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Background: Severe pain and chronic pain have a high impact on individuals and society. Body location of pain is important with regard to perception, articulation, and underlying biological, mental or social causes of pain., Methods: A cross-sectional survey was performed in the general Austrian population with 15,474 personally interviewed subjects aged 15 years and older., Results: The 1‑year period prevalence of severe pain in any body site was 38.6% and of chronic pain 24.9%. In all, 8.1% had pain in at least three body sites. Subjects aged 65 years and older (52.2%), those with low education (43.4%), unemployed subjects (50.4%), retired subjects (52.4%), those with anxiety/depression (67.7%), and subjects with lack of social support (49.6%) were sub-populations with high pain prevalence. In multivariate analyses, depression/anxiety was associated with prevalence and chronicity of severe pain in all body sites (range of ORs 1.89-5.01), while such associations were found for lack of social support (range of ORs 1.33-1.65), female sex (range of ORs 1.38-2.34), higher age (range of ORs 1.09-1.18 for 5 year intervals), as well as low educational (range of ORs 1.47-2.06 primary vs. tertiary education) and unemployment status (range of ORs 1.50-2.62) in most body sites. Being born in non-EU or EFTA states was associated with pain in many body sites (range of ORs 1.38-2.10)., Conclusions: Psychosocial factors are associated with pain presence in similar ways irrespective of location. Regarding socio-demographic factors, differences towards the magnitude and the direction in the association with pain frequency and chronicity in different body sites emerged.

Direct anterior cruciate ligament (ACL) repair has been described with different suture techniques after acute ACL injury, but these procedures showed high failure rates. Recent studies, however, led to a better understanding of the biology of primary ACL healing. This article describes a novel technique combining the "healing response technique" with primary anatomic double-bundle ACL reinsertion after an acute proximal ACL tear using nonabsorbable No. 2 FiberWire (Arthrex, Naples, FL) and PushLock knotless suture anchors (Arthrex). We recommend this technique for patients with acute proximal avulsion-type ACL injuries. Postoperatively, we recommend a knee brace locked in full extension for at least 4 weeks to ensure adequate immobilization and then to increase knee flexion slowly over the next 4 weeks for subsequent healing of the ACL repair. Our technique combines anatomic positioning and reinsertion of the ACL bundles with microfracturing of the region delivering stem cells and growth factors to the repaired ACL, creating optimal conditions for the healing period. In certain cases this technique might be an alternative to conventional ACL reconstruction with autograft or allograft tendons.

The role of calcifediol in the perception of chronic pain is a widely discussed subject. Low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome (FMS). We lack evidence of the role of vitamin D supplementation in these patients. To our knowledge, no randomized controlled trial has been published on the subject. Thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria, with serum calcifediol levels <32ng/mL (80nmol/L), were randomized to treatment group (TG) or control group (CG). The goal was to achieve serum calcifediol levels between 32 and 48ng/mL for 20weeks via oral supplementation with cholecalciferol. The CG received placebo medication. Re-evaluation was performed in both groups after a further 24weeks without cholecalciferol supplementation. The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain (visual analog scale score). Additional variables were evaluated using the Short Form Health Survey 36, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and the Somatization subscale of Symptom Checklist-90-Revised. A marked reduction in pain was noted over the treatment period in TG: a 2 (groups)×4 (time points) variance analysis showed a significant group effect in visual analog scale scores. This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36. Optimization of calcifediol levels in FMS had a positive effect on the perception of pain. This economical therapy with a low side effect profile may well be considered in patients with FMS. However, further studies with larger patient numbers are needed to prove the hypothesis., (Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Background: Little is known about chronic low back pain (CLBP) in combination with widespread musculoskeletal pain (WMP)., Objective: This study examined factors that may be common to these conditions, with the objective of detecting factors that could improve the course of these diseases., Design: This was a prospective case control study., Patients and Intervention: A group of patients with CLBP and WMP (CLBP+WMP group, n=97) was compared with a group of individuals who were pain-free and without a history of musculoskeletal problems (control group, n=97) and with a group of patients with CLBP but without WMP (CLBP-only group, n=52). The mean age of the participants was 42.9 years (SD=8.74); 76% were women, and 24% were men., Measurements: A total of 74 variables were measured, including sociodemographic, physical, and psychosocial variables. After univariate examination for group differences and analyses of variables available for all 3 groups, logistic regression on selected factors was performed. The alpha level was set at .05, but was adjusted to avoid randomly significant results., Results: For a number of variables, significant differences among the 3 groups were observed. For regression model 1 for the CLBP+WMP and control groups, 4 out of 9 variables showed significant likelihood tests: income (lower in the WMP group), depression, anxiety, and fear-avoidance behavior. For regression model 2, 2 out of 13 variables showed significant likelihood tests: endurance capacity (more in the CLBP+WMP group) and balance capability (worse in the CLBP+WMP group). The models predicted at least 91.2% of all cases to the correct group. The regression analysis regarding the CLBP+WMP and CLBP-only groups predicted 86.7% of all cases to the correct group. Three out of 10 variables showed significant likelihood tests: high disability, fear-avoidance behavior, and number of treatments., Limitations: Some variables in testing the patients with WMP and the individuals who were pain-free were not used with the patients with CLBP only., Conclusions: Patients with CLBP and WMP should be examined for indicated physical and psychosocial factors. Therapeutic management should consider them in the early stage of the disease. These findings also might apply to patients with fibromyalgia or myofascial pain.

