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Stone J. Functional neurological disorders: the neurological assessment as treatment. Pract Neurol 2015; 16:7-17. [DOI: 10.1136/practneurol-2015-001241] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 11/03/2022]
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Chambers JB, Marks EM, Hunter MS. The head says yes but the heart says no: what is non-cardiac chest pain and how is it managed? Heart 2015; 101:1240-9. [PMID: 25882503 DOI: 10.1136/heartjnl-2014-306277] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/08/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- J B Chambers
- Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK
| | - E M Marks
- Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Chambers JB, Marks E, Knisley L, Hunter M. Non-cardiac chest pain: time to extend the rapid access chest pain clinic? Int J Clin Pract 2013; 67:303-6. [PMID: 23279648 DOI: 10.1111/ijcp.12030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Non-cardiac chest pain is common. It has a low risk of coronary events, but causes considerable physical and social disability and inappropriate health-care usage. It is a heterogeneous condition, which may be caused by or associated with gastro-oesophageal, musculoskeletal or psychiatric abnormalities and sustained by psychological factors including catastrophisation, avoidance behaviour and abnormal help-seeking. These may coexist and their relative contributions may vary in different patients or at different times in an individual patient. The absence of a unitary cause probably explains why treatment studies show only moderate success. An individualised biopsychosocial approach takes account of all causative and sustaining processes and has been shown to work in pain syndromes at other sites. We suggest that this approach should be tried for chest pain using a multidisciplinary clinic model including cardiologists, psychologists and nurses linked with a Rapid Access Chest Pain Clinic.
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Affiliation(s)
- J B Chambers
- Cardiothoracic Centre and Department of Psychological Medicine, Guy's and St Thomas' Hospitals, London, UK.
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Noel M, Chambers CT, Petter M, McGrath PJ, Klein RM, Stewart SH. Pain is not over when the needle ends: a review and preliminary model of acute pain memory development in childhood. Pain Manag 2012; 2:487-97. [DOI: 10.2217/pmt.12.41] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
SUMMARY Over the past several decades, the field of pediatric pain has made impressive advances in our understanding of the pain experience of the developing child, as well as the devastating impact of inadequately managed pain early in life. It is now well recognized that, from infancy, children are capable of developing implicit memories of pain that can influence their subsequent reactions to pain. The present review provides a synthesis of selected studies that made a significant impact on this field of inquiry, with particular emphasis on recent clinical and laboratory-based experimental research examining children’s explicit autobiographical memories for acute pain. Research has begun to move towards improving the precision with which children at risk for developing negatively estimated pain memories can be identified, given the adverse influence these memories can have on subsequent pain experiences. As such, several fear- and anxiety-related child and parent variables implicated in this process are discussed, and avenues for future research and clinical intervention are identified throughout. Finally, a preliminary empirically and theoretically derived model of acute pain memory development in childhood is presented to parsimoniously summarize the evidence accumulated to date and guide future investigation in this area.
