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Naunton J, Kidgell D, Bennell K, Haines T, Malliaras P. The efficacy of high load-volume exercise versus low load-volume exercise for rotator cuff tendinopathy: A pilot and feasibility trial. Musculoskelet Sci Pract 2024; 75:103218. [PMID: 39591809 DOI: 10.1016/j.msksp.2024.103218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 10/22/2024] [Accepted: 11/12/2024] [Indexed: 11/28/2024]
Abstract
BACKGROUND The most effective exercise variables for rotator cuff tendinopathy are unknown. OBJECTIVE Determine feasibility of a fully powered trial comparing high load-volume versus low load-volume exercise for adults with rotator cuff tendinopathy. DESIGN Two arm, multi-centre pilot and feasibility randomised controlled trial. METHODS Participants aged over 18 were recruited via social media and randomised into 12 weeks of either high load-volume exercise (i.e. with dumbbell resistance) or low load-volume exercise (i.e. without added resistance). Feasibility outcomes were rates of recruitment, retention, questionnaire completion, adverse events and adherence to prescribed exercise. RESULTS Fifteen participants were randomised to high load-volume and 16 to low load-volume (18/31 were female). Retention rate was 84% at 6 weeks, and 81% at 12 and 26 weeks. Five participants withdrew and one participant was lost to follow up. Questionnaire completion rate was 78%. Adherence to the prescribed exercise sets was 77%. Recruitment, conversion and retention rates were above the pre-defined success criterion. There were no serious adverse events. CONCLUSION A fully powered multi-centre randomised trial is feasible with minor amendments addressing exercise adherence and questionnaire response rate. Future trials should utilise outcomes that consider participants baseline physical activity levels and adequately measure pain disparate from performance.
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Affiliation(s)
- Josh Naunton
- Monash Musculoskeletal Research Unit (MMRU), Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Building B, Peninsula Campus, Monash University, Victoria, 3199, Australia; Physiotherapy, Department of Rural Allied Health, La Trobe University Rural Health School, Bendigo, Victoria, 3550, Australia; Physiotherapy & Exercise Physiology, Allied Health and Continuing Care, Bendigo Health, Bendigo, Victoria, 3550, Australia.
| | - Dawson Kidgell
- Monash Exercise Neuroplasticity Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Building B, Peninsula Campus, Monash University, Victoria, 3199, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Level 7, Alan Gilbert Building, The University of Melbourne, Victoria, 3010, Australia
| | - Terry Haines
- Rehabilitation, Ageing and Independent Living Research Centre, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Building G, Peninsula Campus, Monash University, Victoria, 3199, Australia
| | - Peter Malliaras
- Monash Musculoskeletal Research Unit (MMRU), Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Building B, Peninsula Campus, Monash University, Victoria, 3199, Australia
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Villa Muñoz T, Velázquez Saornil J, Sánchez Milá Z, Romero-Morales C, Almazán Polo J, Baraja Vegas L, Hugo-Villafañe J, Abuín-Porras V. Comparative evaluation of the efficacy of therapeutic exercise versus myofascial trigger point therapy in the treatment of shoulder tendinopathies: a randomised controlled trial. BMJ Open Sport Exerc Med 2024; 10:e002043. [PMID: 39430399 PMCID: PMC11487845 DOI: 10.1136/bmjsem-2024-002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 10/22/2024] Open
Abstract
Objective Shoulder pain, primarily due to rotator cuff tendinopathy, significantly impacts function and quality of life, with considerable socioeconomic implications. Physiotherapy myofascial trigger point therapy (MPT) is traditionally used, but therapeutic exercise (TE) has gained attention for its potential administrative and implementation benefits. The aim of this study was to evaluate the efficacy of TE compared with MPT in treating shoulder tendinopathies. Methods A single-blind randomised controlled trial was conducted comparing TE and MPT. Outcome measures included pain intensity with the Numerical Rating Scale, pressure pain threshold (PPT) and range of motion (ROM), assessed before and after 10 treatment sessions. A total number of 72 participants (TE group n=36 age 49.22±15.29/MTP group n=36 age 49.03±19.12) participated in the study. Interventions Participants in both groups were evaluated before treatment and after 10 sessions. A total of 10 sessions were conducted over 5 weeks of intervention. Results Both interventions showed improvements in pain intensity and ROM, with no significant differences between the groups in most measures except PPT, where TE demonstrated a greater decrease in pressure-induced pain. Conclusion TE could serve as an alternative to manual therapy, offering cost-benefit advantages, especially in administration via telecare and group sessions, highlighting its broader application in physiotherapy. Trial registration number NCT06241404.
