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Concept: Kanye West


Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.

Concepts: Difference, Nocebo, Neck, Body, Kanye West, Flo Rida, World government, Blame It


Formation of intra-abdominal adhesions is a common consequence of abdomino-pelvic surgery, radiation therapy, and inflammatory processes. In a small but clinically significant proportion of patients, adhesive disease may develop, wherein adhesions lead to a variety of chronic symptoms such as abdominal distension, pain, nausea, and abnormal bowel movement pattern which can be daily, intermittent, or episodic. Due to the chronic and troublesome nature of these symptoms, adhesive disease may be life-altering in many patients, particularly when not recognized and appropriately addressed, as is the case not infrequently. In addition, there is a paucity of literature regarding the evaluation and management of patients with suspected abdominal adhesive disease. Therefore, in this concise review, we provide a clinically practical synopsis of the etiopathogenesis, symptoms, differential diagnosis, evaluation, and treatment of abdominal adhesive disease.

Concepts: Medicine, Cancer, Medical terms, Chemotherapy, Medical diagnosis, Bowel obstruction, Differential diagnosis, Kanye West


The fear-avoidance model describes how the belief that pain is a sign of damage leads to pain-related fear and avoidance. But other beliefs may also trigger the fear and avoidance responses described by the model. Experts have called for the next generation of fear avoidance research to explore what beliefs underlie pain-related fear and how they evolve. We have previously described damage beliefs and suffering/functional loss beliefs underlying high pain-related fear in a sample of individuals with chronic back pain. The aim of this study is to identify common and differential factors associated with the beliefs in this sample.

Concepts: Back pain, Belief, Das Model, Star Trek: The Next Generation, Next Generation, Chronic pain, Standard Model, Kanye West


Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability worldwide, largely due to pain, the primary symptom of the disease. The pain experience in knee OA in particular is well-recognized as typically transitioning from intermittent weight-bearing pain to a more persistent, chronic pain. Methods to validly assess pain in OA studies have been developed to address the complex nature of the pain experience. The etiology of pain in OA is recognized to be multifactorial, with both intra-articular and extra-articular risk factors. Nonetheless, greater insights are needed into pain mechanisms in OA to enable rational mechanism-based management of pain. Consequences of pain related to OA contribute to a substantial socioeconomic burden.

Concepts: Medicine, Epidemiology, Disease, Rheumatoid arthritis, Osteoarthritis, Knee, Joint, Kanye West


Plantar heel pain (PHP) is a common complaint, yet there are no definitive guidelines for its treatment. Acupuncture is increasingly used by podiatrists, and there is a need for evidence to validate this practice. It is acknowledged that PHP and acupuncture are both complex phenomena.

Concepts: Acupuncture, Kanye West


To describe common 10-year drinking trajectories followed by men age 50 years or older and identify risk factors for those trajectories.

Concepts: Risk, Wine, Drinking culture, Kanye West


Abstract Objective. To describe the histological features of bone tissue harvested from patients affected by jaw osteonecrosis associated with bisphoshponates (BONJ) or with radiotherapy (ORN), in undecalcified ground sections. Materials and methods. Sixteen bone tissue samples from 14 patients with BONJ and two patients with ORN were processed in order to obtain both ground, undecalcified sections and decalcified sections. The sections underwent histometric and morphometric analysis. Results. Bone tissue samples obtained from patients with BONJ or ORN of the jaws shared some histological characteristics. Common histological features included the loss of bone architecture, the absence of a proper Haversian system and proper marrow spaces, the presence of necrotic spots of non-mineralized tissue, areas of empty osteocytic lacunae next to areas of hypercellularity, the presence of resorption pits with rare osteoclast-like cells and the presence of bacteria and of an inflammatory infiltrate. A violet rib of tissue characterized by large resorption pits facing was frequently observed between the mineralized bone and the inflammatory infiltrate. Conclusions. The histological features of BONJ and ORN are similar and resemble those of osteomyelitis. Even though it is not clear whether infection is the cause or consequence of bone exposure, inflammatory cells, bacteria or their products may have a massive, direct lytic effect on bone tissue challenged by bisphosphonates.

Concepts: Inflammation, Bone, Histology, Osseous tissue, Cortical bone, Osteonecrosis of the jaw, Kanye West, Osteon


Breakthrough cancer pain (BtCP), defined as a transient exacerbation of pain that occurs in conjunction with well-controlled background pain, is a common and burdensome problem in patients with cancer.

Concepts: Immune system, Vitamin D, Medicine, Ionizing radiation, Breast cancer, The Canon of Medicine, Kanye West


Synopsis Pain-related fear is implicated in the transition from acute to chronic low back pain and the persistence of disabling low back pain, making it a key target for physiotherapy intervention. The current understanding of pain-related fear is that it is a psychopathological problem where people who catastrophise about the meaning of pain become trapped in a vicious cycle of avoidance behaviour, pain and disability, as recognised in the Fear Avoidance Model. However there is evidence that pain-related fear can also be seen as a common sense response to deal with low back pain, for example, when one is told that their back is vulnerable, degenerating or damaged. In this instance avoidance is a common sense response to protect a ‘damaged’ back. While the Fear Avoidance Model proposes that when someone first develops low back pain, the confrontation of normal activity in the absence of catastrophising leads to recovery, the pathway to recovery for individuals trapped in the fear avoidance cycle is less clear. Understanding pain-related fear from a common sense perspective enables physiotherapists to offer individuals with low back pain and high fear a pathway to recovery by altering how they make sense of their pain. Drawing on a body of published work exploring the lived experience of pain-related fear in people with low back pain, this Clinical Commentary illustrates how Leventhal’s Common Sense Model may assist Physiotherapists to understand the broader sense-making processes involved in the fear avoidance cycle and how they can be altered to facilitate fear reduction by applying strategies established in the behavioural medicine literature. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7434.

Concepts: Spinal disc herniation, Low back pain, Back pain, Pain, Acupuncture, Disability, Massage, Kanye West


We tested whether dreams can anticipate a stressful exam and how failure/success in dreams affect next-day performance. We collected information on students' dreams during the night preceding the medical school entrance exam. Demographic, academic, sleep and dream characteristics were compared to the students' grades on the exam. Of the 719 respondents to the questionnaire (of 2324 total students), 60.4% dreamt of the exam during the night preceding it. Problems with the exam appeared in 78% of dreams and primarily involved being late and forgetting answers. Reporting a dream about the exam on the pre-exam night was associated with better performance on the exam (p=.01). The frequency of dreams concerning the exam during the first term predicted proportionally higher performance on the exam (R=0.1, p=.01). These results suggest that the negative anticipation of a stressful event in dreams is common and that this episodic simulation provides a cognitive gain.

Concepts: Psychology, Educational psychology, Long-term memory, Dream, Kanye West