Medial tibial pain pressure threshold algometry in runners

The Experience of Pain is Strongly Associated With Poor Sleep Quality and Increased Risk for Suicide

OBJECTIVE

Effective suicide prevention is hindered by a limited understanding of the neurobiology leading to suicide. We aimed to examine the association between changes in the experience of pain and disturbances in sleep quantity and quality in patients with elevated risk for suicide.

METHODS

Three groups of adult depressed individuals, including patients following a recent suicide attempt (n = 79), patients experiencing current suicidal ideation (n = 131), and patients experiencing depression but no suicidal ideation or behavior in at least 6 months (n = 51), were examined in a case-control study for sleep quantity and quality, physical and psychological pain, pressure pain threshold, suicidal ideation, and recent suicidal behavior.

RESULTS

Sleep quality, physical and psychological pain were positively associated with suicidal ideation severity. In both cases in which sleep quality was added to a model with either physical or psychological pain, physical or psychological pain became more significantly associated with suicidal ideation severity. Pressure pain threshold was elevated in patients suffering from any type of insomnia. There was no significant association between pressure pain threshold and suicidal ideation severity.

CONCLUSIONS

The impact of these findings lies in the identification of both psychological and physical pain, and sleep quality as potential biological mechanisms underlying suicidal risk. HIGHLIGHTSWe assessed the association between pain and sleep quality in suicidal patients.Sleep quality, physical and psychological pain were associated with suicide risk.Pain perception may mediate the progression to suicidal behavior.

Synergistic effect of chronic pain and nonsuicidal self-harm on pain sensitivity

Abnormalities in pain processing have been observed in patients with chronic pain conditions and in individuals who engage in self-harm, specifically nonsuicidal self-injurious behaviors (NSSI). Both increased and decreased pain sensitivity have been described in chronic pain patients, while decreased pain sensitivity is consistently observed in individuals with NSSI. The objective of the study was to identify the differential effects of chronic pain and NSSI on experimental pain sensitivity, specifically pressure pain threshold, in depressed patients. Moreover, the role that hopelessness may play between depression severity and pain sensitivity was also examined. Depressed patients with and without chronic pain, and with and without lifetime self-harm behaviors were analyzed into four groups. Group 1 (N = 42) included depressed patients with both Chronic pain ( +) and Self-harm ( +), Group 2 (N = 53) included depressed patients with Chronic pain ( +) but no Self-harm (-), Group 3 (N = 64) included depressed patients without Chronic pain (-), but Self-harm ( +), and Group 4 (N = 81) included depressed patients with neither Chronic pain (-) nor Self-harm (-). Healthy controls (N = 45) were also recruited from the community. Depressed patients with both Chronic pain ( +) and Self-harm ( +) reported higher pressure pain threshold measures when compared with the other groups. Mediation analysis indicated that hopelessness mediates the relationship between depression severity and pressure pain threshold. Our findings suggest that a multiprong approach including adequate mental health services and pain control for depressed patients with comorbid chronic pain and nonsuicidal self-harm is needed to yield effective outcomes.

Assessment of pressure sensitivity in the head region for Chinese adults

Measurement of pressure threshold has found its applications in the fields of medical sciences and product design. Hence it has been a profound area of research interest for several decades. However, hardly any detailed investigation has been undertaken to measure the pressure threshold in the head region. In this study, Pressure Discomfort Threshold (PDT) and Pressure Pain Threshold (PPT) were measured for two hundred eighteen healthy Chinese adults at seventy-six anatomical locations, and further statistical analyses were performed on the acquired data to understand the relationship between different demographic parameters. The results suggest that the pressure sensitivity is low in the vertex region, moderate in the forehead and temporal area, and high in the facial and nasal region. From this study, pressure sensitivity maps were developed for PDT and PPT for Chinese adults. The measured pressure threshold data showed no significant relationship with age and Body Mass Index (BMI).

The influence of sex and level of physical activity on maximum tolerance to mechanical pain

Background

A difference in maximum tolerance to mechanical pain (MTMP) between the sexes is widely studied but there is still no consensus on whether the level of physical activity (PA) influences pain.

Objectives

To compare the MTMP between men and women with different levels of PA.

