Affect Dysregulation and C-PTSD
One of the most important features of Complex Post Traumatic Stress Disorder (C-PTSD) is that of ‘affect dysregulation’. The meaning of this somewhat opaque sounding term is perhaps made clearer by using its synonym: emotional dysregulation. It consists of strongly felt emotions, in particular anger and fear, which seize the sufferer rendering him or her powerless to control them. These emotional outbursts can be terrifying both for the victim and anyone else present, lasting anywhere from seconds to a few hours. They are typically prompted by minor stimuli that most people would barely react to, if at all and are perplexing to others confronted with what appears to them to be an irrational, unstable and perhaps even dangerous person. More than that, however, these emotions are often no more comprehensible to the person experiencing them who will typically lack understanding of why he or she feels this way and even what he or she is feeling. The central role of affect dysregulation in C-PTSD treatment Affect dysregulation has long been recognized as a characteristic symptom of bipolar disorder. C-PTSD and bipolar have a complex relationship, which has yet to be adequately defined. Some have gone so far as to suggest that C-PTSD is a replacement diagnosis for bipolar disorder, whereas others view them as separate problems, but with high comorbidity. What it is important to understand is that affect dysregulation plays a different and more crucial role in the way we...
Adequately treating pain and nausea following uterine artery embolization (UAE) is a continuing challenge. Superior hypogastric nerve block (SHNB) is a successful adjunct technique for decreasing pain after embolization. This letter discusses safety measures for administration of SHNB during UAE using radial artery access, including avoiding inadvertent intravascular injection, choosing the optimal anesthetic, and treating local anesthetic systemic toxicity.
A 27-year-old competitive runner presented with deep right thigh pain for 1 year. A T2-weighted hyperintense 3-cm lesion was found in the right vastus lateralis muscle on magnetic resonance imaging, indicative of a ganglion cyst (Fig 1). Corresponding ultrasound showed a well-defined, hypoechoic lesion confirming the diagnosis of ganglion cyst. This location is rare for g anglion cyst, and such lesions have been treated only by surgical excision. Ultrasound-guided aspiration and sclerosis with sodium tetradecyl sulfate was performed.
We report our experience with medial cuneiform decompressive exostectomy and superficial tendon debridement in 14 cases of recalcitrant tibilalis anterior insertional pain. We reviewed 13 patients (14 feet; 12 females, 1 male; mean age 67.9 ± 7.5; range 55 to 80 years) in whom conservative treatment had failed who had undergone debridement of the insertional tibialis anterior tendon and decompressive exostectomy of the medial cuneiform.
Plantar heel pain is a common disabling condition in adults. Biomechanical factors are important in the development of plantar heel pain. Quantitative changes in rearfoot alignment in patients with plantar heel pain have not been previously investigated. From April 2016 to March 2017, 100 patients with plantar heel pain and 100 healthy individuals were recruited. The foot posture index was used for the measurement of foot alignment. The generalized joint hypermobility condition was assessed using the Beighton scale.
PMID: 29672384 [PubMed - in process]
PMID: 29672377 [PubMed - in process]
Authors: Santonocito C, Noto A, Crimi C, Sanfilippo F Abstract The use of remifentanil in clinical practice offers several advantages and it is used for a wide range of procedures, ranging from day-surgery anesthesia to more complex procedures. Nonetheless, remifentanil has been consistently linked with development of opioid-induced hyperalgesia (OIH), which is described as a paradoxical increase in sensitivity to painful stimuli that develops after exposure to opioid treatment. The development of OIH may cause several issues, delaying recovery after surgery and preventing timely patient's discharge. Moreover, it c...
This may seem a little basic, but I’m a resident and am curious how most people dose their opioids. I generally don’t give any long acting opioids for cases without significant post op pain. For cases where they’ll need post op analgesia, I usually dose some long acting opioids at the start of GA because I think it lets me use less fentanyl and smoothes out the hemodynamics. So long as it’s a modest dose, I haven’t had anyone yet that fails to breath by the end of the surgery. Do others do... Opioid dosing under GA
ecker S Abstract Placebo and nocebo effects are intriguing phenomena in pain perception with important implications for clinical research and practice because they can alleviate or increase pain. According to current theoretical accounts, these effects can be shaped by verbal suggestions, social observational learning, and classical conditioning and are necessarily mediated by explicit expectation. In this review, we focus on the contribution of conditioning in the induction of placebo hypoalgesia and nocebo hyperalgesia and present accumulating evidence that conditioning independent from explicit expectation can ...
CONCLUSIONS: Our results may provide more deep insight into the mechanism and a promising therapeutic target. The next step is to put our emphasis on an experiment level and to verify the novel genes from 13 hub genes. PMID: 29672183 [PubMed - as supplied by publisher]