With a growing number of people living with pain, we desperately need to understand it – but we are still unravelling the mysterious mechanisms behind the phenomenon
Chronic pain affects about 40% of the UK population. While there is growing recognition that pain can be an illness in and of itself, there is still a lot we don’t know.
Anand Jagatia hears from fibromyalgia sufferer Vicky Naylor on what it’s like to live with chronic pain, and the Guardian’s science correspondent Linda Geddes about the causes for these sometimes debilitating conditions.
Exercise training is a safe, effective and low-cost intervention for improving walking ability in patients with IC. Additional benefits may include improvements in QoL, muscle strength and cardiorespiratory fitness. Clinical guidelines advocate supervised exercise training as a primary therapy for IC, with walking as the primary modality.
However, evidence is emerging for the role of various other modes of exercise including cycling and progressive resistance training to supplement walking training. In addition, there is emerging evidence for home-based exercise programmes. Revascularisation or drug treatment options should only be considered in patients if exercise training provides insufficient symptomatic relief.
Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or ‘self-facilitated’ exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.
The Johns Hopkins Musculoskeletal Center aims to streamline and improve access for diagnosis and treatment of conditions affecting muscles, bones and connective tissues. Each of the center’s locations feature a diverse group of physicians, therapists, and advanced practitioners who work together to bring you the right treatment at the right time.
This week’s Nature podcast looks at how skin’s unusual response to stretching is finally explained, a coronavirus update and the latest in a huge effort to map DNA.
In this episode:
01:06 Stretching skin
For decades it’s been known that stretching skin causes more skin to grow, but the reasons why have been a mystery. Now, researchers have uncovered a mechanism to explain the phenomenon. Research Article: Aragona et al.; News and Views: Stretch exercises for stem cells expand the skin
07:49 Coronapod
We discuss how the coronavirus pandemic has affected scientific meetings and how the learned societies that organise them are adapting. How scientific conferences will survive the coronavirus shock; How scientific societies are weathering the pandemic’s financial storm;
A year without conferences? How the coronavirus pandemic could change research
18:18 Research Highlights
A genetic trait for pain-resistance, and the accessibility-aware ancient Greeks. Research Highlight: A gene helps women in labour to skip the painkillers; Research Highlight: This temple was equipped with accessibility ramps more than 2,000 years ago
20:42 ENCODE updates
The ENCODE project aims to identify all the regions in the human genome involved in gene regulation. This week, data from its third iteration has been published and we examine the highlights. Research Article: Snyder; News and Views: Expanded ENCODE delivers invaluable genomic encyclopaedia
28:50 Briefing Chat
We take a look at some highlights from the Nature Briefing. This time we look at how smallpox may be much older than previously thought, and how the Earth’s atmosphere rings like a bell. Nature News: Smallpox and other viruses plagued humans much earlier than suspected; Physics World:
Tension-type headaches can be either episodic or chronic. They are rarely disabling or associated with any significant autonomic phenomena, thus patients do not usually seek medical care and usually successfully self-treat. Unlike migraine, there is no significant nausea, no vomiting, and a lack of aggravation by routine physical activity.
In this podcast Mark Green, Professor of Neurology, Anesthesiology and Rehabilitation Medicine, Director of Headache and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, gives a clinical overview of the condition.
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