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Affiliation(s)
- Melanie Noel
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Christine T Chambers
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5850/5980, University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, 5850 University Avenue, PO Box 9700, B3K 6R8, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans’ Memorial Lane, 8th floor, Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, Nova Scotia, B3H 2E2, Canada
| | - Mark Petter
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5850/5980, University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Patrick J McGrath
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5850/5980, University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, 5850 University Avenue, PO Box 9700, B3K 6R8, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans’ Memorial Lane, 8th floor, Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, Nova Scotia, B3H 2E2, Canada
- Research, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS B3K 6R8, Canada
| | - Raymond M Klein
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Sherry H Stewart
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans’ Memorial Lane, 8th floor, Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, Nova Scotia, B3H 2E2, Canada
- Department of Community Health & Epidemiology, Centre for Clinical Research, 5790 University Avenue, Halifax, NS B3H 1V7, Canada
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Integrative treatment approaches: family satisfaction with a multidisciplinary paediatric Abdominal Pain Clinic. Int J Integr Care 2010; 10. [PMID: 20922066 PMCID: PMC2948677 DOI: 10.5334/ijic.551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 05/26/2010] [Accepted: 06/10/2010] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To assess patient and family satisfaction with evaluation received through a multidisciplinary paediatric Abdominal Pain Clinic (APC) staffed by a paediatric gastroenterologist and a paediatric psychologist as compared to a traditional gastroenterology clinic (GI) staffed by a paediatric gastroenterologist only. METHODS Two hundred and ninety-eight families (145 APC, 153 GI) with a child or adolescent aged 8-17 years seen for initial evaluation of a chronic abdominal pain completed an anonymous survey to assess understanding of the treatment recommendations made, intent to follow through with various treatment recommendations, and the overall level of satisfaction with the evaluation service provided. Family perceptions of strengths and challenges of the APC evaluation process also were explored. RESULTS APC families reported being prescribed adjunctive mental health and other therapies at significantly higher rates than GI families, while the rates of medication were comparable. APC families also reported significantly greater receptivity to beginning the treatments prescribed and higher levels of overall satisfaction with the evaluation process. The contribution of integrated medical and psychological perspectives frequently was identified as a strength of the APC evaluation process. Challenges identified for the APC evaluation were few and focused on issues related to paperwork and scheduling issues. CONCLUSIONS Integrative care approaches to the evaluation of paediatric abdominal pain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations. Integrative care starting at the time of first evaluation may be particularly well-tailored to enhance outcomes, reduce health care utilization, and yield financial savings within this population.
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Schweickhardt A, Larisch A, Wirsching M, Fritzsche K. Short-term psychotherapeutic interventions for somatizing patients in the general hospital: a randomized controlled study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2007; 76:339-46. [PMID: 17917469 DOI: 10.1159/000107561] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment acceptance and motivation for psychotherapy of somatizing patients in the general hospital is low. METHODS Patients (n = 91) fulfilling the criteria for somatization were randomized into an intervention group (n = 49) and a control group (n = 42). The patients in the intervention group attended 5 psychotherapeutic sessions based on the modified reattribution model. The patients in the control group received psychoeducational reading material. The primary outcomes were motivation for psychotherapy and contacting a psychotherapist after discharge. The secondary outcomes consisted of changes regarding somatoform symptoms, emotional distress and quality of life. RESULTS Patients from the intervention group were significantly more motivated for psychotherapy (p = 0.001) than patients from the control group. At the 3-month follow-up, 42% of the patients from the intervention group had contacted a psychotherapist, compared to 20% of the patients from the control group (p = 0.045). At the 6-month follow-up, however, the ratio of patients having contacted a psychotherapist had changed to 44 and 29%, respectively, and was no longer significant. The intensity of somatoform symptoms and the anxiety symptoms decreased and mental functioning improved significantly over time for patients from both groups. CONCLUSIONS Short-term psychotherapeutic interventions for somatizing patients in general hospitals have a moderately better effect on motivation for psychotherapy and contacting a psychotherapist than psychoeducational reading material alone. Future studies should attempt to prove the effectiveness of short-term psychoeducational interventions for somatizing patients in the general hospital.
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Affiliation(s)
- Axel Schweickhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Freiburg, Germany
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Stones RW, Lawrence WT, Selfe SA. Lasting impressions: influence of the initial hospital consultation for chronic pelvic pain on dimensions of patient satisfaction at follow-up. J Psychosom Res 2006; 60:163-7. [PMID: 16439269 DOI: 10.1016/j.jpsychores.2005.06.077] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 06/21/2005] [Accepted: 06/28/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Chronic pelvic pain (CPP) is a common condition in women, and care experiences are distressing and unsatisfactory for many. Research suggests that elements of the initial hospital consultation influence clinical outcome. This study aimed to identify the dimensions through which initial consultations were subsequently recalled at follow-up. METHOD A questionnaire study of 100 women, 6 months following a hospital gynaecology consultation for CPP, was conducted. Measures of pain and ratings of the medical consultation were completed at initial consultation and at follow-up. RESULTS Follow-up questionnaire items loaded to constructs of "affect", "expectation", and "cognition", forming three subscales. Patients' initial ratings of the consultation and scores on all three subscales measured at follow-up were correlated, remaining significant for both affect and expectation after controlling for current pain status. CONCLUSION Doctor's affect and the appropriateness of information to meet expectations are important influences on experiences of care and contribute to the long-term therapeutic element of the consultation.
