New intervention shows promise for relief of shoulder pain in wheelchair users with spinal cord injury

A New Jersey team of researchers has reported the successful, long-term relief of chronic refractory shoulder pain in a wheelchair user with spinal cord injury (SCI) following a single injection of autologous, micro-fragmented adipose tissue into the affected shoulder joint. The article, “Autologous micro-fragmented adipose tissue as a treatment for chronic shoulder pain in a wheelchair using individual with spinal cord injury: a case report” (doi: 10.1038/s41394-019-0186-8) was epublished ahead of print on May 13, 2019 by Spinal Cord Series and Cases. This is the first reported use of this intervention for shoulder pain in an individual with spinal cord injury who has failed to improve with conservative care, such as physical therapy and pharmacological agents.

The authors are Chris Cherian, MD, of Rutgers New Jersey Medical School, Gerard Malanga, MD, of the New Jersey Regenerative Institute and Kessler Institute for Rehabilitation, Trevor Dyson-Hudson, MD, and Nathan Hogaboom, PhD, of Kessler Foundation, and Michael A. Pollack, MD, of Montclair Radiology.

Full story at news-medical.net

‘Where Might We Be Now?’ APTA Congressional Briefing Makes a Personal Case for Pain Treatment Alternatives

The plan was set: on May 21, APTA would hold a congressional briefing on the importance of increasing patient access to nonpharmacological approaches to pain treatment. The event would be highlighted by the story of Cindy Whyde and her son Elliott, who became addicted to prescription opioids, and eventually heroin, after receiving an opioid prescription to treat a high school football injury 9 years ago. Elliott’s road to recovery has not been easy.

But the briefing didn’t go as planned. Days before the Whydes were to travel to Washington, DC, Elliott relapsed into addiction and disappeared. Cindy came to the event alone, determined to do whatever she could to effect change. At the time of the event Elliott had been missing for 3 days.

“That is one of the worst fears any parent should have to go through, not knowing where their child is and what’s going on with them,” Whyde said.

Full story at APTA

Home-based exercise program reduces subsequent falls in high-risk seniors

An in-home exercise program reduced subsequent falls in high-risk seniors by 36 per cent, according the results of a 12-month clinical trial published today in the Journal of the American Medical Association.

The study, conducted by UBC faculty of medicine researchers in partnership with the clinical team at the Falls Prevention Clinic at Vancouver General Hospital, found a reduction in fall rate and a small improvement in cognitive function in seniors who received strength and balance training through the clinical trial.

Falls increase risk of injury and loss of independence for older adults. Exercise is a widely recommended fall prevention strategy, but whether it can reduce subsequent falls in those who have previously fallen is not well established.

Full story at news-medical.net

Final HHS Report on Pain Management Adds to Drumbeat for Better Access to Nondrug Approaches

The final report from a US Department Health and Human Services (HHS) inter-agency task force on pain management best practices is out, and its call for greater collaborative care and improved access to physical therapy comes through loud and clear. It’s a report that in many ways echoes APTA’s white paper on opioids and pain management published nearly 1 year ago.

The “Report on Pain Management Best Practices” changed little from its draft version released in January [Editor’s note: this PT in Motion News article covered the draft in depth]. Like its predecessor, the report identifies gaps and inconsistencies in pain management that can contribute to opioid misuse.

While the task force acknowledges that opioids may be appropriate when carefully prescribed in some instances, it also argues that other approaches—including “restorative therapies” furnished by physical therapists and other health care professionals—should be on equal footing with pharmacological alternatives, particularly when it comes to reimbursement and patient access.

Full story at APTA

Study Reveals Racial Disparities in Postdischarge Rehab After Traumatic Injury

The road to recovery after a moderate-to-severe traumatic injury can be daunting for anyone, but a new study suggests that individuals who are African American may face an even more challenging path. Researchers found that in groups matched for age, injury type, and injury severity, African Americans were on average 36% less likely to use rehabilitation services and 40% less likely to have outpatient visits postdischarge.

The presence of the apparent difference echoes APTA’s characterization of racial and ethnic disparities as existing “across a range of illnesses and health care services.”

The study’s conclusions are based on an analysis of 2.5 years’ worth of patient-reported data linked to trauma treatment records from 3 Boston-area level 1 trauma centers participating in the Functional Outcomes and Recovery after Trauma (FORTE) project. Patients included in the study experienced moderate-to-severe trauma, defined as an Injury Severity Score (ISS) of 9 or greater, and participated in phone interviews conducted 6 to 12 months after trauma center discharge. Results were published in the American Journal of Surgery.

