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Chen IW, Liao YT, Tseng H, Lin HC, Chou LW. Pain, function and peritendinous effusion improvement after dry needling in patients with long head of biceps brachii tendinopathy: a single-blind randomized clinical trial. Ann Med 2024; 56:2391528. [PMID: 39140690 PMCID: PMC11328602 DOI: 10.1080/07853890.2024.2391528] [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] [Received: 01/17/2024] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Long head of biceps brachii tendinopathy, a frequent source of anterior shoulder pain, may lead to discomfort and diminished function. The objective of this study is to assess the efficacy of dry needling and transcutaneous electrical nerve stimulation in these patients. PATIENTS AND METHODS Thirty patients were randomized into dry needling and transcutaneous electrical nerve stimulation groups and assessed before treatment, 8 and 15 days after treatment using a visual analogue scale, shoulder pain and disability index, pressure pain threshold, tissue hardness, and biceps peritendinous effusion. RESULTS Both treatments significantly reduced the visual analogue scale in immediate (p < 0.001), short-term (p < 0.01), and medium-term effects (p < 0.01). Dry needling outperformed transcutaneous electrical nerve stimulation for the pain (p < 0.01) and disability (p < 0.03) subscales of the shoulder pain and disability index in the short-term and medium-term effects, respectively. Pressure pain threshold increased after both treatments but didn't last beyond 8 days. Neither treatment showed any improvements in tissue hardness of the long head of biceps brachii muscle. Notably, only the dry needling group significantly reduced biceps peritendinous effusion in both short-term and medium-term effects (p < 0.01). CONCLUSIONS Dry needling showed non-inferior results to transcutaneous electrical nerve stimulation in reducing pain and disability and demonstrated even superior results in reducing biceps peritendinous effusion (see Graphical Abstract). TRIAL REGISTRATION The Institutional Review Board of the China Medical University Hospital (CMUH107-REC2-101) approved this study, and it was registered with Identifier NCT03639454 on ClinicalTrials.gov.
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Affiliation(s)
- I-Wei Chen
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Ying-Tzu Liao
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Le Yang Chinese Medicine Clinic, Taipei, Taiwan
| | - Hsin Tseng
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Che Lin
- Hsiao-Che Lin Chinese Medicine Clinic, Kaohsiung, Taiwan
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
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Gilam G, Silvert J, Raev S, Malka D, Gluzman I, Rush M, Elkana O, Aloush V. Perceived Injustice and Anger in Fibromyalgia With and Without Comorbid Mental Health Conditions: A Hebrew Validation of the Injustice Experience Questionnaire. Clin J Pain 2024; 40:356-366. [PMID: 38345498 DOI: 10.1097/ajp.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/31/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES Perceived injustice (PI), assessed by the Injustice Experience Questionnaire (IEQ), is an important trigger of anger. Both PI and anger are associated with adverse chronic pain outcomes, and with comorbid mental health severity. We aimed examined the roles of PI and anger in mediating pain across Fibromyalgia patients, with and without comorbid anxiety/depression (FM+A/D, FM-A/D, respectively), as well as rheumatoid arthritis (RA), and pain-free controls (PFC). We hypothesized the highest levels of PI, anger, and pain in FM+A/D patients, followed by FM-A/D, RA, and PFC, thus also validating a Hebrew version of the IEQ. METHODS We translated the IEQ using the forward-backward method and collected data online. Based on self-reported anxiety/depression, the sample comprised 66 FM+A/D patients, 64 FM-A/D, 34 RA, and 32 PFCs. Assessments included the IEQ, state and trait anger, pain intensity, anxiety, depression, and pain catastrophizing. The structure and reliability of the Hebrew IEQ were examined using factor analysis and Cronbach alpha. Bootstrapped-based modeling was used to test the roles of state and trait anger in mediating and moderating the relationship between PI and pain intensity. RESULTS We confirmed a one-factor structure of the IEQ, with excellent reliability. FM+A/D patients demonstrated the highest scores in all measures. Within this group, trait anger moderated the mediating effect of state anger in the relationship between PI and pain intensity. DISCUSSION Our findings validate a Hebrew IEQ and highlight the importance of PI and state and trait anger in the differential manifestation of mental health comorbidity in FM.
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Affiliation(s)
- Gadi Gilam
- The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem
| | - Jemma Silvert
- The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem
| | - Sheer Raev
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Din Malka
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Inbar Gluzman
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Melissa Rush
- The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Valerie Aloush
- Institute of Rheumatology and Internal Medicine, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Suzuki H, Tahara S, Mitsuda M, Funaba M, Fujimoto K, Ikeda H, Izumi H, Yukata K, Seki K, Uranami K, Ichihara K, Nishida N, Sakai T. Reference intervals and sources of variation of pressure pain threshold for quantitative sensory testing in a Japanese population. Sci Rep 2023; 13:13043. [PMID: 37563245 PMCID: PMC10415310 DOI: 10.1038/s41598-023-40201-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
Quantitative sensory testing (QST) is useful when analysing musculoskeletal pain disorders. A handheld algometer is most commonly used for pressure pain threshold (PPT) tests. However, reference intervals for PPTs are not elucidated. We assessed reference intervals of PPTs for QST in 158 healthy adult Japanese with no history of musculoskeletal or neurological problems. A handheld algometer was used to record PPT at five different assessment sites on the body: lumbar paravertebral muscle, musculus gluteus maximus, quadriceps, tibialis anterior muscle, and anterior talofibular ligament. Multiple regression analysis was performed to explore sources of variation of PPT according to sex, age, body mass index, UCLA Activity Level Rating, and Tegner Activity Score. Reference intervals were determined parametrically by Gaussian transformation of PPT values using the two-parameter Box-Cox formula. Results of multiple regression analysis revealed that age was significantly associated with PPT of lumbar paravertebral muscle and musculus gluteus maximus. In females, body mass index showed significant positive correlation with PPT of anterior talofibular ligament, and UCLA Activity Level Rating also showed significant positive association with tibialis anterior muscle and anterior talofibular ligament. Site-specific reference intervals of PPTs for Japanese are of practical relevance in fields of pain research using a handheld algometer.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan.
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan.
| | - Shu Tahara
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Mao Mitsuda
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Masahiro Funaba
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Kazuhiro Fujimoto
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Hiroaki Ikeda
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Hironori Izumi
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Kiminori Yukata
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Kazushige Seki
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Kota Uranami
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi, Japan
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Linsen SS, Teschke M, Heim N, Mercuri LG. Is the risk of chronic pain after total temporomandibular joint replacement independent of its indications? A prospective cohort study. Br J Oral Maxillofac Surg 2023; 61:337-343. [PMID: 37230824 DOI: 10.1016/j.bjoms.2023.03.006] [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: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients treated with TMJR regardless of the indication for the operation. A prospective, single-centre study was performed. Data on 36 patients (56 TMJR) were collected preoperatively and at follow up two to three years postoperatively. The primary outcome variable was subjective TMJ pain (none/mild, moderate/severe) at follow up. The predictor variables were objective pressure pain thresholds (PPTs) at the ipsilateral joint(s) and muscle(s), functional parameters (incisal range of motion, maximum voluntary clenching), subjective oral health-related quality of life (OHRQoL), and demographic and surgical variables. The number of patients with moderate/severe pain decreased from 17 preoperatively to 10 at follow up. Self-reported TMJ pain was significantly reduced in the entire group (p = 0.001). Patients with moderate/severe pain at follow up were more restricted in their OHRQoL but did not differ in PPT and functional parameters from the no/mild pain group. Moderate/severe TMJ pain at follow up was associated with unilateral TMJR and more preoperative pain. This study provides preliminary evidence that despite good pain reduction in most patients, persistent pain after TMJR is common and, in rare cases, may even worsen regardless of the original diagnosis. At follow up there was a close relation between OHRQoL and TMJ pain. TMJ pain after TMJR cannot be confirmed by objective measurement methods (PPTs and functional parameters).
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Affiliation(s)
- S S Linsen
- Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany.
| | - M Teschke
- Private Practice, Zeppelinstr.24, 61352 Bad Homburg, Germany
| | - N Heim
- Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - L G Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States; Department of Bioengineering, University of Illinois Chicago, 851 S Morgan St, Chicago, IL 60607, United States; Stryker/TMJ Concepts, 6059 King Drive, Ventura, CA 93003, United States
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5
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Sussman D, Tassone VK, Gholamali Nezhad F, Wu M, Adamsahib F, Mattina GF, Pazmino-Canizares J, Demchenko I, Jung H, Lou W, Ladha KS, Bhat V. Local Injection for Treating Mood Disorders (LIFT-MOOD): A Pilot Feasibility RCT of Stellate Ganglion Block for Treatment-Resistant Depression. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231160315. [PMID: 36895443 PMCID: PMC9989395 DOI: 10.1177/24705470231160315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
Background With nearly one-third of patients with major depressive disorder being resistant to available antidepressants, there is a need to develop new treatments for this population. Stellate ganglion block (SGB) is a procedure used to block sympathetic input to the central autonomic system; it has been administered to treat several conditions, including pain. Recently, indications for SGB have extended and the potential benefits for psychiatric disorders are under investigation. Methods The Local Injection For Treating Mood Disorders (LIFT-MOOD) study investigated the feasibility of a trial of 2 right-sided injections of bupivacaine 0.5% (7 mL) at the stellate ganglion in participants with treatment-resistant depression (TRD) using a randomized, placebo-controlled, pilot trial. Ten participants were randomized in a 1:1 allocation to receive active treatment or placebo (saline). Primary feasibility outcomes included recruitment rate, withdrawal, adherence, missing data, and adverse events. As a secondary, exploratory objective, we explored the efficacy of SGB in improving symptoms of depression by calculating the change in scores from baseline to follow-up on day 42 for each treatment group. Results The recruitment rate was reasonable and sufficient, retention and adherence were high, missing data were low, and adverse events were mild and temporary. Both treatment groups demonstrated decreases in Montgomery-Åsberg Depression Rating Scale scores, compared to baseline, by the end of the study. Conclusion This study supports the feasibility of a confirmatory trial of SGB in participants with TRD. Conclusions regarding efficacy cannot be made based on this preliminary study due to the small number of participants who completed active treatment. Larger-scale randomized controlled trials with long-term follow-ups and alternate sham procedures are needed to assess the efficacy and duration of symptom improvement with the use of SGB in TRD.
