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Fleagle TR, Post AA, Dailey DL, Vance CG, Zimmerman MB, Bayman EO, Crofford LJ, Sluka KA, Chimenti RL. Minimal Clinically Important Change of Movement Pain in Musculoskeletal Pain Conditions. THE JOURNAL OF PAIN 2024; 25:104507. [PMID: 38479557 PMCID: PMC11283950 DOI: 10.1016/j.jpain.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
Movement pain, which is distinct from resting pain, is frequently reported by individuals with musculoskeletal pain. There is growing interest in measuring movement pain as a primary outcome in clinical trials, but no minimally clinically important change (MCIC) has been established, limiting interpretations. We analyzed data from 315 participants who participated in previous clinical trials (65 with chronic Achilles tendinopathy; 250 with fibromyalgia) to establish an MCIC for movement pain. A composite movement pain score was defined as the average pain (Numeric Rating Scale: 0-10) during 2 clinically relevant activities. The change in movement pain was calculated as the change in movement pain from pre-intervention to post-intervention. A Global Scale (GS: 1-7) was completed after the intervention on perceived change in health status. Participants were dichotomized into non-responders (GS ≥4) and responders (GS <3). Receiver operating characteristic curves were calculated to determine threshold values and corresponding sensitivity and specificity. We used the Euclidean method to determine the optimal threshold point of the Receiver operating characteristic curve to determine the MCIC. The MCIC for raw change in movement pain was 1.1 (95% confidence interval [CI]: .9-1.6) with a sensitivity of .83 (95% CI: .75-.92) and specificity of .79 (95% CI: .72-.86). For percent change in movement pain the MCIC was 27% (95% CI: 10-44%) with a sensitivity of .79 (95% CI: .70-.88) and a specificity of .82 (95% CI: .72-.90). Establishing an MCIC for movement pain will improve interpretations in clinical practice and research. PERSPECTIVE: A minimal clinically important change (MCIC) of 1.1- points (95% CI: .9-1.6) for movement pain discriminates between responders and non-responders to rehabilitation. This MCIC provides context for interpreting the meaningfulness of improvement in pain specific to movement tasks.
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Affiliation(s)
- Timothy R. Fleagle
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
| | - Andrew A. Post
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
| | - Dana L. Dailey
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
- Department of Physical Therapy, St. Ambrose University, 1320 W. Lombard St. Davenport, IA, USA 52804
| | - Carol G.T. Vance
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
| | - M. Bridget Zimmerman
- Department of Biostatistics, University of Iowa Colleges of Public Health, 145 N. Riverside Drive Iowa City, IA, USA 52242
| | - Emine O Bayman
- Department of Biostatistics, University of Iowa Colleges of Public Health, 145 N. Riverside Drive Iowa City, IA, USA 52242
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive 6618 John Colloton Pavillion Iowa City, IA, USA 52242
| | - Leslie J. Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Suite T-3113 Medical Center North 1161 21st Avenue South, Nashville, TN, USA 37232
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
| | - Ruth L. Chimenti
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
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Lee S, Neogi T, McGinley B, Wang N, Frey Law L, Torabian KA, Aoyagi K, Stefanik JJ, Carlesso LC, Hausdorff JM, Gazit E, Segal NA, Lewis CE, Nevitt MC, Kumar D. Associations of pain sensitivity and conditioned pain modulation with physical activity: findings from the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2024; 32:982-989. [PMID: 38763431 PMCID: PMC11254545 DOI: 10.1016/j.joca.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Individuals with chronic pain due to knee osteoarthritis (OA) are insufficiently physically active, and alterations of facilitatory and inhibitory nociceptive signaling are common in this population. Our objective was to examine the association of these alterations in nociceptive signaling with objective accelerometer-based measures of physical activity in a large observational cohort. DESIGN We used data from the Multicenter Osteoarthritis Study. Measures of peripheral and central pain sensitivity included pressure pain threshold at the knee and mechanical temporal summation at the wrist, respectively. The presence of descending pain inhibition was assessed by conditioned pain modulation (CPM). Physical activity was quantitatively assessed over 7 days using a lower back-worn activity monitor. Summary metrics included steps/day, activity intensity, and sedentary time. Linear regression analyses were used to evaluate the association of pain sensitivity and the presence of descending pain inhibition with physical activity measures. RESULTS Data from 1873 participants was analyzed (55.9% female, age = 62.8 ± 10.0 years). People having greater peripheral and central sensitivity showed lower step counts. CPM was not significantly related to any of the physical activity measures, and none of the exposures were significantly related to sedentary time. CONCLUSIONS In this cohort, greater peripheral and central sensitivity were associated with reduced levels of objectively-assessed daily step counts. Further research may investigate ways to modify or treat heightened pain sensitivity as a means to increase physical activity in older adults with knee OA.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Boston University, Boston, MA, USA.