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Affiliation(s)
| | | | | | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
| | - Jaime Almazán Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
| | - Luis Baraja Vegas
- Fisioterapia, Universidad Católica de Valencia San Vicente Mártir, Godella, Spain
| | - Jorge Hugo-Villafañe
- Faculty of Sport Sciences, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
| | - Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Madrid, Spain
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Petersen KKS, O'Neill S, Blichfeldt-Eckhardt MR, Nim C, Arendt-Nielsen L, Vægter HB. Pain profiles and variability in temporal summation of pain and conditioned pain modulation in pain-free individuals and patients with low back pain, osteoarthritis, and fibromyalgia. Eur J Pain 2024. [PMID: 39387150 DOI: 10.1002/ejp.4741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/06/2024] [Accepted: 09/24/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Pain profiles (e.g. pro- and anti-nociceptive) can be developed using quantitative sensory testing (QST) but substantial variability exists. This study describes the variability in temporal summation of pain (TSP) and conditioned pain modulation (CPM) in chronic musculoskeletal pain patients, proposes cut-off values, and explores the association with clinical pain intensity. METHODS This is a secondary analysis in which TSP and CPM were assessed using cuff algometry in pain-free subjects (n = 69), and patients with chronic low back pain (cLBP, n = 267), osteoarthritis (n = 134), and fibromyalgia (n = 101). Using TSP and CPM from the pain-free subjects as a reference, four distinct pain profiles TSP (low/high) and CPM (low/high) were created, and differences in clinical pain between pain profiles were explored. RESULTS Individual data revealed large inter-person variability. High TSP and low CPM were found in fibromyalgia (p < 0.01) and osteoarthritis (p < 0.01) but not cLBP when compared to pain-free subjects. The proportion of patients classified into the distinct pain profiles was significantly different (p < 0.001) with the largest proportion in the high TSP and low CPM group in fibromyalgia (52.5%) and osteoarthritis (41.4%). Clinical pain was not significantly different comparing the pain profiles, and no significant correlations were observed between clinical pain and TSP or CPM. CONCLUSION These results demonstrated substantial inter-person variability in TSP and CPM in patients with different chronic pain conditions and pain-free subjects. The proportion of patients with a pro-nociceptive profile appears larger in fibromyalgia and osteoarthritis, but we found no association to clinical pain. SIGNIFICANT STATEMENT This analysis shows that there is variability when assessing TSP and CPM in both pain-free subjects and patients with chronic pain. A cut-off for determining when a person is pain-sensitive is proposed, and data based on this cut-off approach suggest that significantly more patients with osteoarthritis and fibromyalgia are pain-sensitive (i.e. higher TSP and lower CPM) compared to pain-free subjects. This analysis does not find an association between pain sensitivity and clinical pain.
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Affiliation(s)
- Kristian Kjær-Staal Petersen
- Department of Materials and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain, Aalborg University, Aalborg, Denmark
| | - Søren O'Neill
- Department of Regional Health Research, University Hospital of Southern Denmark, Odense, Denmark
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
| | - Morten Rune Blichfeldt-Eckhardt
- Department of Regional Health Research, University Hospital of Southern Denmark, Odense, Denmark
- Department of Anesthesia, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Casper Nim
- Department of Regional Health Research, University Hospital of Southern Denmark, Odense, Denmark
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, Odense, Denmark
| | - Lars Arendt-Nielsen
- Department of Materials and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Bjarke Vægter
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
- Pain Research Group, Pain Center, University Hospital Odense, Odense, Denmark
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Kielstra SC, Reezigt RR, Coppieters MW, de Vries R, Arendt-Nielsen L, Petersen KK, Yarnitsky D, Scholten-Peeters GGM. A myriad of methods to determine temporal summation of pain in people with musculoskeletal pain and healthy participants: a scoping review. Pain Rep 2024; 9:e1176. [PMID: 39239632 PMCID: PMC11377091 DOI: 10.1097/pr9.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 09/07/2024] Open
Abstract
Temporal summation of pain (TSP) is a human proxy for wind-up of dorsal horn neurons as assessed in animals. The common paradigm for eliciting TSP is evoked by repetitive nociceptive stimuli of equal intensity. Various stimulation and assessment protocols have been used. This scoping review aims to provide insight into key elements of TSP stimulation and assessment: modality, instruments, test location, familiarization, train characteristics, and calculations. PubMed, Embase, and Ebsco/CINAHL were searched for studies that measured TSP in adults with musculoskeletal conditions and healthy people. Four hundred six studies were included. Mechanical stimuli were the most commonly used modality (250 studies), followed by thermal stimuli (125 studies). Forty-six different instruments were used. Disregarding studies on widespread musculoskeletal pain and healthy participants, 40 studies evaluated TSP at painful sites, 77 in remote areas, and 66 in both locations. Of the 13 tested locations in patients, the hand (74 studies), lower leg (64 studies), and forearm (59 studies) were most commonly tested. A single practice round was the most common familiarization method (46 studies). Repeated stimuli were applied using 31 different frequencies (0.03-200 Hz) and sustained stimulations ranging from 5 to 1080 seconds were used. Twenty-two different train lengths, 63 different calculations (37 absolute, 19 relative, and 7 alternatives using data directly), and 14 different outcome measures (eg, self-reported pain rating scales and reflex thresholds) were used. Temporal summation of pain protocols vary excessively, hindering the comparison and pooling of results. None of the studies provided substantiation for their protocol choice.
