The role of calcifediol in the perception of chronic pain is a widely discussed subject. Low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome (FMS). We lack evidence of the role of vitamin D supplementation in these patients. To our knowledge, no randomized controlled trial has been published on the subject. Thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria, with serum calcifediol levels <32ng/mL (80nmol/L), were randomized to treatment group (TG) or control group (CG). The goal was to achieve serum calcifediol levels between 32 and 48ng/mL for 20weeks via oral supplementation with cholecalciferol. The CG received placebo medication. Re-evaluation was performed in both groups after a further 24weeks without cholecalciferol supplementation. The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain (visual analog scale score). Additional variables were evaluated using the Short Form Health Survey 36, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and the Somatization subscale of Symptom Checklist-90-Revised. A marked reduction in pain was noted over the treatment period in TG: a 2 (groups)×4 (time points) variance analysis showed a significant group effect in visual analog scale scores. This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36. Optimization of calcifediol levels in FMS had a positive effect on the perception of pain. This economical therapy with a low side effect profile may well be considered in patients with FMS. However, further studies with larger patient numbers are needed to prove the hypothesis.

SummaryBackgroundSevere pain and chronic pain have a high impact on individuals and society. Body location of pain is important with regard to perception, articulation, and underlying biological, mental or social causes of pain.MethodsA cross-sectional survey was performed in the general Austrian population with 15,474 personally interviewed subjects aged 15 years and older.ResultsThe 1‑year period prevalence of severe pain in any body site was 38.6% and of chronic pain 24.9%. In all, 8.1% had pain in at least three body sites. Subjects aged 65 years and older (52.2%), those with low education (43.4%), unemployed subjects (50.4%), retired subjects (52.4%), those with anxiety/depression (67.7%), and subjects with lack of social support (49.6%) were sub-populations with high pain prevalence. In multivariate analyses, depression/anxiety was associated with prevalence and chronicity of severe pain in all body sites (range of ORs 1.89–5.01), while such associations were found for lack of social support (range of ORs 1.33–1.65), female sex (range of ORs 1.38–2.34), higher age (range of ORs 1.09–1.18 for 5 year intervals), as well as low educational (range of ORs 1.47–2.06 primary vs. tertiary education) and unemployment status (range of ORs 1.50–2.62) in most body sites. Being born in non-EU or EFTA states was associated with pain in many body sites (range of ORs 1.38–2.10).ConclusionsPsychosocial factors are associated with pain presence in similar ways irrespective of location. Regarding socio-demographic factors, differences towards the magnitude and the direction in the association with pain frequency and chronicity in different body sites emerged.

Einleitung: Mit dieser prospektiven randomisierten kontrollierten Studie wurde untersucht, ob die Anwendung der harmonischen Schwingungen einer Quarzschalenbehandlung einen positiven Effekt auf Schmerzempfinden, subjektives Wohlbefinden und chronobiologische Vorgänge (Schlafqualität) bei Patienten mit chronischen unspezifischen Wirbelsäulenschmerzen hat. Patienten und Methoden: 54 Personen mit chronischen unspezifischen Wirbelsäulenschmerzen wurden untersucht. Die Interventionsgruppe (IG) erhielt eine Klangschalenbehandlung mit je 6 Therapieeinheiten, die Kontrollgruppe (KG) erhielt eine Scheinbehandlung, bei der Nullgruppe (NG) wurde keine Intervention durchgeführt. Schmerzintensität, Aktivitätseinschränkung und Lebenszufriedenheit wurden vor und 1 Woche nach der Intervention, Pulsfrequenz und Hautleitwert während 3 Behandlungen gemessen. Viermal wurde eine Messung der Herzfrequenzvariabilität durchgeführt. Vor und nach jeder Therapiesitzung wurde der Mehrdimensionale Befindlichkeitsfragebogen (MDBF) ausgefüllt. Ergebnisse: Hinsichtlich der Schmerzintensität kam es zu einem signifikanten Gruppenunterschied nach 6 Wochen. Sowohl bei der IG, als auch bei der KG zeigten sich signifikant geringere Schmerzintensitäten als bei der NG. Bei der NG kam es hingegen zu einem Anstieg der Schmerzintensität. Die Ergebnisse des MDBF sprechen für eine unspezifisch entspannende Wirkung der Behandlung bei IG und KG. Zu 2 Zeitpunkten zeigte sich ein signifikanter Abfall des Pulses während der Therapie. Schlussfolgerung: Unter den gewählten Bedingungen konnte die Hypothese nicht bestätigt werden, dass es durch die Quarzschalenbehandlung im Vergleich zu einer Placebobehandlung zu einer Linderung von chronischen Wirbelsäulenbeschwerden oder zu anhaltenden chronobiologischen Veränderungen kommt.

Direct anterior cruciate ligament (ACL) repair has been described with different suture techniques after acute ACL injury, but these procedures showed high failure rates. Recent studies, however, led to a better understanding of the biology of primary ACL healing. This article describes a novel technique combining the “healing response technique” with primary anatomic double-bundle ACL reinsertion after an acute proximal ACL tear using nonabsorbable No. 2 FiberWire (Arthrex, Naples, FL) and PushLock knotless suture anchors (Arthrex). We recommend this technique for patients with acute proximal avulsion–type ACL injuries. Postoperatively, we recommend a knee brace locked in full extension for at least 4 weeks to ensure adequate immobilization and then to increase knee flexion slowly over the next 4 weeks for subsequent healing of the ACL repair. Our technique combines anatomic positioning and reinsertion of the ACL bundles with microfracturing of the region delivering stem cells and growth factors to the repaired ACL, creating optimal conditions for the healing period. In certain cases this technique might be an alternative to conventional ACL reconstruction with autograft or allograft tendons.

Patients with CLBP and WMP should be examined for indicated physical and psychosocial factors. Therapeutic management should consider them in the early stage of the disease. These findings also might apply to patients with fibromyalgia or myofascial pain.

A sustainable and favourable effect on health promotion could be achieved most notably by motivating people to add more physical activity to their everyday life.

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