute verbal or visual suggestions, personal traits and states as well as other factors (Colloca & Barsky, 2020; Raglin et al., 2020). It has been shown that nocebo as well as placebo effects can have significant impact on sports performance (Hurst et al., 2020). Even though research has shown significant increase or decrease in performance attributed to placebo and nocebo effects, physiological outcome measures of performance seem to remain almost unchanged, raising questions about the mechanisms behind nocebo and placebo effects in the context of sports (Beedie et al. 2006). However, in sport science, most published studies remain descriptive and speculative regarding these mechanisms (Beedie et al., 2020). Prominent scientists in the field have urged for more in-depth exploration of the mechanisms underlying nocebo and placebo effects in sports (Beedie et al., 2020). Recent neuroscience research has identified several neurobiological pathways associated with placebo and nocebo effects that could potentially be relevant to sports performance including different neurotransmitter systems and brain regions (Beedie et al., 2020).
Neuroimaging studies in the context of hypo- and hyperalgesia have already provided insights into temporal aspects related to brain area activity after nocebo and placebo administration (Rossettini et al., 2023). It has been shown that nocebo and placebo stimuli can change EEG (electroencephalogram) brain activity during expectation and perception phases (Piedimonte et al., 2017). It remains unclear whether and/or to what extend these brain activity pattern of placebo and nocebo effects transfer to sports and performance.
This scoping review will examine the current state of EEG research investigating the mechanisms underlying placebo and nocebo effects in sports performance, further addressing set-up protocols and methods of analysis.
Research Questions:
1. How have EEG studies in healthy populations contributed to our current understanding of the mechanisms underlying placebo and nocebo effects in sports performance so far?
2. What is the current extent, range, and nature of research on the distinct characteristics of EEG data of placebo and nocebo effects in the context of sports performance?
3. What setup configurations and analytical approaches have been used for EEG studies in the context of sports performance to date?
References:
Beedie, C., Benedetti, F., Barbiani, D., Camerone, E., Cohen, E., Coleman, D., Davis, A., Elsworth-Edelsten, C., Flowers, E., Foad, A., Harvey, S., Hettinga, F., Hurst, P., Lane, A., Lindheimer, J., Raglin, J., Roelands, B., Schiphof-Godart, L., & Szabo, A. (2018). Consensus statement on placebo effects in sports and exercise: The need for conceptual clarity, methodological rigour, and the elucidation of neurobiological mechanisms. European journal of sport science, 18(10), 1383–1389. https://doi.org/10.1080/17461391.2018.1496144
Beedie, C., Benedetti, F., Barbiani, D., Camerone, E., Lindheimer, J., & Roelands, B. (2020). Incorporating methods and findings from neuroscience to better understand placebo and nocebo effects in sport. European journal of sport science, 20(3), 313–325. https://doi.org/10.1080/17461391.2019.1675765
Beedie, C. J., Stuart, E. M., Coleman, D. A., & Foad, A. J. (2006). Placebo effects of caffeine on cycling performance. Medicine and science in sports and exercise, 38(12), 2159–2164. https://doi.org/10.1249/01.mss.0000233805.56315.a9
Colloca, L., & Barsky, A. J. (2020). Placebo and Nocebo Effects. The New England journal of medicine, 382(6), 554–561. https://doi.org/10.1056/NEJMra1907805
Hurst, P., Foad, A. J., Coleman, D. A., & Beedie, C. (2017). Athletes Intending to Use Sports Supplements Are More Likely to Respond to a Placebo. Medicine and Science in Sports and Exercise, 40(9), 1877-1883. doi:10.1249/MSS.0000000000001297.
