21 research outputs found
Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia
No full textCarol GT Vance,1 Ruth L Chimenti,1 Dana L Dailey,1 Katherine Hadlandsmyth,2 M Bridget Zimmerman,3 Katharine M Geasland,1 Jonathan M Williams,4 Ericka N Merriwether,1,5 Li Alemo Munters,4 Barbara A Rakel,6 Leslie J Crofford,4 Kathleen A Sluka1 1Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA; 2Department of Anesthesia, College of Medicine, University of Iowa, Iowa City, IA, USA; 3Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA; 4Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, USA; 5Department of Physical Therapy, New York University, New York, NY, USA; 6College of Nursing, University of Iowa, Iowa City, IA, USA Introduction: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention clinically used for pain relief. The importance of utilizing the adequate stimulation intensity is well documented; however, clinical methods to achieve the highest possible intensity are not established. Objectives: Our primary aim was to determine if exposure to the full range of clinical levels of stimulation, from sensory threshold to noxious, would result in higher final stimulation intensities. A secondary aim explored the association of pain, disease severity, and psychological variables with the ability to achieve higher final stimulation intensity. Methods: Women with fibromyalgia (N=143) were recruited for a dual-site randomized controlled trial – Fibromyalgia Activity Study with TENS (FAST). TENS electrodes and stimulation were applied to the lumbar area, and intensity was increased to sensory threshold (ST), then to “strong but comfortable” (SC1), then to “noxious” (N). This was followed by a reduction to the final stimulation intensity of “strong but comfortable” (SC2). We called this the Setting of Intensity of TENS (SIT) test. Results: There was a significant increase from SC1 (37.5 mA IQR: 35.6–39.0) to SC2 (39.2 mA IQR: 37.1–45.3) (p<0.0001) with a mean increase of 1.7 mA (95% CI: 1.5, 2.2). Linear regression analysis showed that those with the largest increase between SC1 and N had the largest increase in SC2–SC1. Further, those with older age and higher anxiety were able to achieve greater increases in intensity (SC2–SC1) using the SIT test. Conclusion: The SC2–SC1 increase was significantly associated with age and anxiety, with greater mean increases associated with older age and higher anxiety. Thus, although all patients may benefit from this protocol, older women and women with elevated anxiety receive the greatest benefit. Keywords: pain, transcutaneous electrical nerve stimulation, TENS, fibromyalgia, dosag
Editorial: Advancing critical discovery of novel approaches to understanding and eliminating pain inequities
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Impact of foot progression angle modification on plantar loading in individuals with diabetes mellitus and peripheral neuropathy
No full textMinimum Detectable Change in Gait Velocity during Acute Rehabilitation following Hip Fracture
No full textMANAGEMENT OF DIABETIC KETOACIDOSIS: A BEFORE-AND-AFTER IMPLEMENTATION STUDY OF THE TWO-BAG METHOD
No full textINTRODUCTION: Conventional management of diabetic ketoacidosis (DKA) utilizes a variable rate insulin infusion requiring multiple changes to IV fluid contents to resolve hyperglycemia and anion-gap acidosis. The author\u27s institution standardized DKA management by incorporating the two-bag method into a revised orderset in May 2022. The two-bag method has been associated with earlier anion gap closure, faster normalization of blood glucose, and less hypoglycemia. However, not all studies evaluating the twobag method have reached the same conclusion. This study compares conventional management of DKA to the two-bag method. METHODS: This single-center, pre-post study included adults started on an IV insulin infusion while admitted to the emergency department for DKA treatment from July 1st, 2021 to October 31st, 2022. Patients were divided into two-bag or conventional groups based on timing in relation to the two-bag method orderset go-live in May of 2022. The following patients were excluded: age \u3c 18 years, pregnant, and those not meeting DKA diagnostic criteria at the beginning of treatment. The primary outcome was time to anion-gap resolution (≤12mEq/L). Secondary outcomes included ICU and hospital length of stay (LOS), insulin infusion duration, and time to blood glucose ≤250mg/ dL. Safety outcomes included rates of hypoglycemia and hypokalemia during infusion. RESULTS: Time to anion-gap resolution (conventional(n=43): 11 hours vs. two-bag(n=61): 13 hours; p=0.2), median ICU LOS (1.5 days vs. 1.8 days; p=0.3) and hospital LOS (3.7 days vs. 4.0 days; p=0.9) were all similar between groups. Median duration of insulin infusion (19 hours vs. 15 hours; p=0.02) was shorter in the two-bag group while median time to blood glucose ≤250mg/dL (6 hours vs. 8 hours; p=0.03) was longer in the two-bag group. Incidence of hypoglycemia (28% vs. 5%; p=0.001) and hypokalemia (53% vs. 26%; p=0.005) were lower in the twobag group. CONCLUSIONS: The two-bag method was associated with similar efficacy to the conventional method with a potential improvement in the incidence of hypoglycemia and hypokalemia. However, more studies are needed for full evaluation of two-bag method
Racism Exposure and Trauma Accumulation Perpetuate Pain Inequities – Advocating for Change (RESTORATIVE): A Conceptual Model
No full textExperiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with post-traumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin InequiTIes – AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain, and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as “two halves of the same coin,” in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, acting as facilitators and advocates for the patient’s lived experience with RBTS in clinical pain care teams. To assist with this goal, we offer suggestions for provider and researcher antiracism education, assessment of RBTS in pain populations, and discuss how cultural humility is a central component in implementing the RESTORATIVE model
Additional file 1 of Racial and weight discrimination associations with pain intensity and pain interference in an ethnically diverse sample of adults with obesity: a baseline analysis of the clustered randomized-controlled clinical trial the goals for eating and moving (GEM) study
No full textAdditional file 1: Table S1. Frequencies of participants’ gender by race/ethnicity. Table S2. Descriptive Statistics and Spearman’s rho Correlations for Study Variables. Table S3. Results Of Mann–Whitney U tests To Investigate Differences Between Patients Who Experienced WD And Who Did Not Experience WD. Table S4. Pain Interference. Table S5. Pain Intensity
Confronting Racism in Pain Research: A Call to Action
No full textRacism is an established health determinant across the world. In this 3-part series, we argue that a disregard of how racism manifests in pain research practices perpetuates pain inequities and slows the progression of the field. Our goal in part-1 is to provide a historical and theoretical background of racism as a foundation for understanding how an antiracism pain research framework - which focuses on the impact of racism, rather than “race,” on pain outcomes - can be incorporated across the continuum of pain research. We also describe cultural humility as a lifelong self-awareness process critical to ending generalizations and successfully applying antiracism research practices through the pain research continuum. In part-2 of the series, we describe research designs that perpetuate racism and provide reframes. Finally, in part-3, we emphasize the implications of an antiracism framework for research dissemination, community-engagement practices and diversity in research teams. Through this series, we invite the pain research community to share our commitment to the active process of antiracism, which involves both self-examination and re-evaluation of research practices shifting our collective work towards eliminating racialized injustices in our approach to pain research. Perspective: We call on the pain community to dismantle racism in our research practices. As the first paper of the 3-part series, we introduce dimensions of racism and its effect on pain inequities. We also describe the imperative role of cultural humility in adopting antiracism pain research practices.</p
