Dominic Harmon

Do patients with chronic low back pain have an altered level and/or pattern of physical activity compared to healthy individuals? A systematic review of the literature.

BACKGROUNDnIt is commonly assumed that patients with chronic low back pain are less active than healthy individuals. There has been a recent increase in the number of studies published comparing the physical activity levels of patients with chronic low back pain and healthy individuals.nnnOBJECTIVESnThe aim of this systematic review was to determine, based on the current body of evidence, if patients with chronic low back pain have a lower level and/or altered pattern of physical activity compared with asymptomatic, healthy individuals.nnnDATA SOURCESnThe electronic databases Embase, Medline, ISI Web of Knowledge, Cinahl, Sport Discus and Nursing and Allied Health were searched from the beginning of each database until the end of December 2009.nnnREVIEW METHODSnStudies which compared the level and/or pattern of physical activity of patients with chronic low back pain and healthy controls were included. The quality of the included studies was assessed using an assessment tool based on the Newcastle-Ottawa Scale. The scale was modified for the purposes of this study.nnnRESULTSnSeven studies were included in the final review. Four studies recruited adult patients (18-65 years), two studies examined older adults (≥65 years) and one study recruited adolescents (<18 years). Pooled data revealed no significant difference in the overall activity level of adults or adolescents with CLBP, however there is evidence that older adults with chronic low back pain are less active than controls. The results suggest that patients exhibit an altered pattern of physical activity over the course of a day compared to controls. Major methodological limitations were identified and are discussed.nnnCONCLUSIONnThere is no conclusive evidence that patients with chronic low back pain are less active than healthy individuals. Based on a limited number of studies, there is some evidence that the distribution of activities over the course of a day is different between patients with chronic low back pain and controls.

Constructing the experience of chronic pain through discourse.

Abstract The aim of this study was to investigate the discourses used by people with chronic pain. Using qualitative interview data from five Irish people with a variety of chronic pain conditions, Foucauldian discourse analysis was undertaken to identify the discourses in operation in participants accounts. Three discourses were identified: a moral discourse, a discourse of pain as personal tragedy, and a biomedical discourse. A moral discourse was used to construct participants as moral individuals experiencing real pain who try to accomplish activities and fulfil social roles without burdening others. The discourse of chronic pain as personal tragedy describes the multiple negative consequences of chronic pain including activity, relationship, physical, financial, and emotional consequences, and changed expectations of the future. This discourse bolsters the moral discourse through rejecting any benefits associated with chronic pain. Participants rejected a biomedical discourse by proposing their own explanatory models of pain, resisting psychosocial understandings of pain, criticizing medical professionals and healthcare services, and challenging medical expertise, professionalism, and power. These practices allow participants to reject the patient subject-position with its attendant passivity and requirements for adherence and compliance.

Happiness: A Review of Evidence Relevant to Occupational Science

Occupational scientists must synthesise and apply knowledge generated within related disciplines to ensure the continued development of the discipline. This paper reviews the evidence available to occupational scientists on human happiness. This body of knowledge can be utilised by occupational scientists to better understand the subjective experience of occupational engagement. Two key philosophical traditions in happiness studies, hedonism and eudaimonia, are presented and theories of human happiness, including set-point theory, are described. A number of thematic areas of research on human happiness are reviewed. The relationships between happiness and health, living situation, personal goals, work, volunteering, flow, religiosity and relationships are reviewed. The reviewed studies underscore the centrality of occupation to current understandings of human happiness.

Review of occupational therapy for people with chronic pain.

BACKGROUND/AIMnChronic pain is a significant health-care problem. This review aims to critically analyse occupational therapy services for people with chronic pain and identify significant factors influencing the future development of occupational therapy services for people with chronic pain.nnnMETHODSnA broad range of literature is reviewed and analysed using causal layered analysis, a post-structural critical futures methodology. This layered analysis moves through four layers of analysis; the litany layer, the social causes layer, the worldview analysis layer and the grand myth and metaphor layer.nnnRESULTSnThis layered analysis revealed three significant factors shaping the future development of occupational therapy services for people with chronic pain: the influence of the biopsycho-social model within health-care services for people with chronic pain, occupational therapy philosophy and the social construction of people with chronic pain. Recommendations for future research and practice derived from this analysis include the need to research the effectiveness of occupation-based interventions for people with chronic pain, the significance of client-centred occupational therapy and valuing of clients narratives to avoid pervasive negative social constructions of people with chronic pain influencing occupational therapy practice.nnnCONCLUSIONSnThis critical analysis has made occupational therapy services for people with chronic pain problematic in order to generate reflection, discussion and new insights. This analysis deconstructs contemporary occupational therapy philosophy and practice and therefore provides a new perspective on occupational therapy for people with chronic pain.