Hurst, P., Schipof-Godart, L., Szabo, A., Raglin, J., Hettinga, F., Roelands, B., Lane, A., Foad, A., Coleman, D., & Beedie, C. (2020). The Placebo and Nocebo effect on sports performance: A systematic review. European journal of sport science, 20(3), 279–292. https://doi.org/10.1080/17461391.2019.1655098
Piedimonte, A.; Guerra, G.; Vighetti, S.; Carlino, E. Measuring expectation of pain: Contingent negative variation in placebo and nocebo effects. Eur. J. Pain 2017, 21, 874–885.
Raglin, J., Szabo, A., Lindheimer, J. B., & Beedie, C. (2020). Understanding placebo and nocebo effects in the context of sport: A psychological perspective. European journal of sport science, 20(3), 293–301. https://doi.org/10.1080/17461391.2020.1727021
Rossettini, G., Campaci, F., Bialosky, J., Huysmans, E., Vase, L., & Carlino, E. (2023). The Biology of Placebo and Nocebo Effects on Experimental and Chronic Pain: State of the Art. Journal of clinical medicine, 12(12), 4113. https://doi.org/10.3390/jcm1212411
Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma
No full textUnconscious processing of emotional faces
No full textDue to capacity limits, the brain must select important information for further processing. Evolutionary-based theories suggest that emotional (and specifically threat-relevant) information is prioritised in the competition for attention and awareness (e.g. Ohman & Mineka, 2001). A range of experimental paradigms have been used to investigate whether emotional visual stimuli (relative to neutral stimuli) are selectively processed without awareness, and attract visual attention (e.g. Yang et al., 2007). However, very few studies have used appropriate control conditions that help clarify the extent to which observed effects are driven by the extraction of emotional meaning from these stimuli, or their low-level visual characteristics (such as contrast, or luminance). The experiments in this thesis investigated whether emotional faces are granted preferential access to awareness and which properties of face stimuli drive these effects. A control stimulus was developed to help dissociate between the extraction of emotional information and low-level accounts of the data. It was shown that preferential processing of emotional information is better accounted for by low-level characteristics of the stimuli, rather than the extraction of emotional meaning per se. Additionally, a robust ‘face’ effect was found across several experiments. Investigation of this effect suggested that it may not be driven by the meaningfulness of the stimuli as it was also apparent in an individual that finds it difficult to extract information from faces. Together these findings suggest that high-level information can be extracted from visual stimuli outside of awareness, but the prioritisation afforded to emotional faces is driven by low-level characteristics. These results are particularly timely given continued high-profile debate surrounding the origins of emotion prioritisation (e.g. Tamettio & de Gelder, 2010; Pessoa & Adolphs, 2010)
Non-invasive brain stimulation as a novel approach to the treatment of chronic non-specific low back pain
No full textThis thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Chronic non-specific low back pain (CNSLBP) is a widespread but poorly understood
condition that places a substantial burden on the sufferer, health services and the wider economy. Existing approaches to management do not demonstrate impressive levels of effectiveness. There is growing evidence that CNSLBP is associated with significant alterations in central nervous system (CNS) structure and function, suggesting a possible role for the brain in the aetiology of the condition, and presenting a case for novel therapies which aim to treat CNSLBP by affecting brain function. One such potential therapeutic approach is non-invasive brain stimulation (NIBS). Following a literature review discussing the epidemiology and management of low back pain, the evidence for altered CNS function and the potential role of brain stimulation in CNSLBP and chronic pain generally this thesis includes 3 original scientific studies: A Cochrane systematic review of the effectiveness of NIBS techniques for the treatment of chronic pain.