| | - Tuhina Neogi
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Brooke McGinley
- School of Public Health, Boston University, Boston, MA, USA.
| | - Na Wang
- School of Public Health, Boston University, Boston, MA, USA.
| | - Laura Frey Law
- Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
| | - Kaveh A Torabian
- Department of Physical Therapy, Boston University, Boston, MA, USA.
| | - Kosaku Aoyagi
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Joshua J Stefanik
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Physical Therapy, Northeastern University, Boston, MA, USA.
| | - Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
| | - Jeffrey M Hausdorff
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Rush University Medical Center, Chicago, IL, USA.
| | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Neil A Segal
- Department of Rehabilitation Medicine, University of Kansas, Kansas City, KS, USA.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Deepak Kumar
- Department of Physical Therapy, Boston University, Boston, MA, USA; Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Butera KA, Chimenti RL, Alsouhibani AM, Berardi G, Booker SQ, Knox PJ, Post AA, Merriwether EN, Wilson AT, Simon CB. Through the Lens of Movement-Evoked Pain: A Theoretical Framework of the "Pain-Movement Interface" to Guide Research and Clinical Care for Musculoskeletal Pain Conditions. THE JOURNAL OF PAIN 2024; 25:104486. [PMID: 38316243 PMCID: PMC11180580 DOI: 10.1016/j.jpain.2024.01.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Over 120 million Americans report experiencing pain in the past 3 months. Among these individuals, 50 million report chronic pain and 17 million report pain that limits daily life or work activities on most days (ie, high-impact chronic pain). Musculoskeletal pain conditions in particular are a major contributor to global disability, health care costs, and poor quality of life. Movement-evoked pain (MEP) is an important and distinct component of the musculoskeletal pain experience and represents an emerging area of study in pain and rehabilitation fields. This focus article proposes the "Pain-Movement Interface" as a theoretical framework of MEP that highlights the interface between MEP, pain interference, and activity engagement. The goal of the framework is to expand knowledge about MEP by guiding scientific inquiry into MEP-specific pathways to disability, high-risk clinical phenotypes, and underlying individual influences that may serve as treatment targets. This framework reinforces the dynamic nature of MEP within the context of activity engagement, participation in life and social roles, and the broader pain experience. Recommendations for MEP evaluation, encompassing the spectrum from high standardization to high patient specificity, and MEP-targeted treatments are provided. Overall, the proposed framework and recommendations reflect the current state of science in this emerging area of study and are intended to support future efforts to optimize musculoskeletal pain management and enhance patient outcomes. PERSPECTIVE: Movement-evoked pain (MEP) is a distinct component of the musculoskeletal pain experience and emerging research area. This article introduces the "Pain-Movement Interface" as a theoretical framework of MEP, highlighting the interface between MEP, pain interference, and activity engagement. Evaluating and treating MEP could improve rehabilitation approaches and enhance patient outcomes.