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Affiliation(s)
- David Sussman
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Michelle Wu
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fathima Adamsahib
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Ilya Demchenko
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Hyejung Jung
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Lou
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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6
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Moore MN, Wallace BI, Song J, Muhammad LN, Heisler AC, Clauw DJ, Bolster MB, Marder W, Neogi T, Wohlfahrt A, Dunlop DD, Lee YC. Correlation of Fibromyalgia Survey Questionnaire and Quantitative Sensory Testing Among Patients With Active Rheumatoid Arthritis. J Rheumatol 2022; 49:1052-1057. [PMID: 35649554 PMCID: PMC10044496 DOI: 10.3899/jrheum.220046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) commonly demonstrate disordered pain processing associated with high pain sensitization. Pain sensitization is often assessed using quantitative sensory testing (QST), which is burdensome to patients. The self-administered Fibromyalgia Survey Questionnaire (FSQ) has been proposed as a low-burden, surrogate measure of central pain sensitization. We examined the correlation between FSQ and QST in patients with active RA. METHODS Participants in the Central Pain in Rheumatoid Arthritis (CPIRA) cohort underwent FSQ and QST evaluation at enrollment. QST measures included pressure pain threshold (PPT) at the thumb, trapezius, wrist, and knee; temporal summation (TS) at the wrist and arm; and conditioned pain modulation (CPM). Partial Spearman correlation between FSQ and each QST measure was assessed, adjusted for demographic factors, study site, disease characteristics, and pain catastrophizing. Sensitivity analyses included (1) stratified analysis by sex and (2) evaluation of how each component of FSQ associates with the QST measures. RESULTS Among 285 participants with active RA, FSQ was weakly but statistically significantly correlated with PPT (r range = -0.31 to -0.21), and TS (r range = 0.13-0.15) at all sites in unadjusted analyses. After adjustment, statistically significant correlations persisted for TS at the wrist and PPT at all sites (except the thumb). Sensitivity analyses did not identify differences in association based on sex or with individual FSQ components. CONCLUSION FSQ and QST were correlated among participants with active RA, but the strength of association was weak. QST and FSQ are not interchangeable measures of pain sensitization.
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Affiliation(s)
- Meriah N Moore
- M.N. Moore, MD, MSc, Clinical Instructor, W. Marder, MD, Clinical Professor, Internal Medicine/Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan;
| | - Beth I Wallace
- B.I. Wallace, MD, MSc, Assistant Professor, Internal Medicine/Rheumatology, University of Michigan Medical School, and VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Jing Song
- J. Song, MS, A.C. Heisler, MD, MSc, D.D. Dunlop, PhD, Professor Emeritus, Internal Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lutfiyya N Muhammad
- L.N. Muhammad, PhD, MPH, Assistant Professor, Preventive Medicine/Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew C Heisler
- J. Song, MS, A.C. Heisler, MD, MSc, D.D. Dunlop, PhD, Professor Emeritus, Internal Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel J Clauw
- D.J. Clauw, MD, Professor, Anesthesiology, Internal Medicine/Rheumatology, Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marcy B Bolster
- M.B. Bolster, MD, Associate Professor, Internal Medicine/Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - Wendy Marder
- M.N. Moore, MD, MSc, Clinical Instructor, W. Marder, MD, Clinical Professor, Internal Medicine/Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tuhina Neogi
- T. Neogi, MD, PhD, Professor, Internal Medicine/Rheumatology, Boston University School of Medicine, Evans Biomedical Research Center, Boston, Massachusetts
| | - Alyssa Wohlfahrt
- A. Wohlfahrt, MS, Tufts University School of Medicine, Boston, Massachusetts
| | - Dorothy D Dunlop
- J. Song, MS, A.C. Heisler, MD, MSc, D.D. Dunlop, PhD, Professor Emeritus, Internal Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yvonne C Lee
- Y.C. Lee, MD, MMSc, Associate Professor, Medicine/Rheumatology, Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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7
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Holm LA, Nim CG, Lauridsen HH, Filtenborg JB, O'Neill SF. "Convergent validity of the central sensitization inventory and experimental testing of pain sensitivity". Scand J Pain 2022; 22:597-613. [PMID: 34668367 DOI: 10.1515/sjpain-2021-0090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/21/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of the current study was to examine the convergent validity of the Central Sensitization Inventory by quantifying the correlation with experimental measures of pain sensitivity and self-reported psycho-social questionnaires, in a low back pain population. METHODS All participants were recruited from an outpatient hospital spine care clinic (Spine Centre of Southern Denmark). Participants underwent a standardized experimental pain test protocol and completed the Central Sensitization Inventory (CSI) along with additional self-reported questionnaires to assess psycho-social constructs across different domains. The association between the CSI, experimental pain measures and other self-reported psycho-social questionnaires were analyzed using correlation and contingency tests. ROC-curve analysis was used to determine sensitivity and specificity for CSI. RESULTS One hundred sixty-eight (168) participants were included. The CSI was weakly correlated with nine out of 20 variables in the experimental pain test protocol (rho range -0.37 to 0.22). The CSI was more closely correlated with psycho-social factors such as work ability, disability, and symptoms of exhaustion disorder. ROC-analysis identified an optimal cut-point of 44 on CSI (Sn=39.1% Sp=87.4%). The CSI had an area under the ROC curve of 0.656. Fisher's exact test demonstrated a statistically significant association between participants scoring ≥40 on CSI and participants categorized as sensitized by experimental pain tests (p-value=0.03). CONCLUSIONS Our findings are consistent with previous studies, indicating that the CSI is related to psycho-social constructs. However, the convergent validity with experimental pain measures is small and probably not clinically meaningful.
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Affiliation(s)
- Liam Andrén Holm
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Casper Glissmann Nim
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Department of Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Johanne Brinch Filtenborg
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren Francis O'Neill
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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8
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Acosta E, Agbayani CJG, Jenkins BN, Cortes HG, Kain ZN, Fortier MA. The Impact of Primary Language Spoken on the Pain Experience of Children With Cancer. J Pediatr Hematol Oncol 2022; 44:135-141. [PMID: 35235543 DOI: 10.1097/mph.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
The purpose of the current prospective cohort study was to determine if acculturation, measured by primary language spoken, impacts the pain response of children being treated for cancer during an experimental pain task. Sixty-seven Spanish-speaking and English-speaking children ages 6 to 18 years being treated for cancer provided ratings of pain and upset severity during the completion of the cold pressor task (CPT). One week following the CPT, participants provided their recollection of average pain and upset during the CPT. Repeated measures analysis of variance revealed Spanish-speaking children reported significantly higher pain (F1,64=5.58, P=0.02) and upset (F1,64=7.69, P=0.007) ratings during the CPT compared with English-speaking children. Also, Spanish-speaking children were over 4 times as likely to remove their hands from the water before the CPT 4-minute uninformed ceiling compared with English-speaking children (P=0.002). These findings suggest that cultural and contextual factors, including the level of acculturation, are important considerations in the assessment and management of pain in children with cancer. Future research should continue to examine the mechanisms underlying the association between acculturation and the symptom experience for children receiving treatment for cancer.
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Affiliation(s)
- Erika Acosta
- UCI Center on Stress & Health
- Charles R. Drew University, Enhanced Post Baccalaureate Certificate Program, Los Angeles
| | | | - Brooke N Jenkins
- UCI Center on Stress & Health
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine
- Department of Psychology, Chapman University
| | - Haydee G Cortes
- UCI Center on Stress & Health
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine
| | - Zeev N Kain
- UCI Center on Stress & Health
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine
- Pediatrics, Children's Health of Orange County (CHOC), Orange, CA
- Child Study Center, Yale University School of Medicine, New Haven, CT
| | - Michelle A Fortier
- UCI Center on Stress & Health
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine
- Department of Psychological Science
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine
- Departments of Pediatric Psychology
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9
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Maulitz L, Stickeler E, Stickel S, Habel U, Tchaikovski SN, Chechko N. Endometriosis, psychiatric comorbidities and neuroimaging: Estimating the odds of an endometriosis brain. Front Neuroendocrinol 2022; 65:100988. [PMID: 35202605 DOI: 10.1016/j.yfrne.2022.100988] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
Endometriosis is a chronic pain disorder that affects young women, impairing their physical, mental and social well-being. Apart from personal suffering, it imposes a significant economic burden on the healthcare system. We analyzed studies reporting comorbid mental disorders in endometriosis based on the ICD/DSM criteria, discussing them in the context of available neuroimaging studies. We postulate that at least one-third of endometriosis patients suffer from mental disorders (mostly depression or anxiety) and require psychiatric or psychotherapeutic support. According to three neuroimaging studies involving patients with endometriosis, brain regions related not only to pain processing but also to emotion, cognition, self-regulation and reward likely constitute the so-called "endometriosis brain". It is not clear, however, whether the neurobiological changes seen in these patients are caused by chronic pain, mental comorbidities or endometriosis itself. Given the paucity of high-quality data on mental comorbidities and neurobiological correlates in endometriosis, further research is needed.
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Affiliation(s)
- L Maulitz
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - E Stickeler
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - S Stickel
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany
| | - U Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany
| | - S N Tchaikovski
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Department of Gynaecology and Obstetrics, Otto von Guericke University Magdeburg, Gerhart-Hauptmann-Straße 35, 39108 Magdeburg, Germany
| | - N Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany; Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany.
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10
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Tan L, Cicuttini FM, Fairley J, Romero L, Estee M, Hussain SM, Urquhart DM. Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review. BMC Musculoskelet Disord 2022; 23:113. [PMID: 35114987 PMCID: PMC8815215 DOI: 10.1186/s12891-022-05047-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain sensitisation plays a major role in musculoskeletal pain. However, effective treatments are limited, and although there is growing evidence that exercise may improve pain sensitisation, the amount and type of exercise remains unclear. This systematic review examines the evidence for an effect of aerobic exercise on pain sensitisation in musculoskeletal conditions. METHODS Systematic searches of six electronic databases were conducted. Studies were included if they examined the relationship between aerobic physical activity and pain sensitisation in individuals with chronic musculoskeletal pain, but excluding specific patient subgroups such as fibromyalgia. Risk of bias was assessed using Cochrane methods and a qualitative analysis was conducted. RESULTS Eleven studies (seven repeated measures studies and four clinical trials) of 590 participants were included. Eight studies had low to moderate risk of bias. All 11 studies found that aerobic exercise increased pressure pain thresholds or decreased pain ratings in those with musculoskeletal pain [median (minimum, maximum) improvement in pain sensitisation: 10.6% (2.2%, 24.1%)]. In these studies, the aerobic exercise involved walking or cycling, performed at a submaximal intensity but with incremental increases, for a 4-60 min duration. Improvement in pain sensitisation occurred after one session in the observational studies and after 2-12 weeks in the clinical trials. CONCLUSIONS These findings provide evidence that aerobic exercise reduces pain sensitisation in individuals with musculoskeletal pain. Further work is needed to determine whether this translates to improved patient outcomes, including reduced disability and greater quality of life.