Introduction: Physical activity has high importance in the prevention of diseases, particularly where lifestyle diseases are concerned. To motivate a person to be physically active often proves to be difficult in clinical practice. Thus it was the aim of this study to find out through interviews how to best motivate most notably the part of the population that is less active., Methods: 500 persons aged from 15 years onwards were asked in face-to-face interviews about their leisure activities, self-assessment of their personal fitness, and about inhibiting and motivating factors in connection with their physical activity., Results: Only every second interviewed person is intentionally active in order to improve his/her own fitness. The better part of the inactive population can envisage introducing more physical activity into their everyday life. There are various reasons that instigate to be more active: above all, the recommendation of doctors, but also the wish for physical wellbeing or group dynamics act as a stimulant. Would there be an advertising campaign promoting the importance of physical activity, top athletes and physicians would have the most motivating impact., Conclusion: A sustainable and favourable effect on health promotion could be achieved most notably by motivating people to add more physical activity to their everyday life.

Introduction: This prospective randomized controlled trial examined the effect of harmonic vibrations of crystal singing bowls on the perception of pain, subjective wellbeing and chronobiologic activities (quality of sleep) in patients with chronic unspecific spinal pain., Subjects and Methods: 54 persons with chronic, unspecific spinal pain participated in the study. The treatment group (IG) received 6 units of a singing bowl therapy, the placebo group (KG) received a placebo treatment. The control group (NG) was not treated at all. Pain intensity, pain disability and quality of life were evaluated right before and 1 week after the intervention, pulse rate and skin conductance were measured during 3 therapeutic sessions. A 24-hour measurement of the heart rate variability to evaluate quality of sleep was made four times. Before and after each session the Multidimensional Mood State Questionnaire (MDBF) was filled out., Results: IG and KG had significant lower pain intensities compared to the NG. The NG even experienced an increase in pain intensity. The results of the MDBF suggest an unspecific relaxing effect of the intervention in IG and KG. Twice during the treatment a significant decrease of the pulse rate could be observed., Conclusion: Under the given conditions the hypothesis of pain relief and chronobiologic changes in patients with chronic spinal pain by a treatment with crystal singing bowls compared to placebo could not be confirmed., (Copyright 2008 S. Karger AG, Basel.)

This paper gives a comparative overview of the current clinical care of patients experiencing pain in the musculoskeletal system in Austria and in Germany. The questionnaire used in this study was modified from one used in a survey carried out in Germany in 2002. In our version we asked specifically about pain in the musculoskeletal system. In all 228 health care facilities were reviewed, 56.6% of which offer at least one option for pain therapy. In Austria, the majority of patients with pain in the musculoskeletal system are treated by specialists in the departments of anaesthesiology, internal medicine, and orthopaedics. In 17.4% of the clinics in Austria there are plans to extend the pain therapy they offer, but in over half of the hospitals that responded facilities for pain therapy are considered to be vulnerable. The study highlights a significant higher percentage of in-patient pain therapy services in Austria, while in Germany, in contrast, there are more outpatient options for pain therapy. The quality of pain therapy could by further improved by more intense cooperation between the inpatient and outpatient sectors and by the establishment of interdisciplinary and multimodal solutions.

In advanced periodontal diseases, where the root surface a longer time is exposed to the oral environment, retaining of teeth is only possible through de novo-attachment of the periodontal ligament on the diseased root surface. Even when surgical reconstruction of the alveolar bone is successful, connective tissue fibers fail to attach to the affected dental cementum. Patients with two- and three wall pockets can be successfully treated by Nymans method of guided tissue regeneration. However the restoration of the dental attachment apparatus in cases with advanced horizontal destruction of the alveolar bone is still an unsolved problem of periodontal therapy. Investigations of an artificial attachment support will be presented. A synthetic felt glued onto the root surface with special dental adhesives shall obtain the necessary support reattachment of the connective tissue fibers at the periodontitis affect root.

