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GEVA NIRIT, PRUESSNER JENS, DEFRIN RUTH. Triathletes Lose Their Advantageous Pain Modulation under Acute Psychosocial Stress. Med Sci Sports Exerc 2017; 49:333-341. [DOI: 10.1249/mss.0000000000001110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Somatosensory Brain Function and Gray Matter Regional Volumes Differ According to Exercise History: Evidence from Monozygotic Twins. Brain Topogr 2016; 30:77-86. [DOI: 10.1007/s10548-016-0531-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
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Gehling J, Mainka T, Vollert J, Pogatzki-Zahn EM, Maier C, Enax-Krumova EK. Short-term test-retest-reliability of conditioned pain modulation using the cold-heat-pain method in healthy subjects and its correlation to parameters of standardized quantitative sensory testing. BMC Neurol 2016; 16:125. [PMID: 27495743 PMCID: PMC4974731 DOI: 10.1186/s12883-016-0650-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 07/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Conditioned Pain Modulation (CPM) is often used to assess human descending pain inhibition. Nine different studies on the test-retest-reliability of different CPM paradigms have been published, but none of them has investigated the commonly used heat-cold-pain method. The results vary widely and therefore, reliability measures cannot be extrapolated from one CPM paradigm to another. Aim of the present study was to analyse the test-retest-reliability of the common heat-cold-pain method and its correlation to pain thresholds. METHODS We tested the short-term test-retest-reliability within 40 ± 19.9 h using a cold-water immersion (10 °C, left hand) as conditioning stimulus (CS) and heat pain (43-49 °C, pain intensity 60 ± 5 on the 101-point numeric rating scale, right forearm) as test stimulus (TS) in 25 healthy right-handed subjects (12females, 31.6 ± 14.1 years). The TS was applied 30s before (TSbefore), during (TSduring) and after (TSafter) the 60s CS. The difference between the pain ratings for TSbefore and TSduring represents the early CPM-effect, between TSbefore and TSafter the late CPM-effect. Quantitative sensory testing (QST, DFNS protocol) was performed on both sessions before the CPM assessment. STATISTICS paired t-tests, Intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD), Pearson's correlation, Bland-Altman analysis, significance level p < 0.05 with Bonferroni correction for multiple comparisons, when necessary. RESULTS Pain ratings during CPM correlated significantly (ICC: 0.411…0.962) between both days, though ratings for TSafter were lower on day 2 (p < 0.005). The early (day 1: 16.7 ± 11.7; day 2: 19.5 ± 11.9; ICC: 0.618, SRD: 20.2) and late (day 1: 1.7 ± 9.2; day 2: 7.6 ± 11.5; ICC: 0.178, SRD: 27.0) CPM effect did not differ significantly between both days. Both early and late CPM-effects did not correlate with the pain thresholds. CONCLUSIONS The short-term test-retest-reliability of the early CPM-effect using the heat-cold-pain method in healthy subjects achieved satisfying results in terms of the ICC. The SRD of the early CPM effect showed that an individual change of > 20 NRS can be attributed to a real change rather than chance. The late CPM-effect was weaker and not reliable.
