The meaning of the VAS.

[101N]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754458/pdf/awt211.pdf

VAS and other useful predictors of central pain syndromes. If you don't ask these things, you won't know.

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[Ducttape]

Great article.

Conclusion
Brain activity related to the perception of back pain shifts in location from regions involved in acute pain to engage emotion circuitry as the condition persists, thereby providing a percept-linked brain signature for the transition to chronic pain. We provide a spatial template and time window (6–12 months) for the stabilization of this signature, which identifies a specific functional bio-marker for back pain chronification. Thus, these results have important clinical implications regarding the definition of chronic pain, its aetiology, and the optimal time window for treatments targeting its prevention. Additionally, these results challenge long standing theoretical constructs of brain-mind relationships

I have started telling patients, when they say "so you sayin' its all in my head?", that their chronic pain is much more akin to a "bad memory" ...

 

[101N]

I use "like a misplaced echo" of the acute pain.

 

[Ducttape]

good one, but 1/2 of my patients wouldnt be understand "misplaced echo".

maybe they would understand "thats like the bottle of Vic's you swore you left on the counter..."

 

[lobelsteve]

Pain IS all in your head. I then offer to cut it off as proof to de escalate and say Obamacare wouldnt cover decapitation therapy and the relief only lasts about 4 seconds.

Yes. I really say this several times per day.

 

[emd123]

I use "like a misplaced echo" of the acute pain.

"Sorry Sir, RoxiSomaXanax is not FDA approved for 'misplaced echoes' like yours. "

 

[101N]

Prognostic factors of complaints of arm, neck, and/or shoulder: a systematic review of prospective cohort studies
Bruls, Vivian E. J.*; Bastiaenen, Caroline H. G.; de Bie, Rob A.

Supplemental Author Material

Abstract

Abstract: Complaints of the arm, neck, or shoulder are common musculoskeletal disorders. To gain insight in prognostic factors of complaints of the arm, neck, or shoulder that are associated with recovery, we conducted a systematic review. We included longitudinal prognostic cohort studies that investigated associations between prognostic factors and recovery in terms of symptoms, disability, or sickness absence. Twenty-six papers reporting on 20 cohorts were included following a search of electronic databases (PubMed, Embase, Cinahl, and PsycINFO). The risk of bias (ROB) was independently assessed by 2 reviewers using the Quality in Prognosis Studies tool. Sixteen studies were assessed as having “low” ROB, and 10 studies were assessed as having “high” ROB. Because of heterogeneity in included studies, pooling was not possible. In the qualitative analysis, the number of studies that evaluated a factor, the ROB of each cohort, and consistency of available evidence were taken into account when summarizing the evidence. We examined whether follow-up duration altered the association of prognostic factors with recovery. The results of our best evidence synthesis showed that for short-term follow-up (<6 months), longer duration of complaints, higher symptom severity, more functional limitations, the use of specific coping styles, and accident as “patients' opinion regarding cause” were negatively associated with recovery. For long-term follow-up, we found that longer duration of complaints at presentation had an unfavorable prognostic value for recovery. Our evidence synthesis revealed strong evidence for no prognostic impact of many factors that are suggested to be associated with recovery according to the primary studies.