Rejected

There is theoretical and empirical evidence that persistent pain occurs because of a distortion in top-down perceptual processes. 'Jumping to conclusions' (JTC) tasks, such as the beads task, purportedly capture these processes and have yet to be studied in people with chronic pain. However, the beads task uses visual stimuli, whereas tasks involving processing in the somatosensory domain seem at least more face valid in this population. This study uses a novel somatosensory adaptation of the beads task to explore whether a JTC reasoning style is more common in people with persistent pain compared controls.

While multisession dose fractionated gamma knife radiosurgery (DF GKS) is common, its use has never been described for jugular paragangliomas (JP), which are notoriously difficult to treat.

Dysmenorrhea is a recurrent and chronic primary health care issue. Mefenamic acid and NSAID based therapy regimens have unwanted side effects on its long-term usage. NSAIDs reduce pain, albeit they do not address the enhanced pain sensitivity and other neuronal symptoms of dysmenorrhea. Hence, there is a need for supportive therapy which can target both pelvic pain and the neuronal symptoms. Historically, European medicinal plants and their extracts such as, valeriana officinalis, humulus lupulus, and passiflora incarnata have been used in menstrual disorders for centuries. The current review is focused on the available evidence for its use as monotherapy or as supportive therapy in combination with other conventional medications.

Pain physicians have long been seen as subspecialists that commonly prescribe opioid medications, but the reality exists that primary care, oncologists, and surgical subspecialists find themselves embroiled in these clinical decisions just as frequently. It is a reasonable hope that pain physicians emerge as leaders in navigating these muddy waters, and the most important time to engrave practice standards is during clinical training.

Sometimes it is difficult to diagnose temporal arteritis because the complaints may vary, change in intensity and are not always characteristic. The condition is a cranial form of giant-cell arteritis affecting large and medium-sized arteries. The first manifestation of temporal arteritis can be a sore tongue that does not manifest any abnormalities during a clinical investigation. In a later stage patients sometimes develop ulceration or necrosis of a part of one side of the tongue. Other symptoms can be a recently developed headache, jaw claudication and acute loss of vision. To diagnose temporal arteritis, histological investigation of a biopsy of the temporal artery is carried out. The treatment consists of long-term use of corticosteroids. A patient in your practice with inexplicable pain on one side of the tongue, without clinical abnormalities, or an ulceration of the tongue without an immediately apparent cause may have temporal arteritis.

The authors report an unusual case of an odontoid synchondrosis fracture causing chronic translational anterior atlanto-axial subluxation and present a discussion of the unique management of this case. Traumatic translational anterior atlanto-axial subluxation is a rare manifestation within pediatrics. Patients with preexisting abnormalities in ligamentous or bony structures may present with unusual symptomatology, which could result in delay of treatment. A 6-year-old male patient with autism who presented with acute respiratory arrest was noted to have an odontoid synchondrosis fracture and severe anterior translational atlanto-axial subluxation. Initial attempts at reduction with halo traction were tried for first-line treatment. However, because of concern regarding possible inadvertent worsening of the impingement, the presence of comorbid macrocephaly, and possible instability with only C1-2 fusion, a posterior C1 laminectomy was performed. Further release of the C1-2 complex and odontoid peg from extensive fibrous tissue allowed for complete reduction. Acute injuries of the C1-2 complex may not present as expected, and the presence of pain is not a reliable symptom. Halo traction is an appropriate initial treatment, but some patients may require surgical realignment and stabilization.

Ekbom syndrome is a rare disease characterized by a delusional conviction on the part of the patient of infestation with cutaneous parasites. It is rarely described in an African setting. Herein we report three cases observed in Ouagadougou.

To describe a case series of young adult patients with isolated chronic proximal biceps tendinitis refractory to conservative care found to have anatomic long head biceps tendon (LHBT) origin variations who underwent arthroscopic-assisted subpectoral biceps tenodesis.

Aniseikonia is a difference in the perceived size or shape of images between eyes, and can arise from a variety of physiological, neurological, retinal, and optical causes. Aniseikonia is associated with anisometropia, as both anisometropia itself and the optical correction for anisometropia can cause aniseikonia. Image size differences above one to three per cent can be clinically symptomatic. Common symptoms include asthenopia, headache and diplopia in vertical gaze. Size differences of three and more impair binocular visual functions such as binocular summation and stereopsis. Above five per cent of aniseikonia, binocular inhibition or suppression tend to occur to prevent diplopia and confusion. Aniseikonia can be measured using a range of techniques and can be corrected or reduced by prescribing contact lenses or specially designed spectacle lenses. Subjective testing of aniseikonia is the only way to accurately measure the overall perceived amount of aniseikonia. However, currently it is not routinely assessed in most clinical settings. At least two-thirds of patients with amblyopia have anisometropia, thus we may expect aniseikonia to be common in patients with anisometropic amblyopia. However, aniseikonia may not be experienced by the patient under normal binocular viewing conditions if the image from the amblyopic eye is of poor quality or is too strongly suppressed for image size differences to be recognised. This lack of binocular simultaneous perception in amblyopia may also prevent the measurement of aniseikonia, as most common techniques require direct comparisons of images seen by each eye. Current guidelines for the treatment of amblyopia advocate full correction of anisometropia to equalise image clarity, but do not address aniseikonia. Significant image size differences between eyes may lead to suppression and abnormal binocular adaptations. It is possible that correcting anisometropia and aniseikonia simultaneously, particularly at the initial diagnosis of anisometropia, would reduce the need to develop suppression and improve treatment outcomes for anisometropic amblyopia.