Methods

Sixty five individuals were divided in female (n = 35) and male group (n = 30). The main outcome measures were PA level and MTMP by pressure algometry. Pressure was applied three times on both sides at the following points: cervical (5^th and 7^th) and lumbar (3^th and 5^th) vertebrae; trapezius, rhomboid, gluteus, gastrocnemius, pectoralis major, tibialis anterior, and deltoid muscles, elbow, hand, knee, and ankle.

Results

It was observed that the PA level has little influence on the MTMP at all the assessed points and that men have greater MTMP than women.

Conclusion

Sex, not the PA level, influences the MTMP.

DIAGNOSIS OF THE ACHILLES INSERTIONAL TENDINOPATHIES BY ALGOMETRY

INTRODUCTION

Diagnosis of Achilles insertional tendinopathies (AIT) is based on pain by tendon palpation. However, there is no consensus or standard regarding the amount of force to be used during the evaluation. The algometry is a method of measuring the pressure applied in a specific region and can be a method for determining diagnosis values.

GOAL

To determine a cut-off value for Pain Threshold (PT) in the assessment of AIT.

DESIGN

This is a prospective case-control study of diagnostic accuracy, to develop a diagnostic criterion.

METHODS

Forty asymptomatic individuals and forty patients with insertional Achilles tendinopathy, matched by age and sex, were evaluated, and submitted to algometry for PT and for Visual Analogical Scale (VAS) levels with 3 kg/f at the insertion of the calcaneal tendon by two different evaluators. Inter-observer reproducibility was accessed through the interclass correlation index (ICC). Sensitivity and specificity calculation of PT and of VAS ​​were calculated and plotted on a ROC (Receiver Operator Characteristic) curve.

RESULTS

The lowest ICC found was 0.788. Regarding the diagnosis through TP, the 4.08 kg/f mark showed the best relation between sensitivity and specificity (92.5% and 92.5%, respectively). Algometry values lower than 4.08 were considered positive for disease. For the diagnosis of TIA through VAS with 3 kg/f, the value of 2.98 was determined (sensitivity of 92.5% and specificity of 97.5%).

CONCLUSION

The algometry showed to be a simple and reliable method for diagnosing AIT. Values for PT under 4.08 kg/f were found predictors of the disease.

Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review

This systematic review evaluates the existing literature about medial tibial stress syndrome (MTSS) in novice and recreational runners. PubMed/MEDLINE, EMBASE, Web of Science, Scopus, SPORTDiscus and CINAHL databases were searched until July 2020. Studies covering risk factors, diagnostic procedures, treatment methods and time to recovery of MTSS in novice and recreational runners were selected. Eleven studies met the inclusion criteria and were included. The risk factors of MTSS are mainly intrinsic and include higher pelvic tilt in the frontal plane, peak internal rotation of the hip, navicular drop and foot pronation, among others. Computed tomography (CT) and pressure algometry may be valid instruments to corroborate the presence of this injury and confirm the diagnosis. Regarding treatment procedures, arch-support foot orthoses are able to increase contact time, normalize foot pressure distribution and similarly to shockwave therapy, reduce pain. However, it is important to take into account the biases and poor methodological quality of the included studies, more research is needed to confirm these results.

The neural correlates of low social integration as a risk factor for suicide

Low social integration is commonly described in acutely suicidal individuals. Neural mechanisms underlying low social integration are poorly understood in depressed and suicidal patients. We sought to characterize the neural response to low social integration in acutely suicidal patients. Adult depressed patients within 3 days of a suicide attempt (n = 10), depressed patients with suicidal ideation (n = 9), non-suicidal depressed patients (n = 15), and healthy controls (N = 18) were administered the Cyberball Game while undergoing functional magnetic resonance imaging. We used complementary functional connectivity and region of interest data analysis approaches. There were no group differences in functional connectivity within neural network involving the pain matrix, nor in insula neural activity or the insula during either social inclusion. Superior anterior insula activity exhibited an inverted U-shaped curve across the suicide risk spectrum during social inclusion. Superior insula activity during social inclusion correlated with depression severity and psychological pain. Dorsal anterior cingulate cortex activity during social exclusion correlated with physical pain severity. Neural responses in the anterior insula significantly correlated with depression severity and with psychological pain during social inclusion, whereas dACC activity significantly correlated with physical pain during social exclusion. Recent suicidal behavior seems associated with a distinct neural response to social exclusion independently of presence of depression or suicidal thoughts.