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Affiliation(s)
- Julia Gehling
- Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Tina Mainka
- Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jan Vollert
- Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Esther M. Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, GB A1, 48149 Münster, Germany
| | - Christoph Maier
- Department of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Elena K. Enax-Krumova
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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Flood A, Waddington G, Thompson K, Cathcart S. Increased conditioned pain modulation in athletes. J Sports Sci 2016; 35:1066-1072. [DOI: 10.1080/02640414.2016.1210196] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Tyros I, Soundy A, Heneghan NR. Vibration sensibility of the median nerve in a population with chronic whiplash associated disorder: Intra- and inter-rater reliability study. ACTA ACUST UNITED AC 2016; 25:81-6. [PMID: 27422601 DOI: 10.1016/j.math.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/25/2022]
Abstract
UNLABELLED Whiplash Associated Disorders (WAD) grade II are the most prevalent group of whiplash patients seen on a regular basis by musculoskeletal physiotherapists. Impairment of vibration sensibility may be an early indicator of nerve pathology and it has previously been demonstrated in individuals with chronic WAD symptoms utilising vibrameters. A less expensive option, such the tuning fork (TF) may assist with these measures, but research regarding its measurement properties is lacking. OBJECTIVES To investigate the intra- and inter-rater reliability of vibration sensibility of the median nerve in chronic WAD II (CWAD II). METHODS A double blinded, within day intra- and inter-rater reliability study was undertaken. A convenience sample of 26 individuals (8 males, 18 females, age mean 29.9 ± 10.0 years) with CWADII was recruited. EXCLUSION CRITERIA WAD I, III & indications of neuropathic pain. Vibration attenuation times were recorded from skin innervated by the median nerve (thenar eminence). RESULTS Descriptive statistics (mean scores) and reliability statistics [intraclass correlation coefficient (ICC2,1) and Bland and Altman limits of agreement] were undertaken with p = 0.05. Almost perfect intra-rater reliability (Intraclass Correlation Coefficiency (ICC): 0.972-0.955) and inter-rater reliability (ICC: 0.983) were identified. Confidence Intervals (CI) for inter-rater reliability were 95% CI: -1.461 to -0.056. CONCLUSIONS Almost perfect reliability scores across intra- and inter-rater reliability were found. This provides evidence that, with a standardised testing protocol the TF can be a highly reliable means of vibration sensibility testing. Future studies assessing the validity of the TF in different WAD populations may provide further information about the usefulness of this protocol.
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Affiliation(s)
- I Tyros
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - A Soundy
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - N R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Low back pain in athletes and non-athletes: a group comparison of basic pain parameters and impact on sports activity. SPORT SCIENCES FOR HEALTH 2016. [DOI: 10.1007/s11332-016-0288-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lucas SJE, Helge JW, Schütz UHW, Goldman RF, Cotter JD. Moving in extreme environments: extreme loading; carriage versus distance. EXTREME PHYSIOLOGY & MEDICINE 2016; 5:6. [PMID: 27110357 PMCID: PMC4840901 DOI: 10.1186/s13728-016-0047-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/01/2016] [Indexed: 12/17/2022]
Abstract
This review addresses human capacity for movement in the context of extreme loading and with it the combined effects of metabolic, biomechanical and gravitational stress on the human body. This topic encompasses extreme duration, as occurs in ultra-endurance competitions (e.g. adventure racing and transcontinental races) and expeditions (e.g. polar crossings), to the more gravitationally limited load carriage (e.g. in the military context). Juxtaposed to these circumstances is the extreme metabolic and mechanical unloading associated with space travel, prolonged bedrest and sedentary lifestyle, which may be at least as problematic, and are therefore included as a reference, e.g. when considering exposure, dangers and (mal)adaptations. As per the other reviews in this series, we describe the nature of the stress and the associated consequences; illustrate relevant regulations, including why and how they are set; present the pros and cons for self versus prescribed acute and chronic exposure; describe humans' (mal)adaptations; and finally suggest future directions for practice and research. In summary, we describe adaptation patterns that are often U or J shaped and that over time minimal or no load carriage decreases the global load carrying capacity and eventually leads to severe adverse effects and manifest disease under minimal absolute but high relative loads. We advocate that further understanding of load carrying capacity and the inherent mechanisms leading to adverse effects may advantageously be studied in this perspective. With improved access to insightful and portable technologies, there are some exciting possibilities to explore these questions in this context.
