Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes

Objectives. To provide an overview of the effectiveness of multidisciplinary treatments of chronic pain and investigate about their differential effects on outcome in various pain conditions and of different multidisciplinary treatments, settings or durations. Methods. In this article, the authors performed a systematic review of all currently available randomized controlled trials (RCTs) fulfilling the inclusion criteria, by using a recently developed rating system aimed to assess the strength of evidence with regard to the methodological quality of the trials. Results. Compared with other non-disciplinary treatments, moderate evidence of higher effectiveness for multidisciplinary interventions was shown. In contrast to no treatment or standard medical treatment, strong evidence was detected in favour of multidisciplinary treatments. The evidence that comprehensive inpatient programmes were more beneficial that outpatient programmes was moderate. Fibromyalgia and chronic back pain patients tended to profit more substantially than patients with diverse origins or chronic pain diagnoses. No evidence was found that treatment variables, such as duration or programme components, were influential for the success of the intervention. Conclusion. A standard of multidisciplinary programmes should be internationally established to guarantee generally good outcomes in the treatment of chronic pain. Our results highlight the lack of quality of design, execution or reporting of many of the RCTs included in this article. Future studies should more specifically focus on differential effects of treatment components and patient variables, allowing the identification of subgroups, which most probably would profit from multidisciplinary pain programme

Photon-noise limited sensitivity in titanium nitride kinetic inductance detectors

We demonstrate photon-noise limited performance at sub-millimeter wavelengths in feedhorn-coupled, microwave kinetic inductance detectors (MKIDs) made of a TiN/Ti/TiN trilayer superconducting film, tuned to have a transition temperature of 1.4~K. Micro-machining of the silicon-on-insulator wafer backside creates a quarter-wavelength backshort optimized for efficient coupling at 250~\micron. Using frequency read out and when viewing a variable temperature blackbody source, we measure device noise consistent with photon noise when the incident optical power is $>$~0.5~pW, corresponding to noise equivalent powers $>$~3$\times 10^{-17}$ W/$\sqrt{\mathrm{Hz}}$. This sensitivity makes these devices suitable for broadband photometric applications at these wavelengths

MR/CT image fusion of the spine after spondylodesis: a feasibility study

The objective of this study is to evaluate feasibility, accuracy and time requirements of MR/CT image fusion of the lumbar spine after spondylodesis. Sagittal MR and CT images derived from standard imaging protocols (sagittal T2-weighted MR/sagittal reformatted multi-planar-reformation of the CT) of the lumbar spine with correct (n=5) and incorrect (n=5) implant position were fused by two readers (R1, R2) using OsiriX in two sessions placing one (session 1) or two (session 2) reference point(s) on the dorsal tip(s) of the cranial and caudal endplates from the second lumbar to the first sacral vertebra. R1 was an experienced musculoskeletal radiologist; R2 a spine surgeon, both had received a short training on the software tool. Fusion times and fusion accuracy, defined as the largest deviation between MR and CT in the median sagittal plane on the ventral tip of the cranial end plate of the most cranial vertebra visible on the CT, were measured in both sessions. Correct or incorrect implant position was evaluated upon the fused images for all patients by an experienced senior staff musculoskeletal radiologist. Mean fusion time (session 1/session 2; in seconds) was 100.4/95 (R1) and 104.2/119.8 (R2). Mean fusion deviation (session 1/session 2; in mm) was 1.24/2.20 (R1) and 0.79/1.62 (R2). The correct/incorrect implant position was identified correctly in all cases. In conclusion, MR/CT image fusion of the spine with metallic implants is feasible, fast, accurate and easy to implement in daily routine wor

Synovitis maps for the assessment of inflammatory diseases of the hand

Objectives: To compare accuracy and review times of FLASH-MRI-derived synovitis maps (SM) with conventional MR images (cMRI) in the assessment of articular synovitis and tenosynovitis of the hand. Methods: 80 hands in 40 patients (mean age, 48years; range, 15-72years) were assessed for synovitis on cMRI and SM by two readers independently. Reporting times and diagnostic confidence (scale: 1 = least, 5 = most confident) were measured. Results from an assessment of a panel of senior musculoskeletal radiologists served as the standard of reference. Results: Sensitivity and specificity for the detection of articular synovitis were 0.91/1.00 (R1) and 1.00/0.67 (R2) on cMRI and 0.87/0.75 (R1) and 0.91/0.45 (R2) on SM and for the detection of tenosynovitis 0.95/0.63 (R1) and 0.67/0.79 (R2) on cMRI and 0.67/0.89 (R1) and 0.38/1.00 (R2) on SM. Mean review times (cMRI/SM, sec) were 142/37 (R1) and 167/25 (R2). Mean diagnostic confidence (cMRI/SM) was 3.7/3.4 (R1) and 3.2/3.5 (R2) for articular synovitis and 4.0/4.0 (R1), 3.3/3.7 (R2) for tenosynovitis. Conclusion: Synovitis maps provide a comparable diagnostic accuracy to conventional MR images in the assessment of articular synovitis and tenosynovitis of the hand. Because of short review times, synovitis maps provide a fast overview of locations with synovial enhancemen

Magnetic Sensitivity of AlMn TESes and Shielding Considerations for Next-Generation CMB Surveys

In the next decade, new ground-based Cosmic Microwave Background (CMB) experiments such as Simons Observatory (SO), CCAT-prime, and CMB-S4 will increase the number of detectors observing the CMB by an order of magnitude or more, dramatically improving our understanding of cosmology and astrophysics. These projects will deploy receivers with as many as hundreds of thousands of transition edge sensor (TES) bolometers coupled to Superconducting Quantum Interference Device (SQUID)-based readout systems. It is well known that superconducting devices such as TESes and SQUIDs are sensitive to magnetic fields. However, the effects of magnetic fields on TESes are not easily predicted due to the complex behavior of the superconducting transition, which motivates direct measurements of the magnetic sensitivity of these devices. We present comparative four-lead measurements of the critical temperature versus applied magnetic field of AlMn TESes varying in geometry, doping, and leg length, including Advanced ACT (AdvACT) and POLARBEAR-2/Simons Array bolometers. Molybdenum-copper bilayer ACTPol TESes are also tested and are found to be more sensitive to magnetic fields than the AlMn devices. We present an observation of weak-link-like behavior in AlMn TESes at low critical currents. We also compare measurements of magnetic sensitivity for time division multiplexing SQUIDs and frequency division multiplexing microwave rf-SQUIDs. We discuss the implications of our measurements on the magnetic shielding required for future experiments that aim to map the CMB to near-fundamental limits.Comment: 8 pages, 4 figures, conference proceedings submitted to the Journal of Low Temperature Physic