Examination of pain threshold and neuropeptides in patients with acute suicide risk

INTRODUCTION

One of the main challenges in suicide prevention is the limited understanding of the biological mechanisms underlying suicide. Recent findings suggest impairments in pain processing in acutely suicidal patients. However, little is known about the biological factors that may drive these discrete physiological abnormalities. In this study, we examined plasma peptides involved in analgesic and inflammatory responses and physical pain threshold in acutely suicidal patients.

METHODS

Thirty-seven depressed patients of both sexes hospitalized for severe suicidal ideation or a recent suicide attempt were characterized clinically including history of suicidal ideation and behavior. Psychological and physical pain, and pressure pain threshold was also measured. Plasma levels of β-endorphin, neurotensin, agouti-related protein (AgRP), C-reactive protein (CRP), adrenocorticotropic hormone (ACTH), and brain-derived neurotrophic factor (BDNF) were run in Milliplex multiplex assays.

RESULTS

The number of lifetime suicide attempts was positively correlated with β-endorphin (r = 0.702; p = 0.007), and neurotensin (r = 0.728, p = 0.007) plasma levels. Higher pain threshold was measured in the suicide attempt group as compared to the suicidal ideation group. Pain threshold was strongly and negatively associated with CRP plasma levels (r = -0.548; p < 0.001). In patients reporting chronic pain, lower AgRP levels and lower pain threshold were observed (t = 4.472; p = 0.001).

CONCLUSION

Our results suggest that abnormalities in the opioid and neurotensin systems may underlie the increase in pain threshold found in suicide attempters, and possibly risk for suicidal behavior. Targeting pain circuits and systems may provide therapeutic mechanisms for suicide prevention.

Somatosensory and Motor Differences between Physically Active Patients with Chronic Low Back Pain and Asymptomatic Individuals

Background and Objectives: Chronic low back pain (CLBP) is the most common occupational disorder due to its associated disability and high risk of recurrence and chronicity. However, the mechanisms underlying physical and psychological variables in patients with CLBP remain unclear. The main objective of this study was to assess whether there were differences between physically active patients with nonspecific CLBP compared with asymptomatic individuals in sensorimotor and psychological variables. Materials and Methods: This was an observational cross-sectional design with a nonprobabilistic sample. The sample was divided into two groups: individuals with nonspecific CLBP (n = 30) and asymptomatic individuals as a control (n = 30). The psychological variables assessed were low back disability, fear of movement, pain catastrophizing, and self-efficacy. The sensorimotor variables assessed were two-point discrimination, pressure pain threshold, lumbopelvic stability, lumbar flexion active range of motion, and isometric leg and back strength. Results: Statistically significant differences between the groups in terms of catastrophizing levels (p = 0.026) and fear of movement (p = 0.001) were found, but no statistically significant differences between groups were found in self-efficacy (p > 0.05). No statistically significant differences between the groups in any of the sensorimotor variables were found (p > 0.05). Conclusion: No sensorimotor differences were found between patients with asymptomatic and chronic low back pain, but differences were found in the psychological variables of catastrophizing and fear of movement.

Tarsal Tunnel Mechanosensitivity Is Increased in Patients with Asthma: A Case-Control Study

Background: Based on changes in lung function and musculoskeletal disorders in patients with asthma, this study aimed to compare the tarsal tunnel and fibular bone pressure pain thresholds (PPTs) of patients with asthma and healthy matched-paired controls. Methods: A case-control study was performed. One hundred participants were recruited: 50 asthma patients and 50 healthy matched-paired controls. Bilaterally, tarsal tunnel and fibula bone PPTs were registered. Results: Statistically significant differences (p < 0.01) were shown bilaterally for tarsal tunnel PPT. With the exception of fibula PPT (p > 0.05), asthma patients presented less tarsal tunnel PPT than healthy participants. Statistically significant differences (p < 0.05) were shown for two linear regression prediction models of the right (R² = 0.279) and left (R² = 0.249) tarsal tunnels PPTs as dependent variables, and based on sex, group, contralateral tarsal tunnel PPT and ipsilateral fibula PPT as independent variables. Conclusions: The study findings showed that a bilateral tarsal tunnel mechanosensitivity increase is exhibited in patients diagnosed with asthma. The presence of asthma may bilaterally predict the PPT of tarsal tunnel. These findings may suggest the presence of central sensitization in asthma patients, which could clinically predispose them to musculoskeletal disorders, such as tarsal tunnel syndrome.