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Affiliation(s)
- Samuel J. E. Lucas
- />School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- />Department of Physiology, University of Otago, Dunedin, New Zealand
| | - Jørn W. Helge
- />Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uwe H. W. Schütz
- />Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany
- />Orthopaedic Consulting Office at the Green Tower and Medical Pain Centre Lake Constance–Upper Swabia, Ravensburg, Germany
| | | | - James D. Cotter
- />School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
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Umeda M, Kempka LE, Greenlee BT, Weatherby AC. A smaller magnitude of exercise-induced hypoalgesia in African Americans compared to non-Hispanic Whites: A potential influence of physical activity. Biol Psychol 2016; 113:46-51. [DOI: 10.1016/j.biopsycho.2015.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/22/2015] [Accepted: 11/15/2015] [Indexed: 11/28/2022]
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Krüger S, Khayat D, Hoffmeister M, Hilberg T. Pain thresholds following maximal endurance exercise. Eur J Appl Physiol 2015; 116:535-40. [PMID: 26700745 DOI: 10.1007/s00421-015-3307-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Physical exercise causes alterations in pain sensitivity. Many studies verified so-called exercise-induced analgesia caused by submaximal aerobic intensity. This study aimed to determine the effect of an endurance exercise to exhaustion on pain sensitivity of healthy young men. METHOD Pressure pain thresholds (PPTs) [in Newton, (N)] of 50 healthy males (mean age 26 ± 4 years) were applied to knee, ankle and elbow joints as well as to the sternum and forehead. This was followed by a bout of cycling ergometer exercise to exhaustion. The whole process was repeated after 20 and 60 min respectively. RESULTS Endurance exercise to exhaustion decreased PPTs at sternum and forehead significantly, while thresholds at the joints were not affected. Pain thresholds at forehead and sternum declined 20 min after exercise with the forehead's threshold being more reduced. PPTs remain decreased until 60 min after exercise (forehead: from 43.6 ± 15.2 N to 36.6 ± 19.8 N to 37.2 ± 13.4 N; sternum: from 46.8 ± 21.0 N to 42.5 ± 17.1 N to 44.8 ± 18.2 N). Modulation of pain sensitivity showed large effect sizes over time for both landmarks (forehead w = 0.65; sternum w = 0.50). CONCLUSION Exhaustive endurance exercise is followed by a hyperalgetic condition at forehead and sternum. This may be due to either a reduction in pain inhibiting or an activation in pain stimulating pathways.
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Affiliation(s)
- Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstraße 7, 42285, Wuppertal, Germany.
| | - Dominik Khayat
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstraße 7, 42285, Wuppertal, Germany.
| | - Meike Hoffmeister
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstraße 7, 42285, Wuppertal, Germany.
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Pauluskirchstraße 7, 42285, Wuppertal, Germany.
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Saxena I, Kumar M, Barath AS, Verma A, Garg S, Kumar M. Effect of Age on Response to Experimental Pain in Normal Indian Males. J Clin Diagn Res 2015; 9:CC05-8. [PMID: 26500901 DOI: 10.7860/jcdr/2015/15385.6516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/17/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Response to experimental pain depends on the nature of the pain stimulus, as well as on gender, racial, cultural and socioeconomic factors. This study investigates the effect of age on pain sensitivity and cardiovascular reactivity produced by experimental pain. We have also compared the values of body mass index (BMI) and resting blood pressure of volunteers with the normal values. MATERIALS AND METHODS The study was conducted on 83 Indian males of different age groups. The volunteers were divided into 4 groups: Children, Young Adults, Middle-Aged Adults and Old Adults; and their basal parameters (BMI, resting pulse and blood pressure) were recorded. Selected volunteers were subjected to cold pressor task (CPT). Pain sensitivity (PS) (pain threshold, tolerance and pain rating on a visual analog scale) and cardiovascular reactivity (CVR) (increase in pulse and blood pressure) were recorded. RESULTS Many volunteers had abnormal values of BMI and resting blood pressure and had to be excluded from the study. PS and CVR between different groups were compared by one-way ANOVA. Significant differences in PS were observed, with highest pain sensitivity in Children and lowest in Old Adults. No significant differences were observed in the CVR. CONCLUSION The high numbers of volunteers with abnormal basal parameters (BMI and resting blood pressure) show an urgent need to educate the general public about the dangers and risk factors of obesity and hypertension. Less exposure of children to painful encounters may be responsible for their high pain sensitivity while higher values of resting blood pressure and decreased sensitivity of the sensory systems with advancing age may be responsible for the hypoalgesia observed in old adults.