Full story at APTA

Study Identifies 11 Guideline-Based Recommendations for Musculoskeletal Pain

A multidisciplinary group of researchers, including physical therapists (PTs), has identified a core set of 11 clinical practice guideline (CPG) recommendations for treating adult musculoskeletal (MSK) pain, according to a new article in British Journal of Sports Medicine (BJSM). Authors hope the recommendations will assist emergency and primary care clinicians in providing evidence-based care, as well as help consumers make informed health care decisions.

Authors write that while “care that is more concordant with CPG recommendations results in better patient outcomes and lower costs,” providers across disciplines too often do not practice according to guidelines, resulting in overuse of imaging, surgery, and opioids, and a failure to provide patient education and advice. There are many reasons for this, according to authors: CPGs often are not “user-friendly”; they often lack guidance on how to implement recommendations in practice; and different guidelines for a single condition may include conflicting recommendations.

Full story at APTA

Ayurvedic treatment for rheumatoid arthritis: What to know

Ayurveda is an traditional Indian practice involving a natural, holistic approach to treating medical conditions.

Some Ayurvedic practitioners use Ayurveda to treat rheumatoid arthritis (RA), which they call “amavata.” Ayurvedic treatment can include supplements, dietary changes, and exercise.

This article will review Ayurvedic treatment for RA, including the basic principles and whether research supports its use.

General principles

The term “Ayurveda” is a combination of two Sanskrit terms “ayu” (life) and “veda” (knowledge). Practitioners work to balance the three energy forces, or “doshas,” of life: “vata,” “pitta,” and “kapha.”

Full story at Medical News Today

The number of American women who aren’t active enough is high and growing

Using data from a national survey representing more than 19 million U.S. women with established cardiovascular disease, researchers from the Johns Hopkins University School of Medicine have determined that more than half of women with the condition do not participate in enough physical activity, a number that has grown over the past decade.

According to the American Heart Association, heart disease remains the leading cause of death for American women, 43 million of whom are affected by the condition. The researchers say their findings suggest that women diagnosed with disorders such as coronary artery disease, stroke, heart failure, heart rhythm disturbances, and peripheral artery disease should talk to their physicians about how to increase their physical activity levels to maintain optimal cardiac health and decrease health care costs associated with cardiac disability.

The study, described online in JAMA Network Open, notes that total health care costs among women with cardiovascular disease who met AHA-recommended physical activity guidelines were about 30 percent less than costs among those who did not meet the guidelines.

Full story John Hopkins University

What can cause shoulder pain?

The shoulder is a very flexible joint that is made up of several tendons, ligaments, and muscles that all work together. Should pain can result from injuries, general wear and tear, and a number of inflammatory conditions.

The shoulder comprises three bones:

  • the humerus, which is the upper arm bone
  • the scapula, which is the shoulder blade
  • the clavicle, which is the collarbone

The top of the upper arm fits in to the glenoid, a round socket in the shoulder blade. A set of muscles and tendons called the rotator cuff keep the shoulder joint in place and provide mobility and stability.

In this article, we look at some common causes of shoulder pain and their treatments. We also cover when to see a doctor, diagnosis, and self-care.

Full story at Medical News Today

A link between mitochondrial damage and osteoporosis

Some risk factors for osteoporosis such as being older and female or having a family history of the condition cannot be avoided. But others can, like smoking cigarettes, consuming alcohol, taking certain medications, or being exposed to environmental pollutants. But until now researchers haven’t gained a firm picture of how these exposures link up with bone loss.

A new study led by researchers from Penn’s School of Veterinary Medicine reveals a mechanism by which these factors and osteoporosis may be linked. Damage to mitochondria—key cellular organelles and energy generators—leads to a surge in the creation of cells called osteoclasts, which are responsible for breaking down bone, the researchers report in FASEB Journal. They uncovered these effects in cells in culture as well as in an animal model.

“In a normal individual, the process of bone degradation and rebuilding proceeds in a very balanced way, but in some people they somehow produce a lot more osteoclasts, and this leads to bone loss and osteoporosis,” said Narayan Avadhani, a biochemist at Penn Vet and senior author on the work. “We show in this paper that, when mitochondrial function is affected, it not only affects energy production but also triggers a type of stress signaling that induces the overproduction of osteoclasts.”

Full story at Penn Today