Eleven genome types of adenovirus serotype 11 (Adll) were identified among 20 strains isolated from healthy pregnant women and patients with urinary tract infections, respiratory tract infections, or pharyngoconjuctival fever by use of 13 restriction endonuc-leases: BamHl, Bell, BglI, BglII, BstEII, EcoRl, Hindlll, Hpal, Pstl, SalI, Smal, Xbal, and Xhol. All genome types could be grouped into three genomic clusters according to their genetic homology expressed as pairwise comigrating restriction fragments. The genome types within a genomic cluster were very closely related. They shared on an average pairwise comigrating restriction fragments of 91.6–97.7%. The Adll strains of genomic clusters 1 and 3 were isolated from urine, whereas all the Ad11 strains isolated from the respiratory tract were identified as members of the genomic cluster 2. One genome type of Ad34 and one genome type of Ad35 were identified from a hemorrhagic cystitis patient and an organ transplant recipient, respectively. Both were closely related to Adll. The genome type of Ad35 could be located in the Ad11 genomic cluster 1.

Our results suggest that radiofrequency denervation of thoracic zygapophyseal joint pain is as effective as radiofrequency denervation, the standard treatment, for lumbar and cervical zygapophyseal joint pain. If these results can be confirmed by other centers, radiofrequency denervation is likely to become more widely available for the treatment of thoracic zygapophyseal joint pain.

Introduction Patients exposed to whiplash trauma are at risk of developing pain and dysfunction of the neck and shoulder. Although rarely discussed in the literature, some patients also develop autonomic dysfunction. Case presentation A previously healthy 41-year-old woman was involved in a "head-on" car crash. During the following 3 years she developed severe and complex post-traumatic pain syndrome, which consisted of neck pain, lumbar pain, sensory-motor dysfunction, and myoclonic muscular contractions. Despite pharmacotherapy, physiotherapy, and rehabilitation, her condition worsened, resulting in severe disability. Fourteen years after the car crash, an interventional pain therapy program was started, which consisted of sympathetic ganglion impar block and medial branch blocks of facet joints at different levels. These treatment strategies ultimately normalized her sensory-motor dysfunction, reduced her autonomic dysfunction, and stopped the myoclonic muscular contractions. Conclusion This case highlights a possible interaction between the pain-generating facet joints, the somatosensory nervous system, and the autonomic/sympathetic nervous systems. The case also highlights the importance of identifying autonomic dysfunction in patients with persisting pain syndromes. Implications This complex case shows that many clinical phenomena cannot be explained using our present knowledge of pain mechanisms. We hope that readers who have observed similar cases can learn from our case, and are encouraged to publish their observations.

Background: Chronic pain is a widespread problem that is usually approached by focusing on its psychological aspects or on trying to reduce the pain from the pain generator. Patients report that they feel responsible for their pain and that they are disempowered and stigmatized because of it. Here, we explored interventional pain management from the patient's perspective to understand the process better. Methods: A purposive sample of 19 subjects was interviewed by an independent interviewer. The interviews were transcribed into text and thematic analysis was performed. Results: The subjects' perceptions covered three key themes: themselves as objects; the caregivers, including the process of tests and retests, the encounters and interactions with professionals, and the availability of the caregivers; and finally the outcomes, including the results of the tests and treatments and how these inspired them to think of other people with pain. Linking these themes, the subjects reported something best described as "gained empowerment" during interventional pain management; they were feeling heard and seen, they gained knowledge that helped them understand their problem better, they could ask questions and receive answers, and they felt safe and listened to. Conclusions: Many of the themes evolved in relation to the subjects' contact with the healthcare services they received, but when the themes were merged and structured into the model, a cohesive pattern of empowerment appeared. If empowerment is a major factor in the positive effects of interventional pain management, it is important to facilitate and not hinder empowerment. Trial registration: Clinicaltrials.gov 2013-04-24 (Protocol ID SE-Dnr-2012-446-31 M-3, ClinicalTrials ID NCT01838603).

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