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Affiliation(s)
- Indu Saxena
- Assistant Professor, Deparment of Biochemistry, AIIMS Jodhpur, Rajasthan, India
| | - Manoj Kumar
- Professor, Department of Physiology, TMMC & RC , Moradabad, Uttar Predesh, India
| | | | - Anjali Verma
- Demonstrator, Department of Physiology, TMMC & RC , Moradabad, Uttar Predesh, India
| | - Sumit Garg
- Assistant Professor, Department of Physiology, SIMS , Hapur, Uttar Predesh, India
| | - Manoj Kumar
- Social Worker, Department of Community Medicine, TMMC & RC Moradabad, Uttar Predesh, India
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Physical activity, pain responses to heat stimuli, and conditioned pain modulation in postmenopausal women. Menopause 2015; 22:816-25. [DOI: 10.1097/gme.0000000000000398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Umeda M, Lee W, Marino CA, Hilliard SC. Influence of moderate intensity physical activity levels and gender on conditioned pain modulation. J Sports Sci 2015; 34:467-76. [DOI: 10.1080/02640414.2015.1061199] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hermans L, Van Oosterwijck J, Goubert D, Goudman L, Crombez G, Calders P, Meeus M. Inventory of Personal Factors Influencing Conditioned Pain Modulation in Healthy People: A Systematic Literature Review. Pain Pract 2015; 16:758-69. [DOI: 10.1111/papr.12305] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/09/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Linda Hermans
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Jessica Van Oosterwijck
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Dorien Goubert
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Lisa Goudman
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology; Ghent University; Ghent Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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Vaegter HB, Handberg G, Jørgensen MN, Kinly A, Graven-Nielsen T. Aerobic Exercise and Cold Pressor Test Induce Hypoalgesia in Active and Inactive Men and Women. PAIN MEDICINE 2015; 16:923-33. [DOI: 10.1111/pme.12641] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lemming D, Börsbo B, Sjörs A, Lind EB, Arendt-Nielsen L, Graven-Nielsen T, Gerdle B. Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness--a study of non-athletic healthy subjects. PLoS One 2015; 10:e0125432. [PMID: 25933412 PMCID: PMC4416774 DOI: 10.1371/journal.pone.0125432] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/17/2015] [Indexed: 02/03/2023] Open
Abstract
Exercise is often used for pain rehabilitation but the link between physical activity level and pain sensitivity is still not fully understood. Pressure pain sensitivity to cuff algometry and conditioned pain modulation (CPM) were evaluated in highly active men (n=22), normally active men (n=26), highly active women (n=27) and normally active women (n=23) based on the Godin Leisure-Time Exercise Questionnaire. Cuff pressure pain sensitivity was assessed at the arm and lower leg. The subjects scored the pain intensity on an electronic Visual Analogue Scale (VAS) during ten minutes with 25 kPa constant cuff pressure and two minutes with zero pressure. The maximal VAS score and area under the VAS-curve were extracted. Pressure pain thresholds (PPT) were recorded by manual pressure algometry on the ipsilateral tibialis anterior muscle before, during and after the tonic arm stimulation. Tonic cuff stimulation of the arm and leg resulted in higher VAS peak scores in women compared with men (p<0.04). In all groups the PPTs were reduced during and after the cuff stimulation compared with baseline (p=0.001). PPT were higher in men compared with women (p=0.03) and higher in highly physical active compared with normal active (p=0.048). Besides the well-known gender difference in pressure pain sensitivity this study demonstrates that a high physical fitness degree in non-athletic subjects is associated with increased pressure pain thresholds but does not affect cuff pressure pain sensitivity in healthy people.
