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Norbury R, Smith SA, Burnley M, Judge M, Mauger AR. The effect of hypertonic saline evoked muscle pain on neurophysiological changes and exercise performance in the contralateral limb. Exp Brain Res 2022; 240:1423-1434. [PMID: 35288782 PMCID: PMC9038847 DOI: 10.1007/s00221-022-06342-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
Non-local muscle pain may impair endurance performance through neurophysiological mechanisms, but these are relatively unknown. This study examined the effects of muscle pain on neuromuscular and neurophysiological responses in the contralateral limb. On separate visits, nine participants completed an isometric time to task failure (TTF) using the right knee extensors after intramuscular injection of isotonic saline (CTRL) or hypertonic saline (HYP) into the left vastus lateralis. Measures of neuromuscular fatigue were taken before, during and after the TTF using transcranial magnetic stimulation (TMS) and peripheral nerve stimulation. Mean pain intensity was greater in the left leg in HYP (3.3 ± 1.9) compared to CTRL (0.4 ± 0.7; P < 0.001) which was combined with a reduced TTF by 9.8% in HYP (4.54 ± 0.56 min) compared to CTRL (5.07 ± 0.77 min; P = 0.005). Maximum voluntary force was not different between conditions (all P > 0.05). Voluntary activation was lower in HYP compared to CTRL (P = 0.022). No difference was identified between conditions for doublet amplitude (P > 0.05). Furthermore, no difference in MEP·Mmax−1 or the TMS silent period between conditions was observed (all P > 0.05). Non-local pain impairs endurance performance of the contralateral limb. This impairment in performance is likely due to the faster attainment of the sensory tolerance limit from a greater amount of sensory feedback originating from the non-exercising, but painful, left leg.
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Affiliation(s)
- Ryan Norbury
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chipperfield Building Room 114, Canterbury Campus, Kent, CT2 7PE, UK
| | - Samuel A Smith
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chipperfield Building Room 114, Canterbury Campus, Kent, CT2 7PE, UK
| | - Mark Burnley
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chipperfield Building Room 114, Canterbury Campus, Kent, CT2 7PE, UK
| | - Megan Judge
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chipperfield Building Room 114, Canterbury Campus, Kent, CT2 7PE, UK
| | - Alexis R Mauger
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chipperfield Building Room 114, Canterbury Campus, Kent, CT2 7PE, UK.
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Quesada C, Kostenko A, Ho I, Leone C, Nochi Z, Stouffs A, Wittayer M, Caspani O, Brix Finnerup N, Mouraux A, Pickering G, Tracey I, Truini A, Treede RD, Garcia-Larrea L. Human surrogate models of central sensitization: A critical review and practical guide. Eur J Pain 2021; 25:1389-1428. [PMID: 33759294 PMCID: PMC8360051 DOI: 10.1002/ejp.1768] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022]
Abstract
Background As in other fields of medicine, development of new medications for management of neuropathic pain has been difficult since preclinical rodent models do not necessarily translate to the clinics. Aside from ongoing pain with burning or shock‐like qualities, neuropathic pain is often characterized by pain hypersensitivity (hyperalgesia and allodynia), most often towards mechanical stimuli, reflecting sensitization of neural transmission. Data treatment We therefore performed a systematic literature review (PubMed‐Medline, Cochrane, WoS, ClinicalTrials) and semi‐quantitative meta‐analysis of human pain models that aim to induce central sensitization, and generate hyperalgesia surrounding a real or simulated injury. Results From an initial set of 1569 reports, we identified and analysed 269 studies using more than a dozen human models of sensitization. Five of these models (intradermal or topical capsaicin, low‐ or high‐frequency electrical stimulation, thermode‐induced heat‐injury) were found to reliably induce secondary hyperalgesia to pinprick and have been implemented in multiple laboratories. The ability of these models to induce dynamic mechanical allodynia was however substantially lower. The proportion of subjects who developed hypersensitivity was rarely provided, giving rise to significant reporting bias. In four of these models pharmacological profiles allowed to verify similarity to some clinical conditions, and therefore may inform basic research for new drug development. Conclusions While there is no single “optimal” model of central sensitization, the range of validated and easy‐to‐use procedures in humans should be able to inform preclinical researchers on helpful potential biomarkers, thereby narrowing the translation gap between basic and clinical data. Significance Being able to mimic aspects of pathological pain directly in humans has a huge potential to understand pathophysiology and provide animal research with translatable biomarkers for drug development. One group of human surrogate models has proven to have excellent predictive validity: they respond to clinically active medications and do not respond to clinically inactive medications, including some that worked in animals but failed in the clinics. They should therefore inform basic research for new drug development.