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Agård A, Bentley L, Herlitz J. Experiences and concerns among patients being treated for atypical chest pain. Eur J Intern Med 2005; 16:339-44. [PMID: 16137547 DOI: 10.1016/j.ejim.2004.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 11/01/2004] [Accepted: 11/05/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many patients who are discharged from the hospital without receiving a clear-cut diagnosis of their chest pain continue to consume health care because of disabling physical and psychological symptoms. By identifying their experiences and concerns following hospitalization, an empirical basis for discussions on ways of improving the care of these particular patients will be obtained. METHODS A qualitative analysis of semi-structured interviews with 38 patients with a diagnosis of unspecified chest pain was carried out. RESULTS Two-thirds of the respondents had unanswered questions and concerns that had not been addressed. They found it difficult to understand why they had not undergone more tests. They requested an explanation for their chest pain, at the very least, or were worried about the future. Some respondents accepted the fact that they had not been given a sufficient amount of time and information. They referred to the stressful working situation of the physicians, the view that their admission could be regarded as unnecessary or that physicians at the hospital could not be expected to do more than exclude serious diseases. CONCLUSIONS Health professionals should address their patients' questions and fears properly and provide them with the most probable explanation for their symptoms. When taking the harmlessness of their symptoms or the situation of their caregivers into account, patients may find it inappropriate to impose further demands on care.
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Affiliation(s)
- Anders Agård
- Department of Medicine, Sahlgren's University Hospital, SE-413 45 Göteborg, Sweden.
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Abstract
Many cancer patients are anxious even when disease is in remission. Anxiety about health, ‘health anxiety’, has distinct features, notably seeking medical reassurance about symptoms. Doctors may then communicate that these symptoms are not due to serious illness, a process known as ‘reassurance’. However, reassurance may inadvertently perpetuate some patients' anxiety. We aimed to observe the relation between symptoms, anxiety and reassurance in consultations with cancer patients. A total of 95 outpatients, with breast or testicular cancers in remission, completed questionnaires measuring health anxiety at study entry, then general anxiety – before a consultation, immediately afterwards, 1 week later, and before their next consultation. We examined symptoms reported and reassurance by oncologists from audio recordings of consultations, and the outcome of subjects' anxiety. The results showed that substantial health anxiety was reported by one-third of the patients. Patients with higher levels of health anxiety reported more symptoms during consultations. Reassurance was ubiquitous, but not followed by an enduring improvement in anxiety. Certain forms of reassurance predicted increased anxiety over time, particularly for subjects who were most anxious. In conclusion, health anxiety can be a problem after cancer. Reassurance may not reduce patients' anxiety. Some reassurance was counterproductive for the most anxious patients. Oncologists may need to use reassurance as a procedure, balancing risk, and benefits, and patient selection and to manage cancer patients in remission.
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Affiliation(s)
- D Stark
- The Cancer Research UK Clinical Centre at Leeds, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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Kolk AMM, Schagen S, Hanewald GJFP. Multiple medically unexplained physical symptoms and health care utilization: outcome of psychological intervention and patient-related predictors of change. J Psychosom Res 2004; 57:379-89. [PMID: 15518674 DOI: 10.1016/j.jpsychores.2004.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2003] [Accepted: 02/03/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization. METHODS In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants (N=98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years. RESULTS ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety. CONCLUSION Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.
