Paul Scholten - Academia.edu (original) (raw)
Papers by Paul Scholten
Pain Medicine
Objective The present study examined pre- to post-treatment changes in volumes for brain structur... more Objective The present study examined pre- to post-treatment changes in volumes for brain structures known to be associated with pain processing (thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and accumbens) following an interdisciplinary pain management program. Design Twenty-one patients participating in a four-week interdisciplinary pain management program completed the study. The program consisted of individual and group therapies with the following disciplines: physical therapy, occupational therapy, pain psychology, biofeedback/relaxation training, nursing lectures, and medical management. All patients underwent functional magnetic resonance imaging of the brain before the start and at completion of the program. They also completed standard outcome measures assessing pain, symptoms of central sensitization, disability, mood, coping, pain acceptance, and impressions of change. Results Our results showed a significant increase in total brain volume, as well as incre...
Pain physician, Jul 1, 2017
Higher body mass index (BMI) is associated with difficulty in obtaining imaging studies. While th... more Higher body mass index (BMI) is associated with difficulty in obtaining imaging studies. While there is a small body of literature regarding the relationship between fluoroscopy time and BMI during injections for pain management, this has not been studied for intraarticular (IA) hip injections. Further, in academic training centers, trainee involvement may affect this relationship. To determine the relationship between BMI and fluoroscopy time during IA hip injections, both with and without involvement of a trainee. Multicenter retrospective cohort study. Three academic, outpatient musculoskeletal and pain medicine centers. Patients who underwent fluoroscopically guided IA hip injections with encounter data regarding fluoroscopy time during the procedure and BMI were included. Mean and standard deviation fluoroscopy time were recorded. Comparisons were made between BMI categories of normal (18.5 - 24.9 kg/m2), overweight (25.0 - 29.9 kg/m2), and obese (greater than or equal to30.0 k...
PM & R : the journal of injury, function, and rehabilitation, 2015
Neuropathic pain (NP) is a significant source of suffering, disability, and impairment, as well a... more Neuropathic pain (NP) is a significant source of suffering, disability, and impairment, as well as an enormous cost to society. Historically, pharmacologic treatment has been limited to drugs approved for other conditions, including anticonvulsants, antidepressants, antiarrhythmics, and opioids, but in the past 2 decades several drugs have been approved by the Food and Drug Administration specifically for NP. Understanding the underlying pathophysiology and clinical presentation of the various causes of NP states facilitates a rational selection of pharmacologic, interventional, rehabilitative, and psychological options for reducing pain and maximizing function.
Saudi medical journal, 2009
To evaluate the relationship between vitamin D level and body mass index (BMI) among Saudi Arabia... more To evaluate the relationship between vitamin D level and body mass index (BMI) among Saudi Arabian citizens. Four hundred healthy individuals aged > or =25 years (200 males and 200 females) were included in this cross-sectional study. Subjects were recruited in the period between 1st February 2008 and 31st May 2008 from the medical staff and employees of King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, and from patients attending the endocrinology, orthopedic, and infertility clinics at the same hospital. Clinical evaluation was carried out, and BMI was calculated. Serum 25 hydroxy vitamin D (25OHD), in addition to serum parathyroid hormone levels and calcium chemistry were measured for all subjects. The mean age was 46.5 +/- 14.6 years for males, and 42.6 +/- 15.9 years for females (p=0.01). Mean BMI was similar in both genders, and the difference in the level of serum 25OHD just reached statistical significance (p=0.04). Male subjects with vitamin D def...