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Affiliation(s)
- Charles Quesada
- NeuroPain lab, Lyon Centre for Neuroscience Inserm U1028, Lyon, France.,Pain Center Neurological Hospital (CETD), Hospices Civils de Lyon, Lyon, France
| | - Anna Kostenko
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Idy Ho
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Zahra Nochi
- Danish Pain Research Center, Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alexandre Stouffs
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | - Matthias Wittayer
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - André Mouraux
- Institute of Neuroscience (IoNS), Université Catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | | | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim center for Translational Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Luis Garcia-Larrea
- NeuroPain lab, Lyon Centre for Neuroscience Inserm U1028, Lyon, France.,Pain Center Neurological Hospital (CETD), Hospices Civils de Lyon, Lyon, France
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Oda S, Izumi M, Takaya S, Tadokoro N, Aso K, Petersen KK, Ikeuchi M. Promising Effect of Visually-Assisted Motor Imagery Against Arthrogenic Muscle Inhibition - A Human Experimental Pain Study. J Pain Res 2021; 14:285-295. [PMID: 33568937 PMCID: PMC7868204 DOI: 10.2147/jpr.s282736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/13/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose Clinically, arthrogenic muscle inhibition (AMI) has a negative impact on functional recovery in musculoskeletal disorders. One possible technique to relieve AMI is motor imagery, which is widely used in neurological rehabilitation to enhance motor neuron excitability. The purpose of this study was to verify the efficacy of visually-assisted motor imagery against AMI using a human experimental pain model. Methods Ten healthy volunteers were included. Experimental ankle pain was induced by hypertonic saline infusion into unilateral Kager’s fat pad. Isotonic saline was used as control. Subjects were instructed to imagine while watching a movie in which repetitive motion of their own ankle or fingers was shown. H-reflex normalized by the motor response (H/M ratio) on soleus muscle, maximal voluntary contraction (MVC) force of ankle flexion, and contractile activities of the calf muscles during MVC were recorded at baseline, pre-intervention, post-intervention, and 10 minutes after the pain had subsided. Results Hypertonic saline produced continuous and constant peri-ankle pain (VAS peak [median]= 6.7 [2.1–8.4] cm) compared to isotonic saline (0 [0–0.8] cm). In response to pain, there were significant decreases in the H/M ratio, MVC and contractile activities (P<0.01), all of which were successfully reversed after the ankle motion imagery. In contrast, no significant changes were observed with the finger motion imagery. Conclusion Visually-assisted motor imagery improved the pain-induced AMI. Motor imagery of the painful joint itself would efficiently work for relieving AMI. This investigation possibly shows the potential of a novel and versatile approach against AMI for patients with musculoskeletal pain.
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Affiliation(s)
- Shota Oda
- Department of Rehabilitation Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Masashi Izumi
- Department of Rehabilitation Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan.,Department of Orthopedic Surgery, Kochi University, Nankoku, Kochi, Japan
| | - Shogo Takaya
- Department of Rehabilitation Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan.,Department of Orthopedic Surgery, Kochi University, Nankoku, Kochi, Japan
| | - Nobuaki Tadokoro
- Department of Orthopedic Surgery, Kochi University, Nankoku, Kochi, Japan
| | - Koji Aso
- Department of Orthopedic Surgery, Kochi University, Nankoku, Kochi, Japan
| | - Kristian Kjær Petersen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Masahiko Ikeuchi
- Department of Rehabilitation Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan.,Department of Orthopedic Surgery, Kochi University, Nankoku, Kochi, Japan
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Ford B, Halaki M, Diong J, Ginn KA. Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review. Scand J Pain 2020; 21:217-237. [PMID: 34387953 DOI: 10.1515/sjpain-2020-0076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/16/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Experimental pain is a commonly used method to draw conclusions about the motor response to clinical musculoskeletal pain. A systematic review was performed to determine if current models of acute experimental pain validly replicate the clinical experience of appendicular musculoskeletal pain with respect to the distribution and quality of pain and the pain response to provocation testing. METHODS A structured search of Medline, Scopus and Embase databases was conducted from database inception to August 2020 using the following key terms: "experimental muscle pain" OR "experimental pain" OR "pain induced" OR "induced pain" OR "muscle hyperalgesia" OR ("Pain model" AND "muscle"). Studies in English were included if investigators induced experimental musculoskeletal pain into a limb (including the sacroiliac joint) in humans, and if they measured and reported the distribution of pain, quality of pain or response to a provocation manoeuvre performed passively or actively. Studies were excluded if they involved prolonged or delayed experimental pain, if temporomandibular, orofacial, lumbar, thoracic or cervical spine pain were investigated, if a full text of the study was not available or if they were systematic reviews. Two investigators independently screened each title and abstract and each full text paper to determine inclusion in the review. Disagreements were resolved by consensus with a third investigator. RESULTS Data from 57 experimental pain studies were included in this review. Forty-six of these studies reported pain distribution, 41 reported pain quality and six detailed the pain response to provocation testing. Hypertonic saline injection was the most common mechanism used to induce pain with 43 studies employing this method. The next most common methods were capsaicin injection (5 studies) and electrical stimulation, injection of acidic solution and ischaemia with three studies each. The distribution of experimental pain was similar to the area of pain reported in clinical appendicular musculoskeletal conditions. The quality of appendicular musculoskeletal pain was not replicated with the affective component of the McGill Pain Questionnaire consistently lower than that typically reported by musculoskeletal pain patients. The response to provocation testing was rarely investigated following experimental pain induction. Based on the limited available data, the increase in pain experienced in clinical populations during provocative maneuvers was not consistently replicated. CONCLUSIONS Current acute experimental pain models replicate the distribution but not the quality of chronic clinical appendicular musculoskeletal pain. Limited evidence also indicates that experimentally induced acute pain does not consistently increase with tests known to provoke pain in patients with appendicular musculoskeletal pain. The results of this review question the validity of conclusions drawn from acute experimental pain studies regarding changes in muscle behaviour in response to pain in the clinical setting.
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Affiliation(s)
- Brendon Ford
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
| | - Mark Halaki
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSWAustralia
| | - Joanna Diong
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
| | - Karen A Ginn
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW Australia
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Mukhdomi T, Kendall MC. Comment on a paper by Ibrahim et al. entitled "Ultrasound-guided adductor canal block after arthroscopic anterior cruciate ligament reconstruction: Effect of adding dexamethasone to bupivacaine, a randomized controlled trial". Eur J Pain 2018; 23:635. [PMID: 30582874 DOI: 10.1002/ejp.1350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Taif Mukhdomi
- Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark C Kendall
- Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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