Modifying and extending Bernard's method Fries (1971) developed a universal technique for reconstructive surgery of the lip after tumour resection. So far this technique has been employed in 80 cases, 50 of which were available for follow-up studies. Cosmetic results were invariably found to be optimal. Functional deficits were predominantly associated with whistling and pouting, while eating, speaking and laughing were unimpaired.

Using adequate number of cases, the influence of the spread of primary tumour and the degree of regional metastasis on prognosis were investigated. Assuming a practicable classification as a prerequisite for clinico-therapeutic cancer research, experience has shown that the assessment of the spread of primary tumour alone does not suffice for the establishment of comparable homogenous data. The investigation on the importance of the degree of regional metastasis has shown, above all, that the percentage of N3-metastasis within the T-groups contributes essentially to the fact that these show a marked difference in their prognosis. It would therefore appear necessary also to examine the importance of other clinically accessible data in the assessment of prognosis. Only then could we be in a position to judge whether, and to what extent a clinically practicable classification and integration into special groups is possible on the basis of clinically available data. The inclusion of more clinics in the joint investigation is encouraged.

The prognostic significance of primary tumour site in carcinomas of the oral cavity was investigated in a series of 585 cases. For the subsamples (levels and areas of oral cavity) studied, the numerical distribution of TNM categories, life tables and life table comparisons were computed. This produced the following results: Given an identical extension and analogous metastazising rate, there is no computationally demonstrable difference in prognosis between primary tumours sited at different levels and areas of the oral cavity. The exception are the T1Nx categories, for which a difference exists between precanine and retromolar sites. These results should be re-examined on the basis of a larger series.

A device for the prevention of intraoral soft tissue injuries in comatose patients with uncoordinated chewing movements is presented. Shape and material of the device, which is easily fashioned and handled, are designed to protect oral and buaccal soft tissue structures against self inflicted injuries.

The prognostic significance of so-called organ sites was investigated in 585 cases with carcinoma of the oral cavity and lips. For the subsamples studied the numerical distribution of TNM categories, life tables and life table comparisons were computed. This produced the following results: 1. There is no demonstrable difference in prognosis between identical T catagories in the organs of the oral cavity. 2. In some cases there is a significant difference between identical N categories in organs of the oral cavity. In the No category this is, however, attributable to the substantial differences in the numerical distribution of T categories. By contrast, a logical explanation for the computationally demonstrable significant differences in the Nx category is not available. The problem is currently being investigated. 3. An assessment of identical TN combinations in the "organs" of the oral cavity proved to be impossible on account of the inadequate number of cases available. The so-called "organ localization" of primary tumours in the oral cavity need not - at least for the time being - be accorded any prognostic relevance. The findings should, however, be re-examined on the basis of greater numbers.

An attempt is made to analyse mid-face deformities objectively in operated cleft lip and palate patients with the help of cephalometric techniques. Mid-face growth of cleft patients after the age of 10 years is compared with growth parameters of non-cleft subjects. This comparison indicates that some of the angles in the nasal area (Subnasale angle, Alaria angle) do not undergo any change in size with increasing age. Others which are subject to change (Rhinion angle, Pronasale angle) show no difference in the extent of growth between cleft patients and normal subjects inspite of different conditions at the age of 10 years. The lateral growth of the nasal soft parts (bialar distance) is largely independent of the lateral growth of the bony structures.

Unlabelled: The German-Austrian-Swiss Research Team on Maxillofacial Tumours is investigating a series of 585 carcinomas of the oral cavity, lips and oropharynx by biostatistical methods. The aim of the study is the determination of relevant prognostic symptoms of oral cavity carcinomas, classification of the series on the basis of these symptoms, the determination of therapeutic efficacy and the assessment of collective and individual prognosis., Preliminary Results: 1. Factors of prognostic relevance are probably only tumour size and intensity of regional metastases. 2. The classification of the series becomes problematic due to the lack of relevant prognostic factors.

Problems associated with the classification of cavum oris and labial carcinomata were discussed with particular reference to patients admitted to and treated in seven different clinical hospitals where identical methods of diagnosis and case history evaluation had been used. Using electronic data processing and biostatistical methods it was possible to study the effects of two clinically detectable factors (growth of primary tumor and degree of regional metastasizing) on both the prognosis and classification according to UICC rules. It was possible to show that a determination of the size of primary tumor (T) alone was not sufficient for three homogeneous, prognostically different collectives of tumors to be satisfactorily classified by the new UICC rules. It has been shown that a classification of three collectives of tumors (new classification according to UICC rules), especially as regards the proportion of N3 metastases within the collectives of tumors, was made possible. Therefore, it will be necessary to study the prognostic influences of additional clinically determinable factors with a view to arriving at a useful and practicable classification of oral cavity carcinomata.