PM&R, 2014
To determine the relationship between sacroiliac joint (SIJ) contrast dispersal patterns during S... more To determine the relationship between sacroiliac joint (SIJ) contrast dispersal patterns during SIJ corticosteroid injection and pain relief at 2 and 8 weeks after the procedure. The association between the number of positive provocative SIJ physical examination maneuvers (minimum of one in all patients undergoing SIJ injection) and the patient's response to the intervention was also assessed. Retrospective chart review. Academic outpatient musculoskeletal practice. Fifty-four subjects who underwent therapeutic SIJ corticosteroid injection were screened for inclusion; 49 subjects were included in the final analysis. A retrospective review of electronic medical records identified patients who underwent SIJ corticosteroid injection. Fluoroscopic contrast flow patterns were categorized as type I (intra-articular injection with cephalad extension within the SIJ) or type II (intra-articular injection with poor cephalad extension). Self-reported numeric pain rating scale (NPRS) values at the time of injection and 2 and 8 weeks after the procedure were recorded. The number of positive provocative SIJ physical examination maneuvers at the time of the initial evaluation was also recorded. The primary outcome measure was the effect of contrast patterns (type I or type II) on change in NPRS values at 2 weeks and 8 weeks after the injection. The secondary outcome measure was the association between the number of positive provocative SIJ physical examination maneuvers and decrease in the level of pain after the procedure. At 2 weeks after the procedure, type I subjects demonstrated a significantly lower mean NPRS value compared with type II subjects (2.8 ± 1.4 versus 3.8 ± 1.6, respectively, P = .02). No statistically significant difference was observed at 8 weeks after the procedure. NPRS values were significantly reduced both at 2 weeks and 8 weeks, compared with baseline, in both subjects identified as having type I flow and those with type II flow (P < .0001 for all within-group comparisons). Fluoroscopically guided corticosteroid injections into the SIJ joint are effective in decreasing NPRS values in patients with SIJ-mediated pain. Delivery of corticosteroid to the superior portion of the SIJ leads to a greater reduction in pain at 2 weeks, but not at 8 weeks. Patients with at least one positive provocative maneuver should benefit from an intra-articular corticosteroid injection.
Journal of Biomedical Materials Research Part A, 2011
Few options exist to replace or repair damaged articular cartilage. The optimal solution that has... more Few options exist to replace or repair damaged articular cartilage. The optimal solution that has been suggested is a scaffold that can carry load and integrate with surrounding tissues; but such a construct has thus far been elusive. The objectives of this study were to manufacture and characterize a non-degradable hydrated scaffold. Our hypothesis was that the polymer content of the scaffold can be used to control its mechanical properties, while an internal porous network augmented with biological agents can facilitate integration with the host tissue. Using a two-step water-in-oil emulsion process a porous poly-vinyl alcohol (PVA) hydrogel scaffold combined with alginate microspheres was manufactured. The scaffold had a porosity of 11-30% with pore diameters of 107-187 μm, which readily allowed for movement of cells through the scaffold. Alginate microparticles were evenly distributed through the scaffold and allowed for the slow release of biological factors. The elastic modulus (E s) and Poisson's ratio (υ), Aggregate modulus (H a) and dynamic modulus (E D) of the scaffold were significantly affected by % PVA, as it varied from 10% to 20% wt/vol. E s and υ were similar to that of articular cartilage for both polymer concentrations, while H a and E D were similar to that of cartilage only at 20% PVA. The ability to control scaffold mechanical properties, while facilitating cellular migration suggest that this scaffold is a potentially viable candidate for the functional replacement of cartilage defects.
Journal of Biomechanics, 2008
Studies of the load transfer role of the meniscus have been limited to static experimental and an... more Studies of the load transfer role of the meniscus have been limited to static experimental and analytical approaches. The objective of this study was to develop an experimental technique to allow the contact pressures on the tibial plateau of cadaveric knees to be measured under dynamic physiological loads. Accordingly, we adapted a load-controlled knee joint simulator to accept a cadaveric sheep knee, programmed the simulator with sheep gait kinematics data, and utilized a pressure sensor array to measure the contact pressure distribution on the lateral tibial plateau during gait. The technique was applied to six sheep knees that were tested intact and after meniscectomy. Meniscectomy resulted in a 267% increase in average contact pressure, a 117% increase in peak contact pressure, and an 80% decrease in contact area, all measured at the point of maximum peak contact stress in the gait cycle. It is envisaged that the experimental model herein developed will allow for the screening of candidate materials prior to more expensive and time-consuming animal models.
PM&R, 2013
ABSTRACT Athletic pubalgia is a syndrome of persistent groin pain due to chronic, repetitive trau... more ABSTRACT Athletic pubalgia is a syndrome of persistent groin pain due to chronic, repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet rich plasma (PRP) injection. Following injection, the patient returned to pain-free play at his previous level of intensity. This suggests PRP may be a useful treatment for this diagnosis.
Pain Medicine
Objective The present study examined pre- to post-treatment changes in volumes for brain structur... more Objective The present study examined pre- to post-treatment changes in volumes for brain structures known to be associated with pain processing (thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and accumbens) following an interdisciplinary pain management program. Design Twenty-one patients participating in a four-week interdisciplinary pain management program completed the study. The program consisted of individual and group therapies with the following disciplines: physical therapy, occupational therapy, pain psychology, biofeedback/relaxation training, nursing lectures, and medical management. All patients underwent functional magnetic resonance imaging of the brain before the start and at completion of the program. They also completed standard outcome measures assessing pain, symptoms of central sensitization, disability, mood, coping, pain acceptance, and impressions of change. Results Our results showed a significant increase in total brain volume, as well as incre...
Pain physician, Jul 1, 2017
Higher body mass index (BMI) is associated with difficulty in obtaining imaging studies. While th... more Higher body mass index (BMI) is associated with difficulty in obtaining imaging studies. While there is a small body of literature regarding the relationship between fluoroscopy time and BMI during injections for pain management, this has not been studied for intraarticular (IA) hip injections. Further, in academic training centers, trainee involvement may affect this relationship. To determine the relationship between BMI and fluoroscopy time during IA hip injections, both with and without involvement of a trainee. Multicenter retrospective cohort study. Three academic, outpatient musculoskeletal and pain medicine centers. Patients who underwent fluoroscopically guided IA hip injections with encounter data regarding fluoroscopy time during the procedure and BMI were included. Mean and standard deviation fluoroscopy time were recorded. Comparisons were made between BMI categories of normal (18.5 - 24.9 kg/m2), overweight (25.0 - 29.9 kg/m2), and obese (greater than or equal to30.0 k...
PM & R : the journal of injury, function, and rehabilitation, 2015
Neuropathic pain (NP) is a significant source of suffering, disability, and impairment, as well a... more Neuropathic pain (NP) is a significant source of suffering, disability, and impairment, as well as an enormous cost to society. Historically, pharmacologic treatment has been limited to drugs approved for other conditions, including anticonvulsants, antidepressants, antiarrhythmics, and opioids, but in the past 2 decades several drugs have been approved by the Food and Drug Administration specifically for NP. Understanding the underlying pathophysiology and clinical presentation of the various causes of NP states facilitates a rational selection of pharmacologic, interventional, rehabilitative, and psychological options for reducing pain and maximizing function.
Saudi medical journal, 2009
To evaluate the relationship between vitamin D level and body mass index (BMI) among Saudi Arabia... more To evaluate the relationship between vitamin D level and body mass index (BMI) among Saudi Arabian citizens. Four hundred healthy individuals aged > or =25 years (200 males and 200 females) were included in this cross-sectional study. Subjects were recruited in the period between 1st February 2008 and 31st May 2008 from the medical staff and employees of King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, and from patients attending the endocrinology, orthopedic, and infertility clinics at the same hospital. Clinical evaluation was carried out, and BMI was calculated. Serum 25 hydroxy vitamin D (25OHD), in addition to serum parathyroid hormone levels and calcium chemistry were measured for all subjects. The mean age was 46.5 +/- 14.6 years for males, and 42.6 +/- 15.9 years for females (p=0.01). Mean BMI was similar in both genders, and the difference in the level of serum 25OHD just reached statistical significance (p=0.04). Male subjects with vitamin D def...