A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision.

Study Type – Aetiology (case series)u2028Level of Evidenceu20034

The Flow Experiences of People with Chronic Pain

This electronic momentary assessment study explored the relationship between flow and pain intensity and examined whether flow is an optimal experience for people with chronic pain. Adults with chronic pain (n = 30) were signaled randomly seven times daily during 1 week to respond to a flow questionnaire via personal digital assistant. The participants responded to 718 questionnaires from 1,447 beeps (response rate = 49.6%). Results indicated that participants were most commonly at home, doing self-care activities, with family or alone. Participants experienced flow 34.9%, apathy 44.6%, relaxation 11.6%, and anxiety 8.9% of the sampled time. Participants mean concentration, self-esteem, motivation, and potency scores were highest in flow compared to the other three states. Separate one-way between-groups analyses of variance comparing concentration (F(3) = 11.85; p < .001), self-esteem (F(3) = 11.98; p < .001), motivation (F(3) = 29.29; p < .001), positive affect (F(3) = 2.89; p = .035), potency (F(3) = 19.88; p < .001), and pain intensity (F(3) = 1.39; p = .245) scores across the four states showed a significant overall effect on all comparisons except pain intensity and positive affect.

Study of the anatomical position of the femoral nerve by magnetic resonance imaging in patients with fractured neck of femur: relevance to femoral nerve block

STUDY OBJECTIVEnTo determine the anatomical location of the femoral nerve in patients who have sustained fracture of the neck of femur, and its relevance to femoral nerve block technique.nnnDESIGNnProspective, observational clinical study.nnnSETTINGnOrthopedic and Radiology departments of a regional hospital.nnnSUBJECTSn10 consecutive adult ASA physical status II and III patients (mean age, 78.5 yrs) and 4 adult healthy volunteers.nnnINTERVENTIONSnA T1 magnetic resonance imaging scan was performed of both upper thighs in patients and healthy volunteers successfully.nnnMEASUREMENTSnThe distance (mm) between the midpoint of the femoral artery and the midpoint of the femoral nerve, and the distance of the femoral nerve from the skin was measured at the mid-inguinal ligament, the pubic tubercle, and at the mid-inguinal crease. Data are shown as means (SD). Differences between both sides were compared using paired Students t-tests. P < 0.05 was significant.nnnMAIN RESULTSnIn patients the mean distance (mm) between the midpoint of the femoral nerve from the midpoint of femoral artery at the mid-inguinal crease on the fractured and non-fractured sides was 10.7 and 11.0, respectively (P = 0.87). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the mid-inguinal ligament on the fractured and non-fractured sides was 9.64 and 12.5, respectively (P = 0.03). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the pubic tubercle on the fractured and non-fractured sides was 8.74 and 10.49, respectively (P = 0.18).nnnCONCLUSIONSnBlockade of the femoral nerve may be easier to perform at the mid-inguinal crease in patients with fractured neck of femur.

A cadaveric study of injectate spread in the psoas compartment with a direct iliopsoas injection suggested for use during surgery.

Total hip replacement produces significant postoperative pain. Psoas compartment block is the most effective block of the lumbar plexus in terms of pain relief and reduced blood loss. It is a proven regional technique for analgesia and anaesthesia during and after total hip replacement conferring a number of benefits to the patient. However, traditional techniques used to produce this block require increased theatre time and are associated with a number of serious complications. We present a surgeon‐delivered technique for producing a lumbar plexus block using direct injection into the iliopsoas muscle when it is visible intraoperatively. This study shows a cadaveric model using methylene blue and radiopaque contrast produces injectate spread in a fashion which would produce a successful lumbar plexus block. This novel technique for lumbar plexus block affords the benefits of psoas compartment block with reduced complications and reduced administration time. Clin. Anat. 24:763–767, 2011.