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Affiliation(s)
- Dag Lemming
- Department of Pain and Rehabilitation Center and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
- * E-mail:
| | - Björn Börsbo
- Department of Pain and Rehabilitation Center and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Anna Sjörs
- Department of Pain and Rehabilitation Center and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Eva-Britt Lind
- Department of Pain and Rehabilitation Center and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Laboratory for Experimental Pain Research, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Sensory-Motor Interaction (SMI), Laboratory for Experimental Pain Research, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Björn Gerdle
- Department of Pain and Rehabilitation Center and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
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Khan J, Benavent V, Korczeniewska OA, Benoliel R, Eliav E. Exercise-Induced Hypoalgesia Profile in Rats Predicts Neuropathic Pain Intensity Induced by Sciatic Nerve Constriction Injury. THE JOURNAL OF PAIN 2014; 15:1179-1189. [DOI: 10.1016/j.jpain.2014.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/21/2014] [Accepted: 08/27/2014] [Indexed: 01/07/2023]
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de Zanette SA, Vercelino R, Laste G, Rozisky JR, Schwertner A, Machado CB, Xavier F, de Souza ICC, Deitos A, Torres ILS, Caumo W. Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial. BMC Pharmacol Toxicol 2014; 15:40. [PMID: 25052847 PMCID: PMC4119581 DOI: 10.1186/2050-6511-15-40] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/16/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Central disinhibition is a mechanism involved in the physiopathology of fibromyalgia. Melatonin can improve sleep quality, pain and pain threshold. We hypothesized that treatment with melatonin alone or in combination with amitriptyline would be superior to amitriptyline alone in modifying the endogenous pain-modulating system (PMS) as quantified by conditional pain modulation (CPM), and this change in CPM could be associated with serum brain-derived neurotrophic factor (BDNF). We also tested whether melatonin improves the clinical symptoms of pain, pain threshold and sleep quality. METHODS Sixty-three females, aged 18 to 65, were randomized to receive bedtime amitriptyline (25 mg) (n = 21), melatonin (10 mg) (n = 21) or melatonin (10 mg) + amitriptyline (25 mg) (n = 21) for a period of six weeks. The descending PMS was assessed with the CPM-TASK. It was assessed the pain score on the Visual Analog Scale (VAS 0-100 mm), the score on Fibromyalgia Impact Questionnaire (FIQ), heat pain threshold (HPT), sleep quality and BDNF serum. Delta values (post- minus pre-treatment) were used to compare the treatment effect. The outcomes variables were collected before, one and six weeks after initiating treatment. RESULTS Melatonin alone or in combination with amitriptyline reduced significantly pain on the VAS compared with amitriptyline alone (P < 0.01). The delta values on the VAS scores were-12.85 (19.93),-17.37 (18.69) and-20.93 (12.23) in the amitriptyline, melatonin and melatonin+amitriptyline groups, respectively. Melatonin alone and in combination increased the inhibitory PMS as assessed by the Numerical Pain Scale [NPS(0-10)] reduction during the CPM-TASK:-2.4 (2.04) melatonin + amitriptyline,-2.65 (1.68) melatonin, and-1.04 (2.06) amitriptyline, (P < 0.05). Melatonin + amitriptyline treated displayed better results than melatonin and amitriptyline alone in terms of FIQ and PPT improvement (P < 0.05, fort both). CONCLUSION Melatonin increased the inhibitory endogenous pain-modulating system as assessed by the reduction on NPS(0-10) during the CPM-TASK. Melatonin alone or associated with amitriptyline was better than amitriptyline alone in improving pain on the VAS, whereas its association with amitriptyline produced only marginal additional clinical effects on FIQ and PPT. TRIAL REGISTRATION Current controlled trail is registered at clinical trials.gov upon under number NCT02041455. Registered January 16, 2014.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Wolnei Caumo
- Pain and Palliative Care Service at the Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Tesarz J, Gerhardt A, Treede RD, Eich W. [Pain perception in athletes: characteristic features in pain processing by athletes compared to non-athletes]. Schmerz 2014; 28:184-7. [PMID: 24718749 DOI: 10.1007/s00482-014-1400-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Tesarz
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland,
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Tesarz J, Gerhardt A, Treede RD, Eich W. Authors' response. Pain 2013; 154:2888-2890. [PMID: 24157895 DOI: 10.1016/j.pain.2013.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 10/16/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg D-69120, Germany Chair of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), University of Heidelberg, Mannheim D-68167, Germany Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Heidelberg D-69120, Germany
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Freund W, Schuetz UH, Weber F, Birklein F. Correspondence to Tesarz et al. Alterations in endogenous pain modulation in endurance athletes: An experimental study using quantitative sensory testing and the cold-pressor task. PAIN® 154, 1022–29, 2013. Pain 2013; 154:2234-2235. [DOI: 10.1016/j.pain.2013.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 07/07/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
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