Marc's Musings | May 2015


Effect of Written Emotional Disclosure on Secondary Hyperalgesia in Women with Trauma History; You, D.S. et al. Psychosomatic Medicine 2014 June Vol 776, No 5 pp 337-46.

This study looked at 78 females with a history of trauma and they were randomised to a written emotional disclosure or a controlled writing condition and tested on one day or one month after disclosure. Their pain testing consisted of Capsaicin applied to the forearm to produce local pain and a secondary hyperalgesia in the surrounding untreated skin. In the written disclosure group, secondary hyperalgesia was reduced at one month, compared to one day after writing. Greater use of positive emotional words predicted reduced secondary hyperalgesia at one month. The conclusions the authors drew from this study was that written emotional disclosure in women with a trauma history produces long term reduction of secondary hyperalgesia and may be a therapeutic endeavour that may be helpful for these patients.

Risk Factors for Serious Underlying Pathology in Adult Emergency Department Non-Traumatic Low Back Pain Patients. Thiruganasambamdamoorthy, V et al. Journal of Emergency Medicine 2014 July Vol 47, No 1. Pp 1 – 11.

This study looked at 329 patients presenting over a 14 month period to an academic emergency department with non-traumatic low back pain and evaluated 56 predictor variables and outcomes within 30 days. The mean age of the patients was 49 years, with 51% females, 49% males. 6.7% suffered adverse outcomes or were diagnosed with a serious underlying medical or surgical condition (one death, five compression fractures, four malignancies, four disc prolapses requiring surgery, two retro-peritoneal bleeds, two cases of osteomyelitis and one case each of epidural abscess, cauda equina syndrome and leaking abdominal aortic aneurism graft).

Four factors predicted adverse outcome. These were: anticoagulant use – odds ratio 16; decreased sensation on physical examination – odds ratio 7; pain that is worse at night – odds ratio 4; and, pain that persists despite appropriate treatment – odds ratio 2. These four predictors identified serious pathology with a 91% sensitivity and 55% specificity.

Comment: Although these four risk factors should now be identified in a prospective study, it is reasonable to use these factors, if they are present, for more detailed investigation and observation of a patient in the Emergency Department to look for a serious underlying organic illness (so-called “red flags”).

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