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Affiliation(s)
- Katie A. Butera
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Ruth L. Chimenti
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Ali M. Alsouhibani
- Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Giovanni Berardi
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Staja Q. Booker
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA
| | - Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Andrew A. Post
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Ericka N. Merriwether
- Department of Physical Therapy, NYU Steinhardt School of Culture, Education, and Human Development, Department of Medicine, NYU Grossman School of Medicine, New York University, New York, New York, USA
| | - Abigail T. Wilson
- School of Kinesiology & Rehabilitation Sciences, University of Central Florida, Orlando, Florida, USA
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Johnson AJ, Barron SM, Nichols JA, Cruz-Almeida Y. Association of Muscle Quality and Pain in Adults With Symptomatic Knee Osteoarthritis, Independent of Muscle Strength: Findings From a Cross-Sectional Study. Arthritis Rheumatol 2024; 76:1062-1070. [PMID: 38403452 PMCID: PMC11213672 DOI: 10.1002/art.42834] [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: 11/15/2023] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a leading cause of chronic pain in adults and shows wide interindividual variability, with peripheral and central factors contributing to the pain experience. Periarticular factors, such as muscle quality (eg, echo intensity [EI] and shear wave velocity [SWV]), may contribute to knee OA pain; however, the role of muscle quality in OA symptoms has yet to be fully established. METHODS Twenty-six adults (age >50 years) meeting clinical criteria for knee OA were included in this cross-sectional study. Quantitative ultrasound imaging was used to quantify EI and SWV in the rectus femoris of the index leg. Pearson correlations followed by multiple linear regression was used to determine associations between muscle quality and pain, controlling for strength, age, sex, and body mass index. RESULTS EI and SWV were significantly associated with movement-evoked pain (b = 0.452-0.839, P = 0.024-0.029). Clinical pain intensity was significantly associated with SWV (b = 0.45, P = 0.034), as were pressure pain thresholds at the medial (b = -0.41, P = 0.025) and lateral (b = -0.54, P = 0.009) index knee joint line, adjusting for all covariates. Pain interference was significantly associated with knee extension strength (b = -0.51, P = 0.041). CONCLUSION These preliminary findings suggest that EI and SWV may impact knee OA pain and could serve as malleable treatment targets. Findings also demonstrate that muscle quality is a unique construct, distinct from muscle strength, which may impact pain and treatment outcomes. More research is needed to fully understand the role of muscle quality in knee OA.
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Affiliation(s)
- Alisa J. Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Sarah M. Barron
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jennifer A. Nichols
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Science, University of Florida, Gainesville, FL, USA
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Lozano-Meca JA, Gacto-Sánchez M, Montilla-Herrador J. Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis. Eur J Pain 2024; 28:987-996. [PMID: 38186263 DOI: 10.1002/ejp.2236] [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: 09/23/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Knee Osteoarthritis (KOA) is mainly characterized by pain. The assessment of KOA-related pain frequently focuses on different constructs subject to sources of bias or drawbacks, as the classical Pain at Rest (PAR). Movement-evoked pain (MEP), recently defined as 'pain during walking', emerges as a differential concept, since PAR and MEP are driven by different underlying mechanisms. Given the novelty of the MEP approach, its association with PAR or with different performance-based tests has not been studied in KOA yet. MATERIALS AND METHODS A cross sectional study was conducted. PAR was measured, alongside the performance of four mobility tests and their corresponding MEP: Timed Up and Go Test, 10-metre Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test. Association and agreement were explored for MEP versus PAR, while the correlation of the tests versus each corresponding MEP-measure was assessed. RESULTS Neither association nor agreement were found in the duality MEP versus PAR. Also, the lack of association between the performance of a mobility test and the perceived level of pain during the development of the test was stated. CONCLUSION Movement-evoked pain is neither related to pain at rest nor to functional performance in subjects affected by knee osteoarthritis. The results from our study suggest that MEP and pain at rest measure and refer to different constructs in knee osteoarthritis. The implementation of MEP as an outcome in exercise-therapy could enhance the tracking of results, as well as the development of tailored interventions under different conditions. SIGNIFICANCE This research elucidates the relevance of MEP, recently defined as 'pain during walking', through the analysis of its association with PAR and with functional performance (measured through four mobility tests) in knee osteoarthritis. The results from our study highlight the absence of either association or agreement between MEP and PAR, fact that supports and endorses the idea that both concepts measure and refer to different constructs in knee osteoarthritis.
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Crow JA, Joseph V, Miao G, Goodin BR, Sibille KT, Cardoso J, Bartley EJ, Staud R, Fillingim RB, Booker SQ. A domain-oriented approach to characterizing movement-evoked pain. Pain Rep 2024; 9:e1158. [PMID: 38646659 PMCID: PMC11029970 DOI: 10.1097/pr9.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/04/2024] [Accepted: 02/20/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Movement-evoked pain (MEP) impacts a substantial proportion of US adults living with chronic pain. Evidence suggests that MEP is influenced by numerous biopsychosocial factors and mediated by mechanisms differing from those of spontaneous pain. However, both characteristic and mechanistic knowledge of MEP remain limited, hindering effective diagnosis and treatment. Objectives We asked (1) can chronic pain, functional, psychosocial, and behavioral measures be grouped into descriptive domains that characterize MEP? and (2) what relationships exist between biopsychosocial factors across multiple domains of MEP? Methods We formed 6 characteristic domains from 46 MEP-related variables in a secondary analysis of data from 178 individuals (aged 45-85 years) with knee pain. Ratings of pain during 3 functional activities (ie, Balance, Walking, Chair Stand) were used as primary MEP variables. Pearson correlations were calculated to show linear relationships between all individual domain variables. Relationships between variables were further investigated through weighted correlation network analysis. Results We observed a unique combination of pain characteristics associated with MEP apart from general pain. Notably, minutes doing physical activity were inversely associated with multiple variables within 4 of the 6 domains. Weighted correlation network analysis largely supported our classification of MEP domains. Additional interdomain relationships were observed, with the strongest existing between MEP, Mechanical Pain, and Multiple Pain Characteristics and Symptoms. Additional relationships were observed both within and between other domains of the network. Conclusion Our analyses bolster fundamental understanding of MEP by identifying relevant mechanistic domains and elucidating biopsychosocial and interdomain relationships.