A probe in the connection between inflammation, cognition and suicide

BACKGROUND

Increased inflammation is linked to suicide risk. However, it is unclear whether increased inflammation drives suicidal crises or is a trait associated with lifetime suicidal behavior. Limited data exist on the sources of increased inflammation observed in suicidal patients and on its downstream effects.

AIMS

To examine factors associated with inflammation and with suicidal ideation severity in acutely suicidal depressed patients.

METHODS

Fifty-two adult depressed patients of both sexes hospitalized for severe suicidal ideation were characterized for suicidality, depression, anxiety, medical comorbidity, psychological and physical pain, impulsivity, verbal fluency, C-reactive protein (CRP) and interleukin (IL) 6. Two generalized linear models were performed with either CRP or suicidal ideation severity as dependent variables.

RESULTS

CRP levels were positively associated with age, body mass index (BMI), IL6, current physical pain and number of lifetime suicide attempts. Suicidal ideation severity was not significantly correlated with either CRP or IL6. Suicidal ideation severity was positively associated with female sex, presence of an anxiety disorder, current physical pain, number of lifetime suicide attempts and with delay discounting for medium and large losses.

CONCLUSIONS

Increased inflammation is not associated with acute suicidal risk, but seems to represent a trait associated with lifetime suicidal behavior.

Test Procedures to Assess Somatosensory Abnormalities in Individuals with Peripheral Joint Pain: A Systematic Review of Psychometric Properties

BACKGROUND

Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain (PJP).

METHODS

A comprehensive electronic literature search was conducted in 7 databases from inception to March 2016. The Quality Appraisal for Reliability Studies (QAREL) checklist and the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) tool were used to assess risk for bias of the included studies. Level of evidence was evaluated based on the methodological quality and the quality of the measurement properties.

RESULTS

Forty-one studies related to PJP were included. The majority of included studies were considered to be of insufficient methodological quality, and the level of evidence for PMPs varied across different test procedures. The level of evidence for PMPs varied across different test procedures in different types of PJP. Hand-held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability, agreement, and responsiveness, simultaneously, when it was investigated in patients with chronic knee osteoarthritis.

CONCLUSIONS

This systematic review identified that the level of evidence for PMPs varied across different testing procedures to assess somatosensory abnormalities for different PJP populations. Further research with standardized protocols is recommended to further investigate the predictive ability and responsiveness of reported test procedures in order to warrant their extended utility in clinical practice.

Is One Trial Sufficient to Obtain Excellent Pressure Pain Threshold Reliability in the Low Back of Asymptomatic Individuals? A Test-Retest Study

The assessment of pressure pain threshold (PPT) provides a quantitative value related to the mechanical sensitivity to pain of deep structures. Although excellent reliability of PPT has been reported in numerous anatomical locations, its absolute and relative reliability in the lower back region remains to be determined. Because of the high prevalence of low back pain in the general population and because low back pain is one of the leading causes of disability in industrialized countries, assessing pressure pain thresholds over the low back is particularly of interest. The purpose of this study study was (1) to evaluate the intra- and inter- absolute and relative reliability of PPT within 14 locations covering the low back region of asymptomatic individuals and (2) to determine the number of trial required to ensure reliable PPT measurements. Fifteen asymptomatic subjects were included in this study. PPTs were assessed among 14 anatomical locations in the low back region over two sessions separated by one hour interval. For the two sessions, three PPT assessments were performed on each location. Reliability was assessed computing intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) for all possible combinations between trials and sessions. Bland-Altman plots were also generated to assess potential bias in the dataset. Relative reliability for both intra- and inter- session was almost perfect with ICC ranged from 0.85 to 0.99. With respect to the intra-session, no statistical difference was reported for ICCs and SEM regardless of the conducted comparisons between trials. Conversely, for inter-session, ICCs and SEM values were significantly larger when two consecutive PPT measurements were used for data analysis. No significant difference was observed for the comparison between two consecutive measurements and three measurements. Excellent relative and absolute reliabilities were reported for both intra- and inter-session. Reliable measurements can be equally achieved when using the mean of two or three consecutive PPT measurements, as usually proposed in the literature, or with only the first one. Although reliability was almost perfect regardless of the conducted comparison between PPT assessments, our results suggest using two consecutive measurements to obtain higher short term absolute reliability.