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Affiliation(s)
- A M M Kolk
- Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
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Atkinson MJ, Wishart PM, Wasil BI, Robinson JW. The Self-Perception and Relationships Tool (S-PRT): a novel approach to the measurement of subjective health-related quality of life. Health Qual Life Outcomes 2004; 2:36. [PMID: 15257754 PMCID: PMC497051 DOI: 10.1186/1477-7525-2-36] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Accepted: 07/16/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Self-Perception and Relationships Tool (S-PRT) is intended to be a clinically responsive and holistic assessment of patients' experience of illness and subjective Health Related Quality of Life (HRQL). METHODS A diversity of patients were involved in two phases of this study. Patient samples included individuals involved with renal, cardiology, psychiatric, cancer, chronic pelvic pain, and sleep services. In Phase I, five patient focus groups generated 128 perceptual rating scales. These scales described important characteristics of illness-related experience within six life domains (i.e., Physical, Mental-Emotional, Interpersonal Receptiveness, Interpersonal Contribution, Transpersonal Receptiveness and Transpersonal Orientation). Item reduction was accomplished using Importance Q-sort and Importance Checklist methodologies with 150 patients across the participating services. In Phase II, a refined item pool (88 items) was administered along with measures of health status (SF-36) and spiritual beliefs (Spiritual Involvements and Beliefs Scale--SIBS) to 160 patients, of these 136 patients returned complete response sets. RESULTS Factor analysis of S-PRT results produced a surprisingly clean five-factor solution (Eigen values> 2.0 explaining 73.5% of the pooled variance). Items with weaker or split loadings were removed leaving 36 items to form the final S-PRT rating scales; Intrapersonal Well-being (physical, mental & emotional items), Interpersonal Receptivity, Interpersonal Contribution, Transpersonal Receptivity and Transpersonal Orientation (Eigen values> 5.4 explaining 83.5% of the pooled variance). The internal consistency (Cronbach's Alpha) of these scales was very high (0.82-0.97). Good convergent correlations (0.40 to 0.67) were observed between the S-PRT scales and the Mental Health scales of the SF-36. Correlations between the S-PRT Intrapersonal Well-being scale and three of SF-36 Physical Health scales were moderate (0.30 to 0.46). The criterion-related validity of the S-PRT spiritual scales was supported by moderate convergence (0.40-0.49) with three SIBS scales. CONCLUSION Evidence supports the validity of the S-PRT as a generally applicable measure of perceived health status and HRQL. The test-retest reliability was found to be adequate for most scales, and there is some preliminary evidence that the S-PRT is responsive to patient-reported changes in determinants of their HRQL. Clinical uses and directions for future research are discussed.
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Affiliation(s)
- Mark J Atkinson
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Pfizer Inc, San Diego, California, USA
| | - Paul M Wishart
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Spirituality Research Institute (Sri) Inc., Calgary, Alberta, Canada
| | - Bushra I Wasil
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - John W Robinson
- Department of Oncology and Program in Clinical Psychology, University of Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Abstract
OBJECTIVE To examine the characteristics, subsequent resource use and outcome of a consecutive cohort of admissions with acute chest pain not due to myocardial infarction. METHODS Subjects (N=356) identified in the course of a epidemiological study of myocardial infarction were interviewed and completed HAD, SF-36 and other self-report information in hospital and at 3 months and 1 year. Hospital casenotes were reviewed at 1 year. RESULTS A total of 218 subjects were given cardiac diagnoses and 138 noncardiac diagnoses. Cardiac subjects were more distressed and disabled and used more resources. Those in the noncardiac group reported distress and disability and resource use comparable to infarct admissions. CONCLUSION Awareness of psychosocial variables would aid in the assessment and management of those with and without ischaemic heart disease.
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Affiliation(s)
- R A Mayou
- Department of Psychiatry, Warneford Hospital, University of Oxford, UK.
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Abstract
It is becoming apparent that the disease process of osteoarthritis should be regarded separately from the clinical syndrome of joint pain, use-related stiffness and disability. The latter may best be approached as a chronic regional pain disorder that requires attention to physical, psychological and social factors as well as those related to the disease process. This chapter sets out to look at some of the practical implications of taking this view for the clinical assessment. Starting with the syndrome of hip, knee or hand pain in older adults in the community, we consider what leads people to consult, what the important features to assess might be, the role of imaging in the clinical assessment of osteoarthritis, and finally how a management plan could be formulated. The usefulness of assessing clinical osteoarthritis as a regional pain disorder is uncertain. Even if this were demonstrated, the concept of osteoarthritis as a structural disease should be retained as an integral part.
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Affiliation(s)
- G Peat
- Primary Care Sciences Research Centre, Keele University, Staffordshire, ST5 5BG, UK
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