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Affiliation(s)
- Joshua A. Crow
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Verlin Joseph
- College of Population Health, The University of New Mexico, Albuquerque, NM, USA
| | - Guanhong Miao
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Burel R. Goodin
- Department of Anesthesiology, School of Medicine, Washington University, St. Louis, MO, USA
| | - Kimberly T. Sibille
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Josue Cardoso
- The Pennsylvania State University, University Park, PA, USA
| | - Emily J. Bartley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Rheumatology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Staja Q. Booker
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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Mani R, Adhia DB, Awatere S, Gray AR, Mathew J, Wilson LC, Still A, Jackson D, Hudson B, Zeidan F, Fillingim R, De Ridder D. Self-regulation training for people with knee osteoarthritis: a protocol for a feasibility randomised control trial (MiNT trial). FRONTIERS IN PAIN RESEARCH 2024; 4:1271839. [PMID: 38269396 PMCID: PMC10806808 DOI: 10.3389/fpain.2023.1271839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/07/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Knee osteoarthritis (OA) is a chronic secondary musculoskeletal pain condition resulting in disability, reduced quality of life, and high societal costs. Pain associated with knee OA is linked to increased sensitivity in sensory, cognitive, and emotional areas of the brain. Self-regulation training targeting brain functioning related to pain experience could reduce pain and its associated disability. Self-regulatory treatments such as mindfulness meditation (MM) and electroencephalography neurofeedback (EEG-NF) training improve clinical outcomes in people with knee OA. A feasibility clinical trial can address factors that could inform the design of the full trial investigating the effectiveness of self-regulation training programmes in people with knee OA. This clinical trial will evaluate the feasibility, safety, acceptability, experience and perceptions of the self-regulatory training programmes. Methods The proposed feasibility trial is based on a double-blind (outcome assessor and investigators), three-arm (MM usual care, EEG-NF + usual care and usual care control group) randomised controlled parallel clinical trial. Participants with knee OA will be recruited from the community and healthcare practices. A research assistant (RA) will administer both interventions (20-min sessions, four sessions each week, and 12 sessions over three successive weeks). Feasibility measures (participant recruitment rate, adherence to interventions, retention rate), safety, and acceptability of interventions will be recorded. An RA blinded to the group allocation will record secondary outcomes at baseline, immediately post-intervention (4th week), and 3 months post-intervention. The quantitative outcome measures will be descriptively summarised. The qualitative interviews will evaluate the participants' experiences and perceptions regarding various aspects of the trial, which includes identifying the barriers and facilitators in participating in the trial, evaluating their opinions on the research procedures, such as their preferences for the study site, and determining the level of acceptability of the interventions as potential clinical treatments for managing knee OA. Māori participant perceptions of how assessment and training practices could be acceptable to a Māori worldview will be explored. The interviews will be audio-recorded and analysed thematically. Discussion This trial will provide evidence on the feasibility, safety, and acceptability of the MM and EEG-NF training in people with knee OA, thus informing the design of a full randomised clinical control trial.
