Although chronic back pain is one of the most frequent reasons for permanent impairment in people under 65, the neurobiological mechanisms of chronification remain vague. Evidence suggests that cortical reorganisation, so-called functional plasticity, may play a role in chronic back pain patients. In the search for the structural counterpart of such functional changes in the CNS, we examined 18 patients suffering from chronic back pain with voxel-based morphometry and compared them to 18 sex and age matched healthy controls. We found a significant decrease of gray matter in the brainstem and the somatosensory cortex. Correlation analysis of pain unpleasantness and the intensity of pain on the day of scanning revealed a strong negative correlation (i.e. a decrease in gray matter with increasing unpleasantness/increasing intensity of pain) in these areas. Additionally, we found a significant increase in gray matter bilaterally in the basal ganglia and the left thalamus. These data support the hypothesis that ongoing nociception is associated with cortical and subcortical reorganisation on a structural level, which may play an important role in the process of the chronification of pain.

The level of inactivation by a 50-Gy dose far exceeds that needed to inactivate the number of proliferating tumor cells observed or expected in wound blood. These results provide the experimental basis for the clinical application of blood irradiation for intraoperative blood salvage in cancer surgery.

Although gender differences in pain and analgesia are well known, it still remains unclear whether men and women vary in response to multimodal pain treatment. This study was conducted to investigate whether men and women exhibited different outcomes after an intensive multimodal pain treatment program. The daily outpatient program consisted of individual treatment as well as group therapy, with a total amount of therapy of 117.5h per patient. Overall, 496 patients (254 women) completed the multimodal program. Pretreatment parameters for pain, disability due to pain, pain duration, and pain chronicity stage, as well as age or psychiatric comorbidities, did not differ between genders. The average pain, measured with a Numeric Rating Scale, decreased after treatment of -1.54 (±1.96) with a large effect size (ES) of .911 for the total sample. However, there were considerable differences in the benefit for women (-1.83±2.12; ES 1.045) compared with men (-1.23±1.74; ES .758). Consistently, women (ES .694) improved more in pain-related disabilities in daily life than men (ES .436). These distinctions are not due to differences in pain duration, received medication, psychiatric comorbidities, pain chronicity stage, or application for a disability pension. Therefore, gender differences not only refer to chronic pain prevalence, pain perception, or experimental pain measurement, but also seem to have a clinically relevant impact on the response to pain therapy.

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A proposal of an expert group is reported that was put forward to facilitate the set-up of a system for quality management in intra- and postoperative blood salvage. Retransfusion of unwashed blood is excluded since it cannot meet quality criteria of modern transfusion medicine. Quality assurance is necessary to guarantee the high quality of autologous blood prepared during blood salvage with cell washing. It includes a profound understanding of the composition of shed blood and the preparation process, a thorough documentation, and the measurement of quality control parameters. Process quality can be assessed in regular samples by evaluation of red blood cell recovery (>80%) and plasma wash-out efficiency (>90%). Microbiology testing of this unstored blood is not recommended in sterile procedures for lack of consequence. Product quality should be monitored by volume and hematocrit (>50%) during every application.