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Affiliation(s)
- Sjoerd C Kielstra
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Academy of Health, Department of Physical Therapy, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Roland R Reezigt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Academy of Health, Department of Physical Therapy, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian K Petersen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, Haifa, Israel
- Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Hoegh M, Bannister K. Pain Science in Practice (Part 6): How Does Descending Modulation of Pain Work?. J Orthop Sports Phys Ther 2024; 54:97-100. [PMID: 38288567 DOI: 10.2519/jospt.2024.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
SYNOPSIS To understand the neuroscience of pain relief, one must know about the descending pain modulatory system. Neuronal pathways that originate in the brainstem and project to the spinal cord to modulate spinal neuronal activity provide a well-documented perspective on the mechanisms of analgesia that underpin pharmacological and nonpharmacological treatment options for people with musculoskeletal pain. Peripheral stimuli or signals from the cortex and subcortical regions of the brain can trigger the descending pain modulatory system (DPMS). The system helps explain how counter-stimulation techniques (eg, acupuncture and manual therapy), the patients' expectations and beliefs, and social or contextual factors could influence how people experience pain. J Orthop Sports Phys Ther 2024;54(2):1-4. doi:10.2519/jospt.2024.12112.
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Affiliation(s)
- Morten Hoegh
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsty Bannister
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
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Rasmussen AH, Petersen LK, Kaasgaard Sperling M, Bertelsen MM, Rathleff MS, Petersen KKS. The potential effect of walking on quantitative sensory testing, pain catastrophizing, and perceived stress: an exploratory study. Scand J Pain 2023; 23:751-758. [PMID: 37694875 DOI: 10.1515/sjpain-2023-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Studies suggest that a range of pain mechanisms, such as poor quality of sleep, perceived stress, pain catastrophizing or pain sensitivity, are likely to enhance clinical pain. Animal studies suggest that these pain mechanisms can be modulated by increasing physical activity, but human data are needed to support this hypothesis. This exploratory study aimed to investigate the changes in pain mechanisms after a simple self-directed walking program of 8-weeks. Additionally, this exploratory study investigated the interaction between changes over time in assessments of poor quality of sleep, perceived stress, pain catastrophizing or pain sensitivity and how these changes interacted with each other. METHODS This prospective cohort study included 30 healthy subjects who were assessed at baseline and 4- and 8-weeks after initiating the walking program (30 min walking/day for 8 weeks). Self-report outcomes included: Pain Catastrophizing Scale (PCS), the Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index. Pressure pain thresholds, temporal summation of pain and conditioned pain modulation (CPM) were assessed using cuff algometry. RESULTS Twenty-four subjects completed all the visits (age: 42.2, SD: 14.9, 16 females). PCS and PSS significantly decreased at the 8-week's visit compared to baseline (p<0.05). No significant differences were seen for an improvement in quality of sleep (p=0.071) and pain sensitivity (p>0.075) when comparing the 8-week's visit to the baseline visit. Changes in pain mechanisms comparing baseline and 8-weeks data were calculated and regression analyses found that an improvement in PCS was associated with an improvement in CPM (R2=0.197, p=0.017) and that a higher adherence to the walking program was associated with a larger improvement in PCS (R2=0.216, p=0.013). CONCLUSIONS The current exploratory study indicates that a simple self-directed walking program of 8-weeks can improve pain catastrophizing thoughts, perceived stress. Higher adherence to the walking program were associated with an improvement in pain catastrophizing and an improvement in pain catastrophizing was associated with an increase in conditioned pain modulation.
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Affiliation(s)
- Anna Houmøller Rasmussen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lærke Kjeldgaard Petersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Mette Kaasgaard Sperling
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Maria Møller Bertelsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær-Staal Petersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain, Aalborg University, Aalborg, Denmark
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Aalborg University, Aalborg, Denmark
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