Empty can exercise provokes more pain and has undesirable biomechanics compared with the full can exercise

BACKGROUND

The purpose of this investigation was to characterize the scapular position and scapular muscle activation during the empty can (EC) and full can (FC) exercises. The EC exercise has been shown to produce scapular kinematics associated with the mechanism leading to subacromial impingement syndrome (SAIS) but has not been investigated in patients with (SAIS). This investigation will help improve the treatment of patients with SAIS.

METHODS

Participants with SAIS (n = 28) performed 5 consecutive repetitions of FC and EC exercises. Scapular and clavicular 3-dimensional positions and scapular muscle activity were measured during each exercise. Pain was measured with the numeric pain rating 11-point scale.

RESULTS

Participants reported greater pain during the EC exercise vs the FC exercise (difference, 1; P = .003). During the EC exercise, participants were in greater scapular upward rotation (difference, 3°; P < .001), internal rotation (mean difference, 2°; P = .017), and clavicular elevation (difference, 3°, P < .001) and in less scapular posterior tilt (difference, 2°; P < .001). There was greater activity of upper trapezius (difference, 4%, P = .002), middle trapezius (difference, 3%; P < .001), and serratus anterior (difference, 0.5%; P = .035) during ascent, and during the descent of greater upper trapezius (difference, 2%, P = .005), and middle trapezius (difference, 1%; P = .003), but less activity of the lower trapezius (difference, 1%; P = .039).

CONCLUSIONS

The EC exercise was associated with more pain and scapular positions that have been reported to decrease the subacromial space. Scapular muscle activity was generally higher with the EC, which may be an attempt to control the impingement-related scapular motion. The FC exercise of elevation is preferred over the EC exercise.

Pressure algometry is a useful tool to quantify pain in the medial part of the knee: an intra- and inter-reliability study in healthy subjects

PURPOSE

Pain quantification is essential for diagnostic and pain monitoring purposes in disorders around the knee. Pressure algometry is a method described to determine pressure pain threshold (PPT) by applying controlled pressure to a given body point. The purpose of this study was to determine the reliability of this method when it was applied to the medial part of the proximal tibia metaphysis and to evaluate the PPT levels between genders.

METHODS

Fifty healthy (mean age; 46.9) volunteers were recruited, 25 men and 25 women. Pressure algometry was applied to a 1 cm(2)-probe area on the medial part of the knee by 2 raters. Intra- and interclass correlation (ICC) was obtained and differences between genders were evaluated. Bland-Altman plots were performed to evaluate the variability of the measures.

RESULTS

The mean values of PPT obtained by rater 1 and 2 were 497.5 Kpa and 489 Kpa respectively. The intrarater reliability values (95% IC) for rater 1 and 2 were 0.97 (0.95-0.98) and 0.84 (0.73-0.90) respectively. With regard to interrater reliability, the ICC (95% IC) for the first measurement was 0.92 (0.87-0.95) and 0.86 (0.78-0.92) for the second one. Women showed significant lower values of PPT than men. The Bland-Altmand plots showed excellent agreement.

CONCLUSIONS

Pressure algometry has excellent reliability when it is applied to the medial part of the proximal metaphysis of the tibia. Women have lower values of PTT than men. The high reliability of the PA in an individual volunteer makes it a more valuable tool for longitudinal assessment of a given patient than for comparison between them.

LEVEL OF EVIDENCE

Level III. Prospective study.