After thorough instruction about PEPT, the patients, along with their spouses, set their personal, functional treatment goals. The therapists acted mainly as instructors and coaches, and confirmed and rewarded progression with positive feedback. As a business (-to-business) mediator, Caroline mediates in a variety of business conflicts.

Red in figure legend indicates an FDR with positive correlation and blue indicates FDR with negative correlation. (B) Scatterplots show the effect of dietary pattern on cytokines with significant correlation. Blue dots and lines indicate males, red dots and lines indicate females. Fear-avoidance beliefs, catastrophizing, and kinesiophobia decreased significantly in both groups (Fig 3, Table 2). Patients in the CONV group experienced a decrease in the FABQ work and physical activities scores of 37% (mean improvement 6.0; 95% CI -2.2 to 14.3; n.s.) and 27% (mean improvement 5.6; 95% CI 0.3 to 10.9) respectively.

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At first glance, the CONV group contained relatively more patients with an affected upper extremity and the dominant side was relatively more often affected in this group. Also, the mean time since inciting event and the dispersion appeared different between groups. We used linear mixed models with unstructured repeated covariance, treatment and measurement in time as factors and outcome at baseline as covariate, to determine the between-group differences on the dependent variables over time. Because 26.8% of the patients switched groups prior to treatment initiation, shifts in baseline characteristics occurred. Therefore, we added these as potential confounders (affected extremity and dominant side affected as factors, and time since inciting event as covariate) to the analysis.

Conventional physical therapy was focused on controlling pain, using movements within pain limits, mild exposure and increasing the capacity to perform daily activities step by step in a pain-contingent manner. Pharmacological treatment included the use of analgesics in a step-up procedure in accordance with the WHO pain ladder; free radical scavengers including dimethylsulphoxide 50% ointment (DMSO) and N-acetylcysteine; calcium channel blockers; and ketanserine. Patients presenting with allodynia or hyperalgesia were given gabapentin, amitriptyline, or carbamazepine. Dystonia, myoclonia, and muscle spasms were treated with baclofen, diazepam, or clonazepam. In Familieconflict of cold skin, the anaesthesiologist would prescribe vasodilating drugs such as verapamil, ketensin, and pentoxiphylline. In case of insufficient clinical effect, sympathetic blockade, transcutaneous electrical nerve stimulation, or spinal cord stimulation was considered [16].

Conventional treatment is mainly focused at decreasing pain, where pain is regarded as a sign of physical overload. By decreasing pain with (usually) pharmacological interventions, the physical capacity is increased with pain-contingent physical therapy. Mediation analysis was used to investigate whether the identified diet-immune relations are mediated by microbial species.

The gut microbiome (GM) helps metabolize nutrients, complementing the host’s metabolism8,9. Not only does the GM help extract nutrients, the microbiota also help calibrate immune responses in such a way that the GM and immune system constantly interact to create a gut-immune homeostasis10. One example is the microbial production of short-chain fatty acids (SCFAs) that possess anti-inflammatory properties and modulate cytokine production11. Identifying the mechanisms of diet-immune interactions could help us regulate the effect diet has on the immune system through modulation of the GM.