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Affiliation(s)
- Lynn Tan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Jessica Fairley
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred Hospital, Melbourne, Victoria 3004 Australia
| | - Mahnuma Estee
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Sultana Monira Hussain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004 Australia
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11
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Temporomandibular disorders cases with high-impact pain are more likely to experience short-term pain fluctuations. Sci Rep 2022; 12:1657. [PMID: 35102207 PMCID: PMC8803984 DOI: 10.1038/s41598-022-05598-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractTemporomandibular disorders (TMD) patients can present clinically significant jaw pain fluctuations which can be debilitating and lead to poor global health. The Graded Chronic Pain Scale evaluates pain-related disability and its dichotomous grading (high/low impact pain) can determine patient care pathways and in general high-impact pain patients have worse treatment outcomes. Individuals with low-impact TMD pain are thought to have better psychosocial functioning, more favorable disease course, and better ability to control pain, while individuals with high-impact pain can present with higher levels of physical and psychological symptoms. Thereby, there is reason to believe that individuals with low- and high-impact TMD pain could experience different pain trajectories over time. Our primary objective was to determine if short-term jaw pain fluctuations serve as a clinical marker for the impact status of TMD pain. To this end, we estimated the association between high/low impact pain status and jaw pain fluctuations over three visits (≤ 21-day-period) in 30 TMD cases. Secondarily, we measured the association between jaw pain intensity and pressure pain thresholds (PPT) over the face and hand, the latter measurements compared to matched pain-free controls (n = 17). Jaw pain fluctuations were more frequent among high-impact pain cases (n = 15) than low-impact pain cases (n = 15) (OR 5.5; 95% CI 1.2, 26.4; p value = 0.033). Jaw pain ratings were not associated with PPT ratings (p value > 0.220), suggesting different mechanisms for clinical versus experimental pain. Results from this proof-of-concept study suggest that targeted treatments to reduce short-term pain fluctuations in high-impact TMD pain is a potential strategy to achieve improved patient perception of clinical pain management outcomes.
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12
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Helm S, Shirsat N, Calodney A, Abd-Elsayed A, Kloth D, Soin A, Shah S, Trescot A. Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety. Pain Ther 2021; 10:985-1002. [PMID: 34478120 PMCID: PMC8586061 DOI: 10.1007/s40122-021-00306-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022] Open
Abstract
Peripheral nerve stimulation (PNS) was the first application of neuromodulation. Widespread application of PNS was limited by technical concerns. Recent advances now allow the percutaneous placement of leads with ultrasound or fluoroscopic guidance, while the transcutaneous powering of these leads removes the need for leads to cross major joints. This systematic review was written to assess the current status of high-quality evidence supporting the use of PNS for pain conditions treated by interventional pain physicians. The available literature on PNS, limited to conditions treated by interventional pain physicians, was reviewed and the quality assessed. Literature from 1966 to June 2021 was reviewed. The outcome measures were pain relief and functional improvement. One hundred and two studies were identified. Five randomized controlled trials (RCT) and four observational studies, all case series, met the inclusion criteria. One RCT was of high quality and four were of moderate quality; all four case series were of moderate quality. Three of the RCTs and all four case series evaluated peripheral nerve neuropathic pain. Based upon these studies, there is level II evidence supporting the use of PNS to treat refractory peripheral nerve injury. One moderate-quality RCT evaluated tibial nerve stimulation for pelvic pain, providing level III evidence for this indication. One moderate-quality RCT evaluated surgically placed cylindrical leads for cluster headaches, providing level III evidence for this indication. The evidence suggests that approximately two-thirds of patients with peripheral neuropathic pain will have at least 50% sustained pain relief. Adverse events from PNS are generally minor. A major advantage of PNS over spinal cord stimulation is the absence of any risk of central cord injury. The study was limited by the paucity of literature for some indications. No studies dealt with joint-related osteoarthritic pain.
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Affiliation(s)
- Standiford Helm
- Department of Anesthesiology and Pain Management, University of California, Irvine, Orange, CA, USA.
| | - Nikita Shirsat
- School of Medicine, University of California, Irvine, Orange, CA, USA
| | | | - Alaa Abd-Elsayed
- Department of Anesthesiology and Pain Management, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Shalini Shah
- Department of Anesthesiology and Pain Management, University of California, Irvine, Orange, CA, USA
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13
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Sima RM, Pleş L, Socea B, Sklavounos P, Negoi I, Stănescu AD, Iordache II, Hamoud BH, Radosa MP, Juhasz-Boess I, Solomayer EF, Dimitriu MCT, Cîrstoveanu C, Şerban D, Radosa JC. Evaluation of the SF-36 questionnaire for assessment of the quality of life of endometriosis patients undergoing treatment: A systematic review and meta-analysis. Exp Ther Med 2021; 22:1283. [PMID: 34630638 PMCID: PMC8461506 DOI: 10.3892/etm.2021.10718] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/16/2021] [Indexed: 12/23/2022] Open
Abstract
Endometriosis has a negative influence on the physical, psychological, and social aspects of a patient's life; therefore, it affects the health-related quality of life (HRQoL). The current review aimed to investigate the efficiency of a 36-item generic questionnaire survey (SF-36) for patients with endometriosis who were undergoing medical or surgical treatment. A search strategy including the key words ‘endometriosis’, ‘quality of life’ (QOL), and ‘questionnaire SF-36’ was applied using the PubMed/MEDLINE, EMBASE, and Cochrane databases in order to include articles that evaluated the QOL among women with endometriosis using the SF-36. Only articles that included interviews of patients both before and after surgical or medical endometriosis treatment or those articles that compared study groups were considered. The qualitative analysis was based on 37 articles, whereas the quantitative analysis utilized 14 articles. The research participants included 11,101 women, among whom 6,888 patients were diagnosed with endometriosis. The analysis recorded 17 studies dealing with all types of endometriosis, 9 studies dealing with deep infiltrative endometriosis (DIE), and 9 studies dealing with bowel endometriosis or DIE with bowel involvement. QOL was evaluated using only SF-36 in 12 studies that collectively included 1,912 women and using SF-36 in association with other questionnaires in 25 studies that collectively included 8,022 women. For patients with endometriosis, physical functioning [odds ratio (OR), 78.87; 95% confidence interval (CI), 68.97-88.77; I2=98.77%; P≤0.001] was the most affected life parameter. This parameter showed the highest improvement after surgical intervention (OR, 63.39; 95% CI, 48.71-78.07; I2=97.65%; P≤0.001) or hormonal treatment (OR, 38.65; 95% CI, 14.39-62.91; I2=38.65%; P≤0.001). The 36-item survey generic questionnaire seems to be an efficient tool for assessment of the QOL of life of women with endometriosis who are undergoing surgical or medical treatment. It can be applied before and after the procedure, and it can also be used for comparing study groups.
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Affiliation(s)
- Romina-Marina Sima
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Liana Pleş
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Panagiotis Sklavounos
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Ionuţ Negoi
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Anca-Daniela Stănescu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Ioan-Iulian Iordache
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Bashar Haj Hamoud
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Marc Phillip Radosa
- Department of Gynecology, University Hospital Leipzig, D-04103 Leipzig, Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Erich Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Mihai C T Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Cătălin Cîrstoveanu
- Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Pediatrics Department, 'Maria Sklodowska Curie' Emergency Children Clinical Hospital, 041451 Bucharest, Romania
| | - Dragoş Şerban
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Julia Caroline Radosa
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
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14
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Mousa M, Al-Jefout M, Alsafar H, Becker CM, Zondervan KT, Rahmioglu N. Impact of Endometriosis in Women of Arab Ancestry on: Health-Related Quality of Life, Work Productivity, and Diagnostic Delay. Front Glob Womens Health 2021; 2:708410. [PMID: 34816238 PMCID: PMC8593935 DOI: 10.3389/fgwh.2021.708410] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Endometriosis has a negative effect on health-related quality of life (HRQoL), wellbeing and daily functioning. Endometriosis is an under-researched condition within non-western populations. Cultural representations are needed to understand the relative roles of societal norms, traditional factors, and religious sensitivities on the impact of endometriosis on HRQoL in various populations. In particular, there is a lack of emphasis placed in understanding the association of HRQoL on endometriosis in Arab women. Method: In this prospective case-control study, 2,610 Arab ancestry women in the United Arab Emirates were recruited to investigate the impact of endometriosis on HRQoL, diagnostic delay, psychological co-morbidities, work productivity, and physical activity. Participants completed the following standardized, validated questionnaires: Short Form-36 version 2 questionnaire, the World Endometriosis Research Foundation EPHect minimum clinical questionnaire version, and Work Productivity and Activity Impairment questionnaire. Translations to the Arabic language, validated using the forward-backward translation method, of the questionnaires were utilized. Results: HRQoL scores were significantly impaired in women with endometriosis, as demonstrated in the Physical Composite Scores and Mental Composite Scores in the symptomatic control group (p = 0.001; p = 0.003, respectively) and the asymptomatic control group (p < 0.001; p < 0.001, respectively). Susceptibility and severity of multiple pain syndromes and infertility in women with endometriosis was the main indicator of lower HRQoL. Anxiety (p = 0.007) and depression (p = 0.005) were significantly associated with endometriosis, in comparison to symptomatic controls. The average diagnostic delay was 11.61 years, however single women experience 15.81 years of diagnosis delay, with approximately 18% (n = 15) of the single women experiencing more than a 20-year delay in diagnosis. The intensity of physical activity was not associated with endometriosis, when compared to symptomatic (p = 0.405) or asymptomatic controls (p = 0.144). Conclusion: For the first time, we provide evidence from a combined hospital, clinic, and population-based study that Arab women with endometriosis experience significant impacts on HRQoL, substantial diagnostic delay after the onset of symptoms, significant association to psychological disorders (anxiety and depression), and a negative impact on work productivity. Future research must focus on understanding the personal and culturally centered beliefs of Arab women to ensure a positive HRQoL trajectory by improving diagnosis and management strategies.
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Affiliation(s)
- Mira Mousa
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
| | - Moamar Al-Jefout
- Department of Obstetrics and Gynaecology, College of Medical and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Obstetrics and Gynaecology, Mutah Medical Faculty, Mutah University, Al-Karak, Jordan
| | - Habiba Alsafar
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department of Genetics and Molecular Biology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Christian M. Becker
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
| | - Krina T. Zondervan
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Nilufer Rahmioglu
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
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15
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Impact of 1.0 mg/Day Dienogest Treatment on Bone Metabolism Markers in Young Women with Dysmenorrhea. ENDOCRINES 2021. [DOI: 10.3390/endocrines2030027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A low dose of dienogest (DNG) 1 mg/day is useful for treating dysmenorrhea in young women. However, the effect of DNG on bone turnover during bone growth and formation, rather than at maturity, is currently unknown even at low doses. We investigated change in bone turnover after 3 months of DNG 1 mg/day. This retrospective cohort study included young women aged 10–24 years with dysmenorrhea and irregular menstruation. Gonadotropins and the bone metabolism markers TRACP-5b and BAP were compared before and at 3 months after administration of DNG 1 mg/day. There were no significant changes in TRACP-5b (before, 455.6 ± 323.6 mU/dL; 3 months after, 462.1 ± 346.1 mU/dL), BAP (before, 24.7 ± 19.0 μg/L; 3 months after, 25.2 ± 22.3 μg/L), or the TRACP-5b/BAP ratio (before, 22.1 ± 7.0; 3 months after, 21.5 ± 6.3). Administration of DNG 1 mg/day had no significant effect on bone turnover after 3 months during the bone-growth phase in young women.
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16
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Grundström H, Larsson B, Arendt-Nielsen L, Gerdle B, Kjølhede P. Pain catastrophizing is associated with pain thresholds for heat, cold and pressure in women with chronic pelvic pain. Scand J Pain 2021; 20:635-646. [PMID: 32383692 DOI: 10.1515/sjpain-2020-0015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/19/2020] [Indexed: 01/06/2023]
Abstract
Background and aims Psychological traits such as pain catastrophizing may play a role in the development of chronic pelvic pain (CPP). Pain catastrophizing is the tendency to amplify negative cognitive and emotional pain processes. The Pain Catastrophizing Scale (PCS) assesses elements of pain catastrophizing divided into three subgroups of factors (rumination, helplessness and magnification). Previous studies have shown associations between CPP and increased pain sensitivity, widespread generalized hyperalgesia, and decreased pain thresholds, but the relation between pain catastrophizing and specific pain thresholds has not yet been widely examined in this patient group. The aims of this study were (a) to determine if catastrophizing is increased in women with CPP compared with pain-free women, (b) to assess the importance of pain catastrophizing, psychological distress variables, and subjective pain sensitivity for pain thresholds of heat, cold and pressure in these two groups, and (c) to determine whether psychological variables or pain thresholds best contribute to the differentiation between CPP and controls. Methods Thirty-seven women with chronic pelvic pain who underwent diagnostic laparoscopy on the suspicion of endometriosis participated along with 55 healthy and pain-free controls. All underwent quantitative sensory testing on six locations on the body to determine heat (HPT), cold (CPT) and pressure (PPT) pain thresholds. The PCS, the Pain Sensitivity Questionnaire (PSQ), the Hospital Anxiety Depression Scale, (HADS) demographics and clinical data were collected prospectively. Principal component analysis and orthogonal partial least square regressions were used to assess the associations between PCS scores and pain thresholds. Results The women with CPP scored significantly higher on PCS than the healthy controls. PCS-helplessness, PCS-rumination and HADS-depression were significantly associated with pain thresholds for the whole group. In the CPP group, PCS-rumination, body mass index and PSQ were significant regressors for HPT and CPT. The PCS and the HADS subscales were strongly intercorrelated in women with CPP and were stronger regressors of group membership than the three pain thresholds. In the group of healthy control women, no relationships were found to be significant. The psychological variables were somewhat stronger significant regressors than pain thresholds (also significant) for group membership. Conclusions Women with CPP have significantly higher pain catastrophizing scores than women without CPP. The pain catastrophizing rumination factor is significantly associated with pain thresholds of heat and cold in CPP women. PCS and HADS are strongly intercorrelated and PSQ correlates positively with these variables. It seems that the psychological variables are important for group differentiation. Implications The results clearly indicate the need for a multimodal assessment (bio-psycho-social) of CPP patients including psychological symptoms such as catastrophizing, anxiety and depression. The registration of semi-objective pain thresholds captures both specific pain sensitivity information (mechanical pressure, cold or heat) and the degree of wide spread pain hypersensitivity. There is a need for future larger studies investigating whether certain profiles in the clinical presentations (including pain thresholds and psychological variables) are associated with outcomes after different types of interventions.
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Affiliation(s)
- Hanna Grundström
- Department of Obstetrics and Gynaecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interactions, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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17
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Wang Y, Li B, Zhou Y, Wang Y, Han X, Zhang S, He Z, Ouyang L. Does Endometriosis Disturb Mental Health and Quality of Life? A Systematic Review and Meta-Analysis. Gynecol Obstet Invest 2021; 86:315-335. [PMID: 34352799 DOI: 10.1159/000516517] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate whether endometriosis could disturb the mental health and health-related quality of life (HRQoL) of patients and to provide a new prospective for further treatment of endometriosis. METHODS A comprehensive literature review was conducted among 4 international databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 of the largest Chinese databases (the China National Knowledge Infrastructure and Wangfang). The Newcastle-Ottawa Scale was used to assess the quality of the included articles. Six effect sizes were synthesized through a meta-analysis, and a subgroup analysis was performed to identify potential moderating factors, including types of control groups, methods of assessment, number of study groups, and origin of the study. Potential publication bias was examined using a funnel plot. RESULTS This meta-analysis pooled 44 articles from 4 continents and 13 countries and compared 6 types of main effect sizes (the odds ratio [OR] for depression, the OR for anxiety, the standardized mean difference [SMD] for depression, the SMD for anxiety, the SMD for the physical component summary [PCS] and the SMD for the mental component summary [MCS]) between endometriosis patients and controls. Except for the SMD for depression, all other effect sizes revealed statistically significant differences between the study group and the controls. The main effect size outcomes of the subgroup analysis were also similar. The type of control group (I2 = 35% in non-endometriosis control groups for the SMD of anxiety; I2 = 47% in non-endometriosis control groups for the MCS of the 36-Item Short Form Health Survey) and the continent of origin (I2 = 0% in studies from South America for the OR of depression; I2 = 47% in studies from Europe for the SMD of anxiety) may influence heterogeneity in this analysis. Additionally, depression and anxiety symptoms in patients seemed to be more apparent compared with healthy controls when the sample was smaller and when a questionnaire was used. The publication bias of the articles was acceptable. CONCLUSION Endometriosis can disturb mental health (specifically depression and anxiety) and decrease both the mental and physical HRQoL of patients. There may be some moderating factors that we were unable to identify in the subgroup analysis, but more research is necessary to develop proper management and improve the prognosis of endometriosis patients.
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Affiliation(s)
- Yuehan Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China,
| | - Bo Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Zhou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue Han
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shitai Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zheng He
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Ouyang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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18
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Van Bogaert W, Putman K, Coppieters I, Goudman L, Nijs J, Moens M, Buyl R, Ickmans K, Huysmans E. Health-related quality of life deviations from population norms in patients with lumbar radiculopathy: associations with pain, pain cognitions, and endogenous nociceptive modulation. Qual Life Res 2021; 31:745-757. [PMID: 34342846 DOI: 10.1007/s11136-021-02964-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE The primary goal of this study was to compare the health-related quality of life (HRQoL) of people with lumbar radiculopathy to age- and sex-adjusted population norms. Additionally, it aimed to explore the associations between the HRQoL difference scores and measures related to pain cognitions, pain intensity, and endogenous nociceptive modulation. METHODS Using answers from the Short Form 36-item Health Survey and UK population norms, SF-6D difference scores were calculated. A one-sample t test was used to assess the SF-6D difference scores. Univariate and multivariate regression analyses were used to assess the associations between SF-6D difference scores and pain intensity [Visual Analogue Scale (VAS) for back and leg pain], pain cognitions [Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Pain Vigilance and Awareness Questionnaire (PVAQ)], and correlates for endogenous nociceptive modulation using quantitative sensory testing. RESULTS One hundred and twenty people with lumbar radiculopathy scheduled for surgery were included in this study. The mean SF-6D difference score of - 0.26 [SD = 0.09] was found to be significantly less than 0 [95%CI: - 0.27 to - 0.24]. Univariate analyses showed a significant influence from PCS, TSK, and PVAQ on the SF-6D difference scores. The final multivariate regression model included PCS and PVAQ, with only PCS maintaining a statistically significant regression coefficient [b = - 0.002; 95% CI: - 0.004 to - 0.001]. CONCLUSION People diagnosed with lumbar radiculopathy report significantly lower HRQoL scores when compared with age- and sex-adjusted UK norm values. Even though all examined pain cognitions were found to have a significant association, pain catastrophizing showed the most significant relation to the SF-6D difference scores. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier No. NCT02630732. Date of registration: November 25, 2015.
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Affiliation(s)
- Wouter Van Bogaert
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
- Research Foundation-Flanders (FWO), Brussels, Belgium.
| | - Koen Putman
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Lisa Goudman
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Center for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
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Phan VT, Stratton P, Tandon HK, Sinaii N, Aredo JV, Karp BI, Merideth MA, Shah JP. Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: A cross-sectional study. Eur J Pain 2021; 25:831-840. [PMID: 33326662 DOI: 10.1002/ejp.1713] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/12/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment. OBJECTIVE Characterize the presence and distribution of pain, myofascial dysfunction and sensitisation beyond the pelvis in women with endometriosis-associated chronic pelvic pain. METHODS Cross-sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain-focused abdominopelvic gynaecologic examination with the identification of pelvic floor muscle spasm. Neuro-musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger points in 13 paired muscles. Pressure-pain thresholds were measured over interspinous ligaments and trigger points. Women completed the body territories element of the Body Pain Index. RESULTS All women had a pelvic floor muscle spasm that they self-identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure-pain thresholds and trigger points in over two-thirds of 26 assessed regions. Widespread spinal segmental sensitisation was present in 17/30, thoracic in 21/30 and lumbosacral/pelvic in 18/30. Cervical sensitisation manifested as low pressure-pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p = .024) and lumbosacral/pelvic (p = .036) sensitisation and report over 10 painful body areas (p = .009). CONCLUSIONS Women with endometriosis-associated chronic pelvic pain often have myofascial dysfunction and sensitisation beyond the pelvic region that may be initiated or maintained by on-going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population. Clinicaltrials.gov identifier: NCT01553201. SIGNIFICANCE Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies and these women have regional pelvic sensitisation and myofascial dysfunction. Pelvic floor muscle spasm is a major pain focus in this population. Sensitisation and myofascial dysfunction are widespread, beyond the pelvic region. On-going pelvic floor spasm may initiate or maintain sensitisation. Myofascial/sensitisation manifestations warrant consideration when managing pain in this population.
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Affiliation(s)
- Vy T Phan
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Pamela Stratton
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Hannah K Tandon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ninet Sinaii
- Biostatistics & Clinical Epidemiology Service, Intramural Research Program, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Barbara I Karp
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Melissa A Merideth
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jay P Shah
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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20
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Lunde S, Petersen KK, Søgaard-Andersen E, Arendt-Nielsen L. Preoperative quantitative sensory testing and robot-assisted laparoscopic hysterectomy for endometrial cancer: can chronic postoperative pain be predicted? Scand J Pain 2020; 20:693-705. [PMID: 32817584 DOI: 10.1515/sjpain-2020-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022]
Abstract
Objectives Chronic postoperative pain is prevalent after robot-assisted laparoscopic hysterectomy for endometrial cancer. Preoperative Quantitative Sensory Testing (QST) has been utilized to identify patients at risk of developing chronic postoperative pain after a range of surgical procedures. The aim of this prospective, observational study was to (1) determine the prevalence of chronic postoperative pain, (2) assess selected preoperative risk factors for chronic postoperative pain, and (3) evaluate if preoperative QST profiling could predict the development of chronic postoperative pain following robot-assisted laparoscopic hysterectomy for endometrial cancer. Methods One-hundred and sixty consecutive patients were included and handheld pressure algometry, cuff pressure algometry, temporal summation of pain, conditioned pain modulation, and heat pain thresholds were assessed prior to surgery. Patients were asked to fill out a questionnaire concerning pain in the pre- and post-operative time period six months after surgery. Chronic postoperative pain was defined as persistent, moderate to severe pain (mean visual analogue scale (VAS)≥3) on a daily basis six months after surgery. Results The prevalence of chronic postoperative pain after robot-assisted laparoscopic hysterectomy for endometrial cancer was of 13.6% (95% CI 8.4-20.4%). Patients that would develop chronic postoperative pain had a lower BMI (p=0.032), a higher prevalence of preoperative pelvic pain (p<0.001), preoperative heat pain hyperalgesia (p=0.043) and a higher level of acute postoperative pain (p<0.001) when compared to patients that would not develop chronic postoperative pain. A logistic regression model demonstrated that the presence of preoperative pelvic pain was a significant, independent predictive risk factor for development of chronic postoperative pain (OR=6.62, 95% CI 2.26-19.44), whereas none of the QST parameters could predict postoperative pain. Conclusions Preoperative QST assessment could not predict the development of chronic postoperative pain despite preoperative heat pain hyperalgesia in patients that would develop chronic postoperative pain.
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Affiliation(s)
- Søren Lunde
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Kjær Petersen
- Center for Sensory-Motor Interaction, Center for Neuroplasticity and Pain, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Erik Søgaard-Andersen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction, Center for Neuroplasticity and Pain, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Valentino R, Rongo R, Alessio M, Alstergren P, Bucci R, Leone G, D’Antò V, Michelotti A. “Pressure pain threshold over masticatory muscles and temporomandibular joint in patients with juvenile idiopathic arthritis”. J Oral Rehabil 2020; 47:944-950. [DOI: 10.1111/joor.13024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Roberta Valentino
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Roberto Rongo
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Maria Alessio
- Department of Translational Medicine University Naples Federico II Naples Italy
| | - Per Alstergren
- Orofacial Pain and Jaw Function Institute of Dental Medicine Karolinska Institutet Huddinge Sweden
- Orofacial Pain Unit Faculty of Odontology Malmö University Malmö Sweden
| | - Rosaria Bucci
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Giovanna Leone
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Vincenzo D’Antò
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Ambrosina Michelotti
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
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Aspinall SL, Jacques A, Leboeuf-Yde C, Etherington SJ, Walker BF. Pressure pain threshold and temporal summation in adults with episodic and persistent low back pain trajectories: a secondary analysis at baseline and after lumbar manipulation or sham. Chiropr Man Therap 2020; 28:36. [PMID: 32532328 PMCID: PMC7291433 DOI: 10.1186/s12998-020-00326-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/04/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND People with chronic low back pain (LBP) typically have increased pain sensitivity compared to healthy controls, however its unknown if pain sensitivity differs based on LBP trajectory at baseline or after manual therapy interventions. We aimed to compare baseline pressure pain threshold (PPT) and temporal summation (TS) between people without LBP, with episodic LBP, and with persistent LBP, and to compare changes over time in PPT and TS after a lumbar spinal manipulation or sham manipulation in those with LBP. METHODS Participants were aged 18-59, with or without LBP. Those with LBP were categorised as having either episodic or persistent LBP. PPT and TS were tested at baseline. LBP participants then received a lumbar spinal manipulation or sham, after which PPT and TS were re-tested three times over 30 min. Generalised linear mixed models were used to analyse data. RESULTS One hundred participants (49 female) were included and analysed. There were 20 non-LBP participants (mean age 31 yrs), 23 episodic LBP (mean age 35 yrs), and 57 persistent LBP (mean age 37 yrs). There were no significant differences in PPT or TS between groups at baseline. There was a non-significant pattern of lower PPT (higher sensitivity) from the non-LBP group to the persistent LBP group at baseline, and high variability. Changes in PPT and TS after the interventions did not differ between the two LBP groups. DISCUSSION We found no differences between people with no LBP, episodic LBP, or persistent LBP in baseline PPT or TS. Changes in PPT and TS following a lumbar manual therapy intervention do not appear to differ between LBP trajectories. TRIAL REGISTRATION The trial was prospectively registered with ANZCTR (ACTRN12617001094369).
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Affiliation(s)
- Sasha L. Aspinall
- College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, WA 6150 Australia
| | - Angela Jacques
- College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, WA 6150 Australia
| | - Charlotte Leboeuf-Yde
- College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, WA 6150 Australia
- Institute of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 3, 5000 Odense C, Denmark
| | - Sarah J. Etherington
- College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, WA 6150 Australia
| | - Bruce F. Walker
- College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, WA 6150 Australia
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23
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Davie S, Hamilton Y, Webb L, Amoako AA. Sleep quality and endometriosis: A group comparison study. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520909979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Endometriosis affects around 10% of women of reproductive age with symptoms of pelvic pain, dysmenorrhoea, dyspareunia, dyschezia, and infertility. Current research highlights a possible relationship between endometriosis and poor sleep quality. The aim of this study was to assess the relationship between sleep quality and endometriosis. Outcomes measured included sleep quality and quality of life and pain score. Methods: Thirty women with a histological diagnosis of endometriosis and 30 control patients completed an online questionnaire that assessed sleep quality (Pittsburgh Sleep Quality Index) and quality of life (WHO-QOL-BREF). Pain scores within the endometriosis group were evaluated using a visual analogue scale. Results: Women with endometriosis had significantly poorer sleep quality (80% vs 50%, p = 0.015) and lower quality of life scores when compared to the control group. Within the endometriosis group, there were trends between poor sleep, a reduced quality of life, and higher pain scores; however, these did not reach statistical significance. Discussion: Sleep quality and quality of life were significantly reduced in women with endometriosis when compared to controls.
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Affiliation(s)
- Stacey Davie
- Department of Obstetrics and Gynecology, Gold Coast University Hospital, Southport, QLD, Australia
- Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Yasu Hamilton
- Department of Obstetrics and Gynecology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Lachlan Webb
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Akwasi A Amoako
- Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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24
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Evaluation of pain and flexor reflex responses and their association with clinical parameters in patients with fibromyalgia. Turk J Phys Med Rehabil 2020; 66:1-9. [PMID: 32318668 DOI: 10.5606/tftrd.2020.3753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/21/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives In the present study, we aimed to evaluate electrophysiological outcomes of flexor reflexes (FR) emerging in response to painful stimuli in fibromyalgia (FM) patients. Patients and methods This study included a total of 21 female FM patients (mean age 36.8±8.0 years; range, 20 to 50 years) and 28 healthy female controls (mean age 37.3±8.8 years; range, 22 to 53 years). Clinical features of the patients, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores were recorded. Electrophysiological stimulation threshold, visual analog scale (VAS) scores of generated pain after each stimulation, current intensity, flexor responses obtained from muscles, and electrophysiological measurement of these responses were noted. Results The threshold for perception of electrical current was higher and resistance level to maximum electrical current was lower in FM patients (p<0.05). The VAS scores of FM patients under maximum electrical current were higher than the control group (p<0.05), while the lowest current value in which FR response obtained in FM patients was lower (p<0.05). The latency was lower, amplitude was higher, and response area was wider in FM patients (p<0.05). No significant relationship between the FIQ, BDI, BAI scores and stimulant perception threshold levels was found in FM patients (p>0.05). Conclusion Based on these findings, FR responses may be useful as an electrophysiological parameter in FM diagnosis.
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Sethi J, Sarker K, Mohanty U. Comparative clinical effects of spinal manipulation, core stability exercise, and supervised exercise on pain intensity, segmental instability, and health-related quality of life among patients with chronic nonspecific low back pain: A randomized control trial. J Nat Sci Biol Med 2020. [DOI: 10.4103/jnsbm.jnsbm_101_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Bucourt E, Martaillé V, Goupille P, Joncker-Vannier I, Huttenberger B, Réveillère C, Mulleman D, Courtois AR. A Comparative Study of Fibromyalgia, Rheumatoid Arthritis, Spondyloarthritis, and Sjögren’s Syndrome; Impact of the Disease on Quality of Life, Psychological Adjustment, and Use of Coping Strategies. PAIN MEDICINE 2019; 22:372-381. [DOI: 10.1093/pm/pnz255] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Fibromyalgia, rheumatoid arthritis, spondyloarthritis, and Sjögren’s syndrome are chronic rheumatic diseases with very different clinical characteristics, but which share symptoms such as pain and fatigue. The aim of the study was to examine the impact of the disease on psychological adaptation in fibromyalgia compared with other rheumatic diseases (rheumatoid arthritis, spondyloarthritis, and Sjögren’s syndrome).
Methods
In a multicenter study, 165 women with rheumatic diseases (48 with fibromyalgia, 47 with rheumatoid arthritis, 47 with spondyloarthritis, 23 with Sjögren’s syndrome) completed the General Health Questionnaire–28 (emotional distress), Fatigue Severity Scale (fatigue), Fibromyalgia Impact Questionnaire (impact of the disease), Coping Strategies Questionnaire (coping), and Mini International Neuropsychiatric Interview (comorbidity with DSM IV axis-I disorders). We used the Kruskal-Wallis test, Mann-Whitney U test, and chi2 test to compare comorbid anxiety and depressive disorders and to compare the impact of the disease on patients’ mental well-being and daily life and adjustment (coping strategies).
Results
Anxiety and depressive disorders were more common in fibromyalgia patients; they had higher scores on impact of the disease, physical symptoms, pain, and fatigue than rheumatoid arthritis patients and reported more fatigue than patients with spondyloarthritis. Overall, they used more maladaptive coping strategies (less use of distancing from pain than patients with rheumatoid arthritis and spondyloarthritis, less use of ignoring pain sensations, and more use of catastrophizing than those with rheumatoid arthritis). No differences were found between fibromyalgia and Sjögren’s syndrome on impact and adjustment.
Conclusions
Compared with other rheumatic diseases, fibromyalgia has a greater impact on daily life; patients have more difficulty adjusting to the disease and generally use poorer strategies to cope with pain.
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Affiliation(s)
- Emilie Bucourt
- Département de Psychologie, Université de Tours, EE 1901 Qualipsy ‘Qualité de Vie et Santé Psychologique,’ Tours Cedex, France
| | - Virginie Martaillé
- Service de Rhumatologie, CHRU de Tours, Université de Tours, Tours, France
| | - Philippe Goupille
- Service de Rhumatologie, CHRU de Tours, Université de Tours, Tours, France
| | | | - Brigitte Huttenberger
- Plastique de la Face et Stomatologie, Service de Chirurgie Maxillo-Faciale, CHRU de Tours, Université de Tours, Tours, France
| | - Christian Réveillère
- Département de Psychologie, Université de Tours, EE 1901 Qualipsy ‘Qualité de Vie et Santé Psychologique,’ Tours Cedex, France
| | - Denis Mulleman
- Service de Rhumatologie, CHRU de Tours, Université de Tours, Tours, France
| | - and Robert Courtois
- Département de Psychologie, Université de Tours, EE 1901 Qualipsy ‘Qualité de Vie et Santé Psychologique,’ Tours Cedex, France
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours Cedex, France
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Aoyagi K, He J, Nicol AL, Clauw DJ, Kluding PM, Jernigan S, Sharma NK. A Subgroup of Chronic Low Back Pain Patients With Central Sensitization. Clin J Pain 2019; 35:869-879. [PMID: 31408011 PMCID: PMC7197191 DOI: 10.1097/ajp.0000000000000755] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Our knowledge of central sensitization (CS) in chronic low back pain (CLBP) is limited. 2011 fibromyalgia criteria and severity scales (2011 FM survey) have been used to determine FM positive as a surrogate of CS. The major features of CS including widespread hyperalgesia and dysfunction of the descending inhibitory pathways can be identified by pressure pain threshold (PPT) and conditioned pain modulation (CPM) tests. The purpose of the study was to examine neurophysiological characteristics and psychosocial symptoms in a subgroup of FM-positive CLBP compared with FM-negative CLBP patients. METHODS A total of 46 participants with CLBP and 22 pain-free controls completed outcome measures of the 2011 FM survey, PPT and CPM tests, and psychosocial questionnaires. Differences between FM-positive and FM-negative CLBP participants on these measures and correlations were analyzed. RESULTS The 2011 FM survey identified 22 (48%) participants with CLBP as FM positive. FM-positive CLBP participants showed lower PPT values of the thumbnail (P=0.011) and lower back (P=0.003), lower CPM values of the thumbnail (P=0.002), and more severe pain catastrophizing, anxiety, and depression symptoms (P<0.05) than FM-negative CLBP participants. The 2011 FM scores were significantly correlated with the PPT and CPM values of the thumbnail and with psychosocial symptoms (P<0.001). DISCUSSION Our findings suggest a subgroup of CLBP patients exhibiting with signs and symptoms of CS. Associations between subjective and objective CS measures indicate that the 2011 FM survey can be utilized to identify the presence of CS in CLBP in clinical practice.
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Affiliation(s)
- Kosaku Aoyagi
- Departments of Physical Therapy and Rehabilitation Science
| | | | - Andrea L Nicol
- Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | | | | | - Neena K Sharma
- Departments of Physical Therapy and Rehabilitation Science
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Pain Mechanisms in Low Back Pain: A Systematic Review With Meta-analysis of Mechanical Quantitative Sensory Testing Outcomes in People With Nonspecific Low Back Pain. J Orthop Sports Phys Ther 2019; 49:698-715. [PMID: 31443625 DOI: 10.2519/jospt.2019.8876] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mechanical quantitative sensory testing (QST) assesses sensory functioning and detects functional changes in (central) nociceptive processing. It has been hypothesized that these functional changes might be apparent in people with nonspecific low back pain (LBP), although the results are mixed. OBJECTIVE The aim of this systematic review was to examine whether sensory function, measured with QST, was altered in people with nonspecific LBP. METHODS This systematic review was conducted according to PRISMA guidelines. Six databases were searched for relevant literature. Studies comparing mechanical QST measures involving people with subacute and chronic LBP and healthy controls were included if (1) pressure pain thresholds (PPTs), (2) temporal summation, or (3) conditioned pain modulation were reported. Risk of bias was assessed using the Newcastle-Ottawa scale. When possible, the results from different studies were pooled. RESULTS Twenty-four studies were included. Scores on the Newcastle-Ottawa scale varied between 1 and 6 points. People with nonspecific LBP, compared to healthy controls, had significantly lower PPTs at remote sites and increased temporal summation at the lower back. The PPTs measured at the scapula were significantly lower in patients with nonspecific LBP than in healthy controls (pooled mean difference, 119.2 kPa; 95% confidence interval: 91.8, 146.6 kPa; P<.001). CONCLUSION The PPT measurements at remote body parts were significantly lower in people with nonspecific LBP compared with healthy controls. Temporal summation and conditioned pain modulation measurements had mixed outcomes. LEVEL OF EVIDENCE Therapy, level 3a. J Orthop Sports Phys Ther 2019;49(10):698-715. Epub 23 Aug 2019. doi:10.2519/jospt.2019.8876.
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Grundström H, Larsson B, Arendt-Nielsen L, Gerdle B, Kjølhede P. Associations between pain thresholds for heat, cold and pressure, and Pain Sensitivity Questionnaire scores in healthy women and in women with persistent pelvic pain. Eur J Pain 2019; 23:1631-1639. [PMID: 31192501 DOI: 10.1002/ejp.1439] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/22/2019] [Accepted: 06/02/2019] [Indexed: 08/22/2024]
Abstract
BACKGROUND The Pain Sensitivity Questionnaire (PSQ) is a self-rating instrument developed as a time- and cost-saving alternative to quantitative sensory testing (QST). The aims of the study were to assess (a) the associations between PSQ scores and QST in women with persistent pelvic pain and in pain-free controls and (b) to what extent demographic variables and psychological distress influenced PSQ scores. METHODS Fifty-five healthy women and 37 women with persistent pelvic pain participated. All filled in the PSQ and Hospital Anxiety and Depression Scale and had QST (heat, cold and pressure pain thresholds) performed on six locations on the body. Information on age, body mass index, smoking habits and pain duration were collected. Principal component analysis and orthogonal partial least square regressions were used. RESULTS The patients scored significantly higher on PSQ than the controls. Significant multivariate correlations between pain thresholds and PSQ scores were found only in the patient group. In the patient group, the heat and cold pain thresholds correlated more strongly with PSQ scores than the pressure pain threshold. CONCLUSIONS The PSQ score was significantly higher in pelvic pain patients, and correlations between QSTs and the PSQ were only found for patients. SIGNIFICANCE The PSQ reflects pain sensitivity in women with PPP and can be used as a non-invasive and painless way to assess this condition in clinical practice.
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Affiliation(s)
- Hanna Grundström
- Department of Obstetrics and Gynecology, Linköping University, Norrköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interactions, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Preben Kjølhede
- Children and Women's Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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30
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Sempere-Rubio N, Aguilar-Rodríguez M, Inglés M, Izquierdo-Alventosa R, Serra-Añó P. Physical Condition Factors that Predict a Better Quality of Life in Women with Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173173. [PMID: 31480366 PMCID: PMC6747062 DOI: 10.3390/ijerph16173173] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 12/17/2022]
Abstract
What physical qualities can predict the quality of life (QoL) in women with fibromyalgia (FM)? QoL is a very complex outcome affected by multiple comorbidities in people with fibromyalgia. This study aims to determine which physical qualities can predict the quality of life in women with FM. Also, a comparison between the physical qualities of women with FM and healthy counterparts was conducted. In total, 223 women participated in this cross-sectional study, 123 with FM, with ages ranging between 45 and 70 years. The study was conducted at several fibromyalgia associations and specialized medical units. QoL was measured as the main outcome. In addition, functional capacity, muscular strength, maintenance of thoracic posture, postural control, flexibility, pain threshold, and anxiety were measured. Prediction of the QoL was conducted with multiple linear regression analysis and comparison between groups, using the Mann–Whitney U test. There were significant differences between groups in all the variables measured (p < 0.01). The multiple linear regression model showed that factors influencing QoL in women with FM for all the variables measured were functional capacity, handgrip strength and bicep strength, maintenance of thoracic posture, pain threshold, and anxiety (R2 = 0.53, p < 0.05). To conclude, women with FM show a significantly lower QoL than their healthy counterparts, and the factors that predict their perceived QoL are functional capacity, muscular strength, postural maintenance, pain threshold, and anxiety.
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Affiliation(s)
- Núria Sempere-Rubio
- Unidad de Biomecánica Clínica (UBIC Research Group), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València 46010, Spain
| | - Marta Aguilar-Rodríguez
- Unidad de Biomecánica Clínica (UBIC Research Group), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València 46010, Spain
| | - Marta Inglés
- Freshage Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES-ISCIII), Fundación Investigación del Hospital Clínico Universitario de Valencia (INCLIVA), València 46010, Spain
| | - Ruth Izquierdo-Alventosa
- Unidad de Biomecánica Clínica (UBIC Research Group), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València 46010, Spain
| | - Pilar Serra-Añó
- Unidad de Biomecánica Clínica (UBIC Research Group), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València 46010, Spain.
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31
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The relationship between catastrophizing and altered pain sensitivity in patients with chronic low-back pain. Pain 2019; 160:833-843. [PMID: 30531308 DOI: 10.1097/j.pain.0000000000001461] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Changes in central pain processing have been shown in patients with chronic low-back pain (cLBP). We used quantitative sensory testing methods to identify differences in pain sensitization between patients with cLBP (N = 167) and healthy controls (N = 33). Results indicated that, compared with healthy pain-free controls, cLBP patients showed increased sensitivity and greater painful aftersensations for mechanical pressure and pin-prick stimuli and lower tactile spatial acuity in the 2-point discrimination task (ps < 0.05). Then, we examined the role of pain catastrophizing as a mediator of the group differences in pain sensitization. We found that catastrophizing partially accounted for group differences in pressure required to produce moderate pain. Finally, we examined the relationship between pain sensitization, catastrophizing, and clinical pain among patients with cLBP. We found that catastrophizing and deep-tissue pressure pain were associated with greater pain intensity in the past month, week, and at the visit as well as low-back pain bothersomeness. Furthermore, deep-tissue pressure pain mediated the associations between catastrophizing and both pain in the past month and low-back pain severity. Taken together, these results indicate that not only do patients with cLBP demonstrate increased pain sensitization and decreased sensitivity to innocuous stimuli, but these changes are also linked with increased catastrophizing. Furthermore, both catastrophizing and sensitization are associated with increased clinical pain among cLBP patients.
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32
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Abstract
Women with chronic pelvic pain (CPP) frequently suffer from mood disturbances and reduced quality of life. Whether pain improvement ameliorates mood and quality of life is still unclear, and it was investigated in an observational prospective study performed in a cohort of 117 of the outpatient services for endometriosis and chronic pelvic pain at a University Hospital. Depending on disease, women were treated either by surgery or by the administration of an estrogen-progestin or a progestin alone. Pain during menses, between menses and at intercourse was evaluated by a 100 mm visual analog (VAS) scale. Quality of life was evaluated by the SF-36 questionnaire, state of anxiety by the Y-1 form of the State-Trait Anxiety Inventory (STAI-Y1) and depression the Self Evaluating Depression Scale (SDS). Women were 34.2 ± 8.1 years old. After a mean follow-up period of 10.0 ± 9.1 months, and independently on treatment (43.6% surgery), pain during menses (-28.2 ± 36.8; p<.0001), between menses (-11.3 ± 37.1; p<.002) and at intercourse (-8.3 ± 35.4; p<.02) decreased. SF-36 increased (3.3 ± 16.2; p<.03), STAI slightly decreased (-1.9 ± 8.6; p<.02), while depression did not change (-0.7 ± 7.8; p=.36). Pain changes were not related to changes of SF-36 or mood scores. In women with CPP, prolonged pain amelioration, has little impact on mood, particularly on depression. The data support the need for a multidisciplinary approach to women with CPP.
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Affiliation(s)
- Angelo Cagnacci
- a Obstetrics and Gynecology Unit , University Hospital of Modena , Modena , Italy
- b Obstetrics and Gynecology Unit , University Hospital of Udine , Udine , Italy
| | - Elena Della Vecchia
- a Obstetrics and Gynecology Unit , University Hospital of Modena , Modena , Italy
| | - Anjeza Xholli
- a Obstetrics and Gynecology Unit , University Hospital of Modena , Modena , Italy
- b Obstetrics and Gynecology Unit , University Hospital of Udine , Udine , Italy
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33
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Comptour A, Chauvet P, Canis M, Grémeau AS, Pouly JL, Rabischong B, Pereira B, Bourdel N. Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis. J Minim Invasive Gynecol 2019; 26:717-726. [DOI: 10.1016/j.jmig.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022]
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Abstract
A great need exists for the identification of new effective analgesics to treat sustained pain. However, most preclinical nociceptive assays measure behavioral responses evoked by noxious stimuli (ie, pain-stimulated behavior), which presents a challenge to distinguish between motor impairing and antinociceptive effects of drugs. Here, we demonstrate that chronic constriction injury (CCI) of the sciatic nerve elicits common pain-stimulated responses (ie, mechanical allodynia and thermal hyperalgesia) as well as reduces marble burying/digging behaviors that occur during the early stages of the neuropathy and resolve within 1 week. Although drugs representing distinct classes of analgesics (ie, morphine, valdecoxib, and gabapentin) reversed both CCI-induced and CCI-depressed nociceptive measures, diazepam lacked antinociceptive effects in all assays and the kappa-opioid receptor agonist U69593 reversed pain-stimulated, but not pain-depressed behaviors. In addition, we tested drugs targeting distinct components of the endocannabinoid system, including agonists at cannabinoid receptors type 1 (CB1) and type 2 (CB2), as well as inhibitors of the endocannabinoid-regulating enzymes fatty acid amide hydrolase and monoacylglycerol lipase. Each of these drugs reversed all CCI-induced nociceptive measures, with the exception of the fatty acid amide hydrolase inhibitor that reversed pain-stimulated behaviors, only. These findings support the use of the mouse marble-burying assay as a model of pain-depressed behavior within the first week of sciatic nerve injury to examine candidate analgesics. These data also support existing preclinical research that cannabinoid receptor agonists and inhibitors of endocannabinoid-regulating enzymes merit consideration for the treatment of pain.
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Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
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Khudhair J, Al Hashimi A, Hamandi Y. Comparison between somatosensory-evoked potential parameters in patients with nonspecific versus specific chronic low back pain. MEDICAL JOURNAL OF BABYLON 2019. [DOI: 10.4103/mjbl.mjbl_65_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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37
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Grundström H, Gerdle B, Alehagen S, Berterö C, Arendt-Nielsen L, Kjølhede P. Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis. Acta Obstet Gynecol Scand 2018; 98:327-336. [DOI: 10.1111/aogs.13508] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Hanna Grundström
- Department of Obstetrics and Gynecology; Linköping University; Norrköping Sweden
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Center and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Siw Alehagen
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Carina Berterö
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interactions; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
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38
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van Aken M, Oosterman J, van Rijn T, Woudsma K, Ferdek M, Ruigt G, Kozicz T, Braat D, Peeters A, Nap A. Experimental pain tolerance is decreased and independent of clinical pain intensity in patients with endometriosis. Fertil Steril 2018; 110:1118-1128. [DOI: 10.1016/j.fertnstert.2018.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
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39
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Verket NJ, Uhlig T, Sandvik L, Andersen MH, Tanbo TG, Qvigstad E. Health-related quality of life in women with endometriosis, compared with the general population and women with rheumatoid arthritis. Acta Obstet Gynecol Scand 2018; 97:1339-1348. [PMID: 30007080 DOI: 10.1111/aogs.13427] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Women with endometriosis have reduced health-related quality of life (HRQoL). However, comparisons to the general population and other patient groups are lacking. MATERIAL AND METHODS The present cross-sectional questionnaire study included 157 women with endometriosis, 156 women from the general population, and 837 women with rheumatoid arthritis (RA). During a period from 2012 to 2013, women aged 18-45 years were recruited from the Norwegian Endometriosis Association and from a random sample of women residing in Oslo, Norway. HRQoL data from women with RA were included from a survey conducted in 2009 among patients of the Oslo Rheumatoid Arthritis Register. The Short Form-36 (SF-36) questionnaire was used to measure HRQoL. RESULTS Compared with the control group, the endometriosis group had significantly reduced mean scores for all SF-36 scales. The difference was largest for the scale bodily pain with a mean score of 47.6 in the endometriosis group vs 81.5 in the control group. Compared with the RA group, the endometriosis group had significantly reduced mean scores for the three SF-36 scales vitality, social functioning, and mental health. The mean scores of these scales in the endometriosis group were 33.4, 62.7, and 66.3, respectively, vs 42.7, 68.8, and 72.6 in the RA group. CONCLUSIONS Women with moderate to severe endometriosis seem to have overall impaired HRQoL compared with women from the general population, and poorer mental HRQoL compared with women with RA.
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Affiliation(s)
- Nina J Verket
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research Center for Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Till Uhlig
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Leiv Sandvik
- Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Marit H Andersen
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Tom G Tanbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Reproductive Medicine, Oslo University Hospital, Oslo, Norway
| | - Erik Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gynecology, Oslo University Hospital, Oslo, Norway
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Meints SM, Wang V, Edwards RR. Sex and Race Differences in Pain Sensitization among Patients with Chronic Low Back Pain. THE JOURNAL OF PAIN 2018; 19:1461-1470. [PMID: 30025944 DOI: 10.1016/j.jpain.2018.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
Abstract
Growing evidence suggests that chronic low back pain (CLBP) is associated with pain sensitization, and that there are sex and race disparities in CLBP. Given the sex and race differences in pain sensitization, this has been hypothesized as a mechanism contributing to the sex and race disparities in CLBP. This study examined sex and race differences in pain sensitization among patients with CLBP, as well as the role of catastrophizing as a potential mediator of those differences. The study found that compared with men, women required less pressure to produce deep muscle pain and rated mechanical punctate pain as more painful. Compared with non-Hispanic white patients, black patients demonstrated greater pain sensitivity for measures of deep muscle hyperalgesia and mechanical punctate pain. Furthermore, catastrophizing partially mediated the race differences in deep muscle pain such that black participants endorsed greater pain catastrophizing, which partially accounted for their increased sensitivity to, and temporal summation of, deep muscle pain. Taken together, these results support the need to further examine the role of catastrophizing and pain sensitization in the context of sex and race disparities in the experience of CLBP. PERSPECTIVE: This study identifies sex and race differences in pain sensitization among patients with CLBP. Further, it recognizes the role of catastrophizing as a contributor to such race differences. More research is needed to further dissect these complex relationships.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts..
| | - Victor Wang
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
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41
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Dodds KN, Beckett EAH, Evans SF, Hutchinson MR. Spinal Glial Adaptations Occur in a Minimally Invasive Mouse Model of Endometriosis: Potential Implications for Lesion Etiology and Persistent Pelvic Pain. Reprod Sci 2018; 26:357-369. [PMID: 29730970 DOI: 10.1177/1933719118773405] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Glial adaptations within the central nervous system are well known to modulate central sensitization and pain. Recently, it has been suggested that activity of glial-related proinflammatory cytokines may potentiate peripheral inflammation, via central neurogenic processes. However, a role for altered glial function has not yet been investigated in the context of endometriosis, a chronic inflammatory condition in women associated with peripheral lesions, often manifesting with persistent pelvic pain. Using a minimally invasive mouse model of endometriosis, we investigated associations between peripheral endometriosis-like lesions and adaptations in central glial reactivity. Spinal cords (T13-S1) from female C57BL/6 mice with endometriosis-like lesions (ENDO) were imaged via fluorescent immunohistochemistry for the expression of glial fibrillary acidic protein (GFAP; astrocytes) and CD11b (microglia) in the dorsal horn (n = 5). Heightened variability ( P = .02) as well as an overall increase ( P = .04) in the mean area of GFAP immunoreactivity was found in ENDO versus saline-injected control animals. Interestingly, spinal levels showing the greatest alterations in GFAP immunoreactivity appeared to correlate with the spatial location of lesions within the abdominopelvic cavity. A subtle but significant increase in the mean area of CD11b immunostaining was also observed in ENDO mice compared to controls ( P = .02). This is the first study to describe adaptations in nonneuronal, immune-like cells of the central nervous system attributed to the presence of endometriosis-like lesions.
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Affiliation(s)
- Kelsi N Dodds
- 1 Discipline of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth A H Beckett
- 1 Discipline of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Susan F Evans
- 2 Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark R Hutchinson
- 1 Discipline of Physiology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,3 Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, University of Adelaide, Adelaide, South Australia, Australia
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42
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Sewell M, Churilov L, Mooney S, Ma T, Maher P, Grover SR. Chronic pelvic pain – pain catastrophizing, pelvic pain and quality of life. Scand J Pain 2018; 18:441-448. [DOI: 10.1515/sjpain-2017-0181] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/18/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Chronic pelvic pain (CPP) impacts significantly on the lives of women. Negative coping responses such as pain catastrophizing are thought to be significant in predicting both pain severity and outcome. The combined effect of the individual’s response to pain and its severity on their quality of life (QoL) has not been well studied in women with CPP. Aims were to determine the prevalence of pain catastrophizing in women with CPP and to examine the associations between pain catastrophizing and levels of dysmenorrhea, non-cyclical pelvic pain, dyspareunia, dysuria, dyschezia and QoL.
Methods
A cross-sectional study including women aged 18–50 years, referred to a tertiary gynecology outpatients department at an Australian women’s hospital in 2015. Participants completed questionnaires including: pain catastrophizing scale (PCS); pelvic pain levels in the prior 3 months; and the World Health Organisation Quality of life – Bref Questionnaire (WHOQoL-Bref). Statistical analysis was performed using STATA (StataCorp, USA Version13).
Results
Participants (n = 115) had a median age of 29.0 [interquartile range (IQR): 23.0–38.0] years. The Pain catastrophizing score revealed that 60/113 [95% confidence interval (CI): 48.6, 71.2] of participants had a clinically relevant total score ≥30. There were statistically significant positive correlations between pain catastrophizing scores and pelvic pain levels in all five pain categories studied, dysmenorrhea (ρ = 0.37, p = 0.0001), non-cyclical pelvic pain (ρ = 0.46, p<0.0001), dyspareunia (ρ = 0.32, p = 0.0008), dysuria (ρ = 0.32, p = 0.0005) and dyschezia (ρ = 0.38, p = 0.0012). Participants who reported maximal pain levels (5/5) had significantly higher median pain catastrophizing scores when compared to those who reported no pain (0/5) in all categories. Overall QoL was considered as “good” in 71/113 (95% CI: 60.1, 81.0) participants and “poor” in 42/113 (95% CI: 32.0, 53.0) participants. Comparison to Australian female norms revealed significantly lower QoL scores in the physical domain, across all ages, and in psychological domain for those aged <30 and 30–40 years. There was a significant association between increased catastrophizing scores and reduced odds of good QoL. An increase in PCS by one point is associated with a 6.3% decrease in the odds of good QoL [odds ratio (OR) per one-point increase: 0.94 (95% CI: 0.89, 0.98), p = 0.008].
Conclusions
Pain catastrophizing is prevalent at clinically relevant levels in women with CPP across all domains. It is associated with higher pain levels and decreased QoL.
Implications
There is potential for further studies to investigate the predictive nature of pain catastrophizing and management targeting catastrophizing to improve outcomes in women with CPP.