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Affiliation(s)
- Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Divya Bharatkumar Adhia
- Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Sharon Awatere
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
- The Health Boutique, Napier, New Zealand
| | | | - Jerin Mathew
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | | | - Amanda Still
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Jackson
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Fadel Zeidan
- Department of Anesthesiology, School of Medicine, University of California, San Diego, CA, United States
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence, Clinical and Translational Science Institute, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Dirk De Ridder
- Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
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Montesino-Goicolea S, Valdes-Hernandez P, Laffitte Nodarse C, Johnson AJ, Cole JH, Antoine LH, Goodin BR, Fillingim RB, Cruz-Almeida Y. Brain-predicted age difference mediates the association between PROMIS sleep impairment, and self-reported pain measure in persons with knee pain. AGING BRAIN 2023; 4:100088. [PMID: 37519450 PMCID: PMC10382912 DOI: 10.1016/j.nbas.2023.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
Knee pain, the most common cause of musculoskeletal pain (MSK), constitutes a severe public health burden. Its neurobiological causes, however, remain poorly understood. Among many possible causes, it has been proposed that sleep problems could lead to an increase in chronic pain symptomatology, which may be driven by central nervous system changes. In fact, we previously found that brain cortical thickness mediated the relationship between sleep qualities and pain severity in older adults with MSK. We also demonstrated a significant difference in a machine-learning-derived brain-aging biomarker between participants with low-and high-impact knee pain. Considering this, we examined whether brain aging was associated with self-reported sleep and pain measures, and whether brain aging mediated the relationship between sleep problems and knee pain. Exploratory Spearman and Pearson partial correlations, controlling for age, sex, race and study site, showed a significant association of brain aging with sleep related impairment and self-reported pain measures. Moreover, mediation analysis showed that brain aging significantly mediated the effect of sleep related impairment on clinical pain and physical symptoms. Our findings extend our prior work demonstrating advanced brain aging among individuals with chronic pain and the mediating role of brain-aging on the association between sleep and pain severity. Future longitudinal studies are needed to further understand whether the brain can be a therapeutic target to reverse the possible effect of sleep problems on chronic pain.
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Affiliation(s)
- Soamy Montesino-Goicolea
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Pedro Valdes-Hernandez
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Chavier Laffitte Nodarse
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Alisa J. Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - James H. Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
- Dementia Research Centre, Institute of Neurology, University College London, UK
| | - Lisa H. Antoine
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, United States
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, United States
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States
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Lipat AL, Peterson JA, Murillo BC, Clark DJ, Cruz-Almeida Y. Pain severity, distribution, and duration are associated with spatiotemporal gait performance in community-dwelling older adults with chronic musculoskeletal pain. Gait Posture 2023; 103:178-183. [PMID: 37236053 DOI: 10.1016/j.gaitpost.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 04/05/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Our current understanding of the impact of chronic pain on spatiotemporal gait performance has mainly been achieved through comparison studies between individuals with and without chronic pain. Further investigation into the relationship between specific outcome measures of chronic pain and gait may improve our understanding of the impact of pain on gait and may benefit future interventions that aim to improve mobility in this population. RESEARCH QUESTION Which pain outcome measures are associated with spatiotemporal gait performance in older adults with chronic musculoskeletal pain? METHODS This study was secondary analysis of older adult participants enrolled in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study (n = 43). Pain outcome measures were obtained using self-reported questionnaires, and spatiotemporal gait analysis was conducted using an instrumented gait mat. Separate multiple linear regressions were run to determine which pain outcome measurements were associated with gait performance. RESULTS Higher pain severities were associated with shorter stride lengths (β = -0.336, p = 0.041), shorter swing times (β = -0.345, p = 0.037), and longer double support times (β = 0.342, p = 0.034). A greater number of pain sites was associated with a wider step width (β = 0.391, p = 0.024). Longer pain durations were associated with shorter double support times (β = -0.373, p = 0.022). SIGNIFICANCE The results of our study illustrate that specific pain outcomes measures are associated with specific gait impairments in community-dwelling older adults with chronic musculoskeletal pain. As such, pain severity, number of pain sites, and pain duration should be considered when developing mobility interventions in this population to reduce disability.
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Affiliation(s)
- Ania L Lipat
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL 32610, USA
| | - Jessica A Peterson
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL 32610, USA; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL 32610, USA
| | - Bryce C Murillo
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL 32610, USA
| | - David J Clark
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL 32603, USA; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL 32610, USA; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL 32610, USA.
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10
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Carlesso LC. The impact of altered neural processing of nociceptive signals on physical function in people with knee OA - we know little and have much to learn. Osteoarthritis Cartilage 2023:S1063-4584(23)00753-7. [PMID: 37088264 DOI: 10.1016/j.joca.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canad.
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11
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Rasmussen GHF, Madeleine P, Arroyo-Morales M, Voigt M, Kristiansen M. Pain sensitivity and shoulