Pain Practice最新文献

{"title":"Do patients with fibromyalgia syndrome and healthy people differ in their opinions on placebo effects in routine medical care?","authors":"Johan P A van Lennep, Simone Meijer, Merve Karacaoglu, Ralph Rippe, Kaya J Peerdeman, Henriët van Middendorp, Andrea W M Evers","doi":"10.1111/papr.70000","DOIUrl":"10.1111/papr.70000","url":null,"abstract":"<p><strong>Objectives: </strong>Placebo effects can relieve acute and chronic pain in both research and clinical treatments by learning mechanisms. However, the application of placebo-based treatment strategies in routine medical care is questioned. The current study investigated the opinions of patients with fibromyalgia and healthy controls regarding learning of placebo effects and their practical applications.</p><p><strong>Method: </strong>An online survey asked 158 age- and sex-matched adult patients and controls (79 per group) to rate the perceived influence of various placebo learning mechanisms on pain relief, and the acceptability and perceived effectiveness of placebo-based strategies (open-label, closed-label, dose-extending, and treatment-enhancing strategies). Respondents' knowledge about placebo effects was obtained through a 7-item quiz.</p><p><strong>Results: </strong>The groups did not differ in the perceived influence of placebo learning mechanisms on pain relief (p = 0.217). Controls considered closed-label and treatment-enhancing strategies more acceptable than patients (p = 0.003 and p < 0.001), whereas controls perceived all strategies more effective. In both groups, closed-label strategies were significantly less acceptable than any other strategy (p-values < 0.001), and treatment-enhancing or dose-extending strategies were most acceptable. Higher acceptability was predicted by higher perceived effectiveness ratings (p < 0.001). Also, increased placebo knowledge was related to higher acceptability (p = 0.03) and perceived effectiveness (p < 0.001).</p><p><strong>Discussion: </strong>This survey suggests that both the medical history of patients and knowledge about placebo effects affect the acceptability and perceived effectiveness of placebo-based strategies. Furthermore, strategies that are transparent, assumed effective, or combined with existing medical treatments are deemed most acceptable. Keeping these factors in mind is essential for the clinical implementation of placebo-based strategies in routine medical care.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 2","pages":"e70000"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Permanent trials for spinal cord stimulation.","authors":"Sruti Bandlamuri, Tessa A Harland, Julie G Pilitsis, Vishad V Sukul","doi":"10.1111/papr.70006","DOIUrl":"10.1111/papr.70006","url":null,"abstract":"<p><strong>Introduction: </strong>Prior to the permanent implant of a spinal cord stimulator, patients typically undergo a screening trial using a percutaneously placed lead to ensure adequate response. However, due to several factors, patients may not be candidates for this screening trial and therefore instead undergo a \"permanent trial\" where either a percutaneous lead or paddle lead is placed using a tunneled extension for the trial, with the intent of conversion to a permanent system. If these patients proceed with an implant, the epidural space is not re-accessed and only an impulse generator (IPG) is needed. Although this technique is commonly employed, there is a paucity of literature describing outcomes with the \"permanent trial\" methodology. We present here our clinical experience with this technique.</p><p><strong>Methods: </strong>Participants who underwent permanent trials at a single institution between 2014 and 2020 were identified. Charts were reviewed to collect demographic information, numerical rating score (NRS) data, length of follow-up, revisions, complications, and removals.</p><p><strong>Results: </strong>A total of 27 patients who underwent permanent trial placement were identified from a database of 762 patients who underwent SCS placement (3.54%). The permanent placement group included 7 paddle trials, 14 percutaneous trials, and 6 dorsal root ganglion (DRG) trials. The reasons for pursuing a permanent trial included previously aborted percutaneous trial (n = 8), inability to hold anticoagulation for a prolonged period (n = 4), previous thoracic spine surgery or presence of thoracic stenosis on MRI (n = 4), and significant medical comorbidities precluding typical percutaneous trial lead placement at a surgery center (n = 3). 24/27 (88.8%) proceeded to permanent implant, and 16/24 (66.7%) were considered responders (greater than 50% reduction in pain) after 3 months. Over an average follow-up of 28.7 months, complications included 1 peri-operative intracranial hemorrhage delaying IPG placement, 2 lead fractures, 1 lead migration, and 1 CSF leak. Three patients required revision surgery for lead migration, lead fracture, and CSF leak, respectively. One patient had his system explanted 25.9 months after initial placement due to increased pain from stimulation.</p><p><strong>Conclusion: </strong>This study aims to characterize our experience with permanent trials for SCS. Here we demonstrate a higher rate of trial-to-implant conversion than previously documented for traditional percutaneous trials. We show similar rates of revisions and complications, elucidating the important role of permanent SCS trials in high-risk patients.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 2","pages":"e70006"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical and morphological variations in the dorsal root ganglion: Technical implications for chronic pain treatment with neuromodulation-A systematic review.","authors":"Juan Carlos Acevedo-Gonzalez, Carlos Felipe Ariza-Piñeros, José Manuel Vega-Corredor","doi":"10.1111/papr.70008","DOIUrl":"10.1111/papr.70008","url":null,"abstract":"<p><strong>Objectives: </strong>In the last 20 years, we have seen the flourishing of multiple treatments targeting the dorsal root ganglion (DRG) for pain. However, there is concern regarding the variation in the location of the DRG, which could influence the long-term clinical outcomes. The aim of this work was to determine the exact position of the DRG in the spine and propose a pre-surgical planning.</p><p><strong>Materials and methods: </strong>A systematic search was conducted following the principles recommended by PRISMA. Search terms \"ganglia,\" \"DRG,\" \"dorsal root ganglia, anatomy,\" \"radiological,\" \"neuromodulation,\" \"dorsal root ganglion stimulation\" (PubMed, Scopus, Medline, Web of Science, and Embase) were identified 177 articles and subjected to the selection criteria (inclusion/exclusion) based on the independent review of the abstracts.</p><p><strong>Results: </strong>Eighteen articles were selected (seven anatomical dissections on cadavers, five radiological studies, and six narrative reviews).</p><p><strong>Discussion: </strong>Percutaneous procedure targeting the DRG for the treatment of chronic pain requires preoperative planning independent to the study of the etiology of pain. The DRG should be typified using magnetic resonance imaging. We propose a preoperative evaluation scale based on four specific items: A-position in the vertebral canal, B-position of the DRG within the foramen, C-number of ganglia in the root, and D-ratio (proportion) of foramen/DRG.</p><p><strong>Conclusion: </strong>Percutaneous treatments for chronic pain directed at the DRG are effective. Clinical outcomes depend of good preoperative planning that allows for optimizing its effects. We propose a DRG morphology evaluation scale useful for the planning process prior to any treatment directed at the ganglion.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 2","pages":"e70008"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical function estimates change in pain following IIPT among children with chronic pain.","authors":"Mayank Seth, Katherine Bentley, Kathryn Hottinger, Kate Vieni, Anke Reineke, Pritha Dalal","doi":"10.1111/papr.70009","DOIUrl":"10.1111/papr.70009","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain can negatively impact a child's quality of life. Pediatric Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to improve overall functioning despite pain through various rehabilitative strategies. It is, however, unclear whether improved function corresponds to self-reported decrease in pain levels. Hence, the purpose of this study is to examine the relationship between changes in physical function and perceived pain among children with chronic pain who have undergone inpatient IIPT.</p><p><strong>Materials and methods: </strong>A secondary analysis of pre-existing databases of IIPT from two different inpatient acute rehabilitation programs was carried out. Children and adolescents (N = 309; age = 16.2 ± 2.6; 79% females) with chronic pain who attended on average 4-week inpatient IIPT from Nov 2011 to Jan 2023 were included. Participants completed pain intensity (Numerical Pain Rating Scale) and self-reported function measures (Lower Extremity Functional Scale [LEFS], Upper Extremity Functional Index [UEFI], Canadian Occupational Performance Measure [COPM]-Performance, and COPM-Satisfaction) at admission and discharge.</p><p><strong>Results: </strong>Change in self-reported physical function was significantly associated with change in pain from admission to discharge. After covariate adjustment, self-reported physical function (per the LEFS, UEFI, COPM-Performance, and COPM-Satisfaction) explained 19.8%, 7.8%, 12.0%, and 8.6% of the variance in change in pain, respectively. These measures of self-reported physical function further distinguished between minimal (<30%) and moderate (≥30%) pain reduction.</p><p><strong>Conclusions: </strong>Self-reported functional gains during IIPT are associated with greater change in perceived pain. Moreover, measures of self-reported physical function can help identify children at risk of minimal pain reduction post-IIPT.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 2","pages":"e70009"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"7. Cervical facet pain: Degenerative alterations and whiplash-associated disorder.","authors":"M D Hellinga, M van Eerd, M P Stojanovic, S P Cohen, J de Andrès Ares, J W Kallewaard, K Van Boxem, J Van Zundert, M Niesters","doi":"10.1111/papr.70005","DOIUrl":"10.1111/papr.70005","url":null,"abstract":"<p><strong>Introduction: </strong>Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. Here, we provide an overview of the literature on the diagnosis and treatment of cervical facet-related pain with special emphasis on interventional treatment techniques.</p><p><strong>Methods: </strong>A literature search on the diagnosis and treatment of cervical facet joint pain and whiplash-associated disorders (WAD) was performed using PubMed, Cochrane, and Embase databases. All relevant literature was retrieved and summarized.</p><p><strong>Results: </strong>Facet-related pain is typically diagnosed based on history and physical examination of the patients, combined with a diagnostic block (eg, with local anesthetic) of the medial branches innervating the joints. There is no additive value for imaging techniques to diagnose cervical facet pain, but imaging may be used for procedure planning. First-line therapy for pain treatment includes focused exercise, graded activity, and range-of-motion training. Pharmacological treatment may be considered for acute facet joint pain; however, for chronic facet joint pain, evidence for pharmacological treatment is lacking. Considering the lack of evidence for treatment with botulinum toxin, intra-articular steroid injections, or surgery, these interventions are not recommended. Diagnostic blocks are not considered a viable treatment option, though some patients may experience a prolonged analgesic effect. Long-term analgesia (>6 months) has been observed for radiofrequency treatment of the medial branches.</p><p><strong>Conclusions: </strong>Cervical facet pain is diagnosed based on history, physical examination, and a diagnostic block of the medial branches innervating the painful joints. Conservative management, including exercise therapy, is the first line of treatment. When conservative management does not result in adequate improvement of pain, radiofrequency treatment of the medial branches should be considered, which often results in adequate pain relief.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 2","pages":"e70005"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable, noninvasive, pulsed shortwave (radiofrequency) therapy for postoperative analgesia: A randomized, double-masked, sham-controlled pilot study.","authors":"Brian M Ilfeld, John J Finneran, Engy T Said, Scott T Ball, Anne M Wallace, Ryan C Broderick, Bryan J Sandler, Jay J Doucet, Sandy R Hu, Brannon J Cha, Adhithi Narayana Murthy, Baharin Abdullah","doi":"10.1111/papr.70007","DOIUrl":"10.1111/papr.70007","url":null,"abstract":"<p><strong>Background: </strong>Nonthermal, pulsed shortwave (radiofrequency) therapy (PSWT) is a nonpharmacologic, noninvasive modality that limited evidence suggests provides analgesia. Its potential favorable risk-benefit ratio stems from its lack of side effects and significant medical risks, applicability to any anatomic location, long treatment duration, and ease of application by simply affixing it with tape. Even with a relatively small treatment effect, PSWT might contribute to a multimodal analgesic regimen, similar to acetaminophen. However, widespread clinical use is hindered by a lack of systematic evidence. The current randomized, controlled pilot study was undertaken to determine the feasibility and optimize the protocol for a subsequent definitive investigation and estimate the treatment effect of PSWT on postoperative pain and opioid consumption.</p><p><strong>Methods: </strong>Within the recovery room following primary knee and hip arthroplasty, cholecystectomy, hernia repair, and non-mastectomy breast surgery, we applied 1-3 PSWT devices (Model 088, BioElectronics Corporation, Frederick, Maryland) over the surgical bandages. Participants were randomized to 28 days of either active or sham treatment in a double-masked fashion. The outcomes of primary interest were the cumulative opioid consumption and the mean of the \"average\" and \"worst\" daily pain measured with the Numeric Rating Scale over the first 7 postoperative days.</p><p><strong>Results: </strong>During the first 7 postoperative days, oxycodone consumption in participants given active treatment (n = 55) was a mean (SD) of 21 mg (24) versus 17 mg (26) in patients given sham (n = 57): difference 4 (95% CI, -5 to 13), p = 0.376. During this same period, the \"average\" daily pain intensity in patients given active treatment was 2.4 (1.6) versus 2.6 (1.7) in sham: difference -0.2 (95% CI -0.8 to 0.5), p = 0.597. Concurrently, the worst/maximum pain for the active group was 4.6 (2.0) versus 4.7 (2.1) in sham: difference -0.1 (95% CI -0.8 to 0.7), p = 0.888. No device-related systemic side effects or serious adverse events were identified.