A randomised double-blind exploratory study of transcranial direct current stimulation of the motor cortex in the treatment of CNSLBP Is blinding to the stimulation condition maintained in trials comparing 2mA tDCS with sham stimulation? A randomised cross-over study. RESULTS: There is limited existing evidence that some forms of NIBS may have a beneficial effect on
chronic pain, though caution is warranted. Exploratory data from study 2 is not suggestive that tDCS to the motor cortex is effective for treating CNSLBP. Commonly used sham controls in trials of tDCS do not ensure adequate blinding, and so introduce a potential source of bias to the existing evidence base. CONCLUSION: Further research is required to establish the value of NIBS as a treatment for chronic pain and CNSLBP. Future research in tDCS will need to develop and employ fully validated sham controls to ensure adequate blinding. NIBS cannot currently be recommended for the treatment of CNSLBP.This study is partly funded by the BackCare UK and the Rosetrees Trust
СРАВНИТЕЛЬНАЯ ОЦЕНКА БОЛИ И КАЧЕСТВА ЖИЗНИ У ПАЦИЕНТОВ ПОСЛЕ ОТКРЫТОЙ И ВИДЕОАССИСТИРОВАННОЙ ЛОБЭКТОМИИ ПО ПОВОДУ РАКА ЛЕГКОГО
No full textThe pain and pain syndrome remain to be serious problems of clinical medicine and surgery as one of its aspects. The positive correlation was found out between the type of surgery and post-operative pain in abdominal, thoracic and orthopedic surgeries. Materials and methods. Results of a questionnaire survey in 130 patients were analyzed; from 2015 to 2017 all those patients had lobectomies for lung cancer using video-assisted thoracoscopic or open accesses in the Thoracic Department of Petrov National Medical Research Center of Oncology. The intensity of pain and life quality in the post-operative period were assessed using visual analogue scales, the Wong-Baker FACES pain rating scale, verbal rating scales, and McGill pain questionnaire. In order to assess life quality, the non-specific questionnaire of SF-36 was used in the cancer patients and those enrolled in the clinical studies of EORTC QLQ-C30 including the special module of QLQ-LC13 for lung cancer patients. The obtained results were analyzed and it was found out that intensity of pain was statistically significantly lower in video-assisted thoracoscopic access versus thoracotomy (U = 678.00; p < 0.05). When using the questionnaires of SF-36 (U = 8,742.50; p < 0.05) and EORTC QLQ-C30 (U = 3,759.00; p < 0.05) and the special module of QLQ-LC13 for lung cancer (U = 4,243.00; p < 0.05), the obtained data also indicated the better life quality and functions, reduction of pathologic manifestations versus open surgical access. Conclusion: Reduction in the pain intensity and higher life quality were typical of surgeries with use of video-assisted thoracoscopic technologies versus classical open access.
Complementary and alternative drug therapy versus science-oriented medicine
No full textThis opinion deals critically with the so-called complementary and alternative medical (CAM) therapy on the basis of current data. From the authors’ perspective, CAM prescriptions and most notably the extensive current endeavours to the “integration” of CAM into conventional patient care is problematic in several respects.Thus, several CAM measures are used, although no specific effects of medicines can be proved in clinical studies. It is extensively explained that the methods used in this regard are those of evidence-based medicine, which is one of the indispensable pillars of science-oriented medicine. This standard of proof of efficacy is fundamentally independent of the requirement of being able to explain efficacy of a therapy in a manner compatible with the insights of the natural sciences, which is also essential for medical progress. Numerous CAM treatments can however never conceivably satisfy this requirement; rather they are justified with pre-scientific or unscientific paradigms. The high attractiveness of CAM measures evidenced in patients and many doctors is based on a combination of positive expectations and experiences, among other things, which are at times unjustified, at times thoroughly justified, from a science-oriented view, but which are non-specific (context effects). With a view to the latter phenomenon, the authors consider the conscious use of CAM as unrevealed therapeutic placebos to be problematic. In addition, they advocate that academic medicine should again systematically endeavour to pay more attention to medical empathy and use context effects in the service of patients to the utmost.The subsequent opinion discusses the following after an introduction to medical history: the definition of CAM; the efficacy of most common CAM procedures; CAM utilisation and costs in Germany; characteristics of science-oriented medicine; awareness of placebo research; pro and contra arguments about the use of CAM, not least of all in terms of aspects related to medical ethics