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Affiliation(s)
- Megan Sewell
- Mercy Hospital for Women , 163 Studley Road, Heidelberg, 3084 , Victoria , Australia , Phone: +61 401 190 137
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health , Heidelberg, Victoria , Australia
- School of Mathematics and Geospatial Sciences , RMIT University , Melbourne , Australia
| | - Samantha Mooney
- Mercy Hospital for Women , 163 Studley Road, Heidelberg, 3084 , Victoria , Australia
| | - Tony Ma
- Mercy Hospital for Women , 163 Studley Road, Heidelberg, 3084 , Victoria , Australia
| | - Peter Maher
- University of Melbourne , Parkville, Victoria , Australia
| | - Sonia R. Grover
- Mercy Hospital for Women , 163 Studley Road, Heidelberg, 3084 , Victoria , Australia , Phone: +61 401 190 137
- University of Melbourne , Parkville, Victoria , Australia
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Pain Sensitivity and its Relation to Spreading on the Body, Intensity, Frequency, and Duration of Pain: A Cross-Sectional Population-based Study (SwePain). Clin J Pain 2018; 33:579-587. [PMID: 27648588 DOI: 10.1097/ajp.0000000000000441] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Individuals with chronic pain often report increased pain sensitivity compared with pain-free individuals; hence, it is crucial to determine whether and how different pain characteristics influence or interact with pain sensitivity. An alternative to experimental pain sensitivity testing is the self-reported pain sensitivity questionnaire (PSQ), which captures pain sensitivity in various body areas.This study compares PSQ in individuals with and without pain and clarifies how pain sensitivity relates to spreading of pain on the body, and to intensity, frequency, duration of pain and to age and sex. MATERIALS AND METHODS A total of 5905 individuals with pain and 572 individuals without pain from the general population in southeastern Sweden completed and returned a postal questionnaire. RESULTS The mean PSQ score was 3.9 (95% confidence interval [CI], 3.88-3.98) in individuals with pain and 3.5 (95% CI, 3.38-3.64) in pain-free individuals. Hence, PSQ was the highest among individuals with pain, with a difference of 0.4 (95% CI, 0.30-0.56). There was a considerable variation in the PSQ values (mean=3.5; SD=1.54) among pain-free individuals. Pain sensitivity was positively related to spreading, intensity, and frequency of pain, with a correlation coefficient of 0.3. PSQ was higher in widespread pain, 4.5 (95% CI, 4.27-4.69) in women and 4.3 (95% CI, 3.94-4.71) in men, than in local pain, 3.7 (95% CI, 3.61-3.91) in women and 3.8 (95% CI, 3.66-3.95) in men. The score for women with regional pain was between local and widespread pain at 4.0 (95% CI, 3.95-4.11) and that for men with regional pain was 3.8 (95% CI, 3.69-3.87), which is equal to that of local pain. DISCUSSION The positive association between pain sensitivity and spreading of pain on the body provides some evidence that the extent of spreading may be related to the degree of pain sensitivity. Before clinical use of PSQ, psychometric development and further research are needed.
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Marinho MC, Magalhaes TF, Fernandes LFC, Augusto KL, Brilhante AV, Bezerra LR. Quality of Life in Women with Endometriosis: An Integrative Review. J Womens Health (Larchmt) 2018; 27:399-408. [DOI: 10.1089/jwh.2017.6397] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Manuela C.P. Marinho
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
| | - Thais F. Magalhaes
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
| | | | - Kathiane L. Augusto
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
- Medicine Course of University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Aline V.M. Brilhante
- Post-Graduate Program in Public Health, University of Fortaleza (UNIFOR), Fortaleza, Brazil
- Medicine Course of University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Leonardo R.P.S. Bezerra
- Department of Surgery and Maternidade Escola Assis Chateaubriand of Federal University of Ceará (UFC), Fortaleza, Brazil
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Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J 2018; 29:631-638. [PMID: 29318334 PMCID: PMC5913379 DOI: 10.1007/s00192-017-3536-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/29/2017] [Indexed: 01/06/2023]
Abstract
Introduction and hypothesis Chronic pelvic pain (CPP) in women is a complex syndrome. Pain sensation and intensity often do not correspond with the identified lesion location but are felt elsewhere, leading to muskuloskeletal and myofascial disorders and sexual dysfunction (SD). Although physical aspects are prevalent, they are often underdiagnosed and undertreated due to lack of understanding regarding its origin and distribution. Frequently, patients experience pelvic pain as psychological distress resulting in physical complaints, leading clinicians to prescribe medication or surgical intervention to correct or alleviate these symptoms, often with insufficient results. Because pelvic floor muscle disorders contribute significantly to CPP and SD, there is rationale for physiotherapy. However, physiotherapy is a widely underused and untapped resource, which has its place in the multidisciplinary approach to these health problems. Methods Computer-aided and manual searches and methodological quality assessment were carried out for meta-analyses, systematic reviews, and randomized controlled trials (RCTs) published between 1990 and 2017 investigating classification, assessment, and (physiotherapeutic) treatment of pelvic pain and/or female SD defined by the keywords below. Expert opinions were sought via interviews. Results Due to a lack of sufficient relevant medical information, referral data, and test results, focused physiotherapy is difficult to administer adequately. However, recent quality studies indicate significant clinical effects of physiotherapy for CPP and female SD, and experts advocate a multidisciplinary approach that includes physiotherapy. Conclusions Because of its holistic approach, physiotherapy can contribute significantly to the multidisciplinary assessment and treatment of CPP and female SD.
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Affiliation(s)
- Bary Berghmans
- Pelvic Care Center Maastricht, Maastricht University Medical Centre, P.O.Box 5800, 6202 az, Maastricht, The Netherlands.
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Being Adaptive to Pain Enhances Sham Acupuncture Analgesia: A Crossover Healthy Human Study. J Acupunct Meridian Stud 2017; 10:385-395. [PMID: 29275794 DOI: 10.1016/j.jams.2017.10.002] [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: 03/28/2017] [Revised: 09/06/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022] Open
Abstract
We have reported a model that distinguishes pain adaptive individuals (PA) from those who are pain non-adaptive (PNA). The present randomised, cross-over, participant-assessor blinded study aimed to determine the impact of pain adaptability on individuals' response to real and sham acupuncture. Healthy volunteers (nine PA and 13 PNA) were randomly allocated to receive real and sham acupuncture on the left hand and forearm in two separate acupuncture sessions. Pressure pain thresholds (PPTs) were measured at bilateral forearms and right leg before, immediately after and 20 minutes after the end of acupuncture. Ratings to pinprick and suprathreshold PPT were also recorded. The two groups were comparable in their demographic and baseline data. Analgesia induced by real or sham acupuncture did not differ on any outcome measures. PA responded to acupuncture needling better than PNA, and to sham needling (20% increase in PPT) better than to real acupuncture (7.9%). Those differences were at 20 min after end of acupuncture in the areas distant to the needling sites. PNA reported little changes in PPT. Being adaptive to pain was associated with enhanced distant analgesia in response to sham acupuncture. Our finding might partly explain varied acupuncture analgesia in clinical practice and trials.
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Ribeiro H, Sesterhenn RB, de Souza A, de Souza AC, Alves M, Machado JC, Burger NB, Torres ILDS, Stefani LC, Fregni F, Caumo W. Preoperative transcranial direct current stimulation: Exploration of a novel strategy to enhance neuroplasticity before surgery to control postoperative pain. A randomized sham-controlled study. PLoS One 2017; 12:e0187013. [PMID: 29190741 PMCID: PMC5708693 DOI: 10.1371/journal.pone.0187013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 09/25/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An imbalance in the excitatory/inhibitory systems in the pain networks may explain the persistent chronic pain after hallux valgus surgery. Thus, to contra-regulate this dysfunction, the use of transcranial direct current stimulation (tDCS) becomes attractive. OBJECTIVE We tested the hypothesis that two preoperative active(a)-tDCS sessions compared with sham(s)-tDCS could improve the postoperative pain [as indexed by Visual Analogue Scale (VAS) at rest and during walking (primary outcomes)]. To assess their effect on the change in the Numerical Pain Scale (NPS0-10) during Conditioned Pain Modulation (CPM-task), disability related to pain (DRP) and analgesic consumption (secondary outcomes). Also, we assessed if the brain derived neurotrophic factor (BDNF) in the cerebral spinal fluid (CSF) after tDCS could predict the intervention's effect on the DRP. METHODS It is a prospective, double blind, sham-controlled, randomized single center, 40 women (18-70 years-old) who had undergone hallux valgus surgery were randomized to receive two sessions (20 minutes each) of anodal a-tDCS or s-tDCS on the primary motor cortex at night and in the morning before the surgery. To assess the DRP was used the Brazilian Profile of Chronic Pain: Screen (B-PCP:S). RESULTS A-tDCS group showed lower scores on VAS at rest and during walking (P<0.001). At rest, the difference between groups was 2.13cm (95%CI = 1.59 to 2.68) while during walking was 1.67cm (95%CI = 1.05 to 2.28). A-tDCS, when compared to s-tDCS reduced analgesic doses in 73.25% (P<0.001), produced a greater reduction in B-PCP:S (mean difference of 9.41 points, 95%CI = 0.63 to 18.21) and higher function of descending pain modulatory system (DPMS) during CPM-task. CONCLUSION A-tDCS improves postoperative pain, the DRP and the function of DPMS. Also, the CSF BDNF after a-tDCS predicted the improvement in the DRP. In overall, these findings suggest that a-tDCS effects may be mediated by top-down regulatory mechanisms associated with the inhibitory cortical control. TRIAL REGISTRATION ClinicalTrials.gov NCT02360462.
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Affiliation(s)
- Hugo Ribeiro
- Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Surgery Department, Hospital Independência, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Andressa de Souza
- Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ana Claudia de Souza
- Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Monique Alves
- Surgery Department, Hospital Independência, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jessica Catarina Machado
- Postgraduate Program in Health and Human Development, La Salle University Center, Canoas, Rio Grande do Sul, Brazil
| | | | - Iraci Lucena da Silva Torres
- Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Pharmacology Department, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciana Cadore Stefani
- Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Surgery Department, Anesthesia and Perioperative Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Fregni
- Physical Medicine & Rehabilitation Department, Center of Neuromodulation & Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Wolnei Caumo
- Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Surgery Department, Anesthesia and Perioperative Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Pain and Palliative Care Service, Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
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Farrokhi S, Mazzone B, Schneider M, Gombatto S, Mayer J, Highsmith MJ, Hendershot BD. Biopsychosocial risk factors associated with chronic low back pain after lower limb amputation. Med Hypotheses 2017; 108:1-9. [DOI: 10.1016/j.mehy.2017.07.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 11/27/2022]
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Rovner GS, Sunnerhagen KS, Björkdahl A, Gerdle B, Börsbo B, Johansson F, Gillanders D. Chronic pain and sex-differences; women accept and move, while men feel blue. PLoS One 2017; 12:e0175737. [PMID: 28441403 PMCID: PMC5404887 DOI: 10.1371/journal.pone.0175737] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/30/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation. Method 1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p ≤.01. Results Analysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level. Conclusion Pain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.
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Affiliation(s)
- Graciela S. Rovner
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Katharina S. Sunnerhagen
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- * E-mail:
| | - Ann Björkdahl
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- Ersta Skondal University College, Campus Bracke, Gothenburg, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linkoping University, Linkoping, SE-581 85 Linköping, Sweden
| | - Björn Börsbo
- Division of Community Medicine, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
- Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jonkoping, Sweden
| | | | - David Gillanders
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
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