</p><p><strong>Conclusions: </strong>Pulsed shortwave (radiofrequency) therapy did not reduce pain scores and opioid requirements to a statistically significant or clinically relevant degree during the initial postoperative week in this pilot study. These results must be replicated with a subsequent study before being considered definitive. Data from this preliminary study may be used to help plan future trials.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 2","pages":"e70007"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The comparison of spread of methylene blue after the Pericapsular Nerve Group block and a double injection selectively targeting the articular branches to the anterior hip capsule in human cadavers.","authors":"Rachel J H Smits, Edward C T H Tan, Luuk R van den Bersselaar, Anne de Bruijn, Eva Hendriksen, Kris C P Vissers, Kim T E Olde Dubbelink, Selina E I van der Wal","doi":"10.1111/papr.70002","DOIUrl":"10.1111/papr.70002","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, the spread of methylene blue was compared between an ultrasound-guided Pericapsular Nerve Group (PENG) block and a double injection technique, where the approach towards the inferomedial acetabulum was added to the latter.</p><p><strong>Methods: </strong>The two techniques were performed in 11 fresh frozen cadavers. The spread was measured after anatomical dissection in which the supplying femoral and obturator nerves were identified.</p><p><strong>Results and conclusion: </strong>Our study demonstrates adequate staining of the iliac bone with comparable distal and medial spread in both techniques, indicating that the PENG block with a single injection is adequate in blocking the hip capsule with 10 mL local anesthetics. Staining of the femoral nerve occurred in 2/6 specimens after the PENG block, and staining of the obturator nerve in 1 specimen in each group.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 2","pages":"e70002"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triptan treatment is associated with a higher number of red wine-induced migraine episodes: An exploratory questionnaire-based survey.","authors":"Saad Masood, Muhammad Ahrar Bin Naeem, Muhammad Qasim, Javeeria Arshad","doi":"10.1111/papr.13412","DOIUrl":"10.1111/papr.13412","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13412"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"11. Cervicogenic headache and occipital neuralgia.","authors":"Nicole Lefel, Hans van Suijlekom, Steven P C Cohen, Jan Willem Kallewaard, Jan Van Zundert","doi":"10.1111/papr.13405","DOIUrl":"10.1111/papr.13405","url":null,"abstract":"<p><strong>Introduction: </strong>Cervicogenic headache (CEH) and occipital neuralgia (ON) are headaches originating in the occiput and that radiate to the vertex. Because of the intimate relationship between structures based in the occiput and those in the upper cervical region, there is significant overlap between the presentation of CEH and ON. Diagnosis starts with a headache history to assess for diagnostic criteria formulated by the International Headache Society. Physical examination evaluates range of motion of the neck and the presence of tender areas or pressure points.</p><p><strong>Methods: </strong>The literature for the diagnosis and treatment of CEH and ON was searched from 2015 through August 2022, retrieved, and summarized.</p><p><strong>Results: </strong>Conservative treatment includes pain education and self-care, analgesic medication, physical therapy (such as reducing secondary muscle tension and improving posture), the use of TENS (transcutaneous electrical nerve stimulation), or a combination of the aforementioned treatments. Injection at various anatomical locations with local anesthetic with or without corticosteroids can provide pain relief for a short period. Deep cervical plexus block can result in improved pain for less than 6 months. In both CEH and ON, an occipital nerve block can provide important diagnostic information and improve pain in some patients, with PRF providing greater long-term pain control. Radiofrequency ablation of the cervical facet joints can result in improvement for over 1 year. Occipital nerve stimulation (ONS) should be considered for the treatment of refractory ON.</p><p><strong>Conclusion: </strong>The treatment of CEH preferentially consists of radiofrequency treatment of the facet joints, while for ON, pulsed radiofrequency of the occipital nerves is indicated. For refractory cases, ONS may be considered.</p>","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":" ","pages":"e13405"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11680101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosing persistent spinal pain syndrome type 2.","authors":"Alaa Abd-Elsayed, Christopher Gilligan","doi":"10.1111/papr.13447","DOIUrl":"https://doi.org/10.1111/papr.13447","url":null,"abstract":"","PeriodicalId":19974,"journal":{"name":"Pain Practice","volume":"25 1","pages":"e13447"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}