PM&R, 2014
To determine the relationship between sacroiliac joint (SIJ) contrast dispersal patterns during S... more To determine the relationship between sacroiliac joint (SIJ) contrast dispersal patterns during SIJ corticosteroid injection and pain relief at 2 and 8 weeks after the procedure. The association between the number of positive provocative SIJ physical examination maneuvers (minimum of one in all patients undergoing SIJ injection) and the patient's response to the intervention was also assessed. Retrospective chart review. Academic outpatient musculoskeletal practice. Fifty-four subjects who underwent therapeutic SIJ corticosteroid injection were screened for inclusion; 49 subjects were included in the final analysis. A retrospective review of electronic medical records identified patients who underwent SIJ corticosteroid injection. Fluoroscopic contrast flow patterns were categorized as type I (intra-articular injection with cephalad extension within the SIJ) or type II (intra-articular injection with poor cephalad extension). Self-reported numeric pain rating scale (NPRS) values at the time of injection and 2 and 8 weeks after the procedure were recorded. The number of positive provocative SIJ physical examination maneuvers at the time of the initial evaluation was also recorded. The primary outcome measure was the effect of contrast patterns (type I or type II) on change in NPRS values at 2 weeks and 8 weeks after the injection. The secondary outcome measure was the association between the number of positive provocative SIJ physical examination maneuvers and decrease in the level of pain after the procedure. At 2 weeks after the procedure, type I subjects demonstrated a significantly lower mean NPRS value compared with type II subjects (2.8 ± 1.4 versus 3.8 ± 1.6, respectively, P = .02). No statistically significant difference was observed at 8 weeks after the procedure. NPRS values were significantly reduced both at 2 weeks and 8 weeks, compared with baseline, in both subjects identified as having type I flow and those with type II flow (P < .0001 for all within-group comparisons). Fluoroscopically guided corticosteroid injections into the SIJ joint are effective in decreasing NPRS values in patients with SIJ-mediated pain. Delivery of corticosteroid to the superior portion of the SIJ leads to a greater reduction in pain at 2 weeks, but not at 8 weeks. Patients with at least one positive provocative maneuver should benefit from an intra-articular corticosteroid injection.
Journal of Biomedical Materials Research Part A, 2011
Few options exist to replace or repair damaged articular cartilage. The optimal solution that has... more Few options exist to replace or repair damaged articular cartilage. The optimal solution that has been suggested is a scaffold that can carry load and integrate with surrounding tissues; but such a construct has thus far been elusive. The objectives of this study were to manufacture and characterize a non-degradable hydrated scaffold. Our hypothesis was that the polymer content of the scaffold can be used to control its mechanical properties, while an internal porous network augmented with biological agents can facilitate integration with the host tissue. Using a two-step water-in-oil emulsion process a porous poly-vinyl alcohol (PVA) hydrogel scaffold combined with alginate microspheres was manufactured. The scaffold had a porosity of 11-30% with pore diameters of 107-187 μm, which readily allowed for movement of cells through the scaffold. Alginate microparticles were evenly distributed through the scaffold and allowed for the slow release of biological factors. The elastic modulus (E s) and Poisson's ratio (υ), Aggregate modulus (H a) and dynamic modulus (E D) of the scaffold were significantly affected by % PVA, as it varied from 10% to 20% wt/vol. E s and υ were similar to that of articular cartilage for both polymer concentrations, while H a and E D were similar to that of cartilage only at 20% PVA. The ability to control scaffold mechanical properties, while facilitating cellular migration suggest that this scaffold is a potentially viable candidate for the functional replacement of cartilage defects.
Journal of Biomechanics, 2008
Studies of the load transfer role of the meniscus have been limited to static experimental and an... more Studies of the load transfer role of the meniscus have been limited to static experimental and analytical approaches. The objective of this study was to develop an experimental technique to allow the contact pressures on the tibial plateau of cadaveric knees to be measured under dynamic physiological loads. Accordingly, we adapted a load-controlled knee joint simulator to accept a cadaveric sheep knee, programmed the simulator with sheep gait kinematics data, and utilized a pressure sensor array to measure the contact pressure distribution on the lateral tibial plateau during gait. The technique was applied to six sheep knees that were tested intact and after meniscectomy. Meniscectomy resulted in a 267% increase in average contact pressure, a 117% increase in peak contact pressure, and an 80% decrease in contact area, all measured at the point of maximum peak contact stress in the gait cycle. It is envisaged that the experimental model herein developed will allow for the screening of candidate materials prior to more expensive and time-consuming animal models.
PM&R, 2013
ABSTRACT Athletic pubalgia is a syndrome of persistent groin pain due to chronic, repetitive trau... more ABSTRACT Athletic pubalgia is a syndrome of persistent groin pain due to chronic, repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet rich plasma (PRP) injection. Following injection, the patient returned to pain-free play at his previous level of intensity. This suggests PRP may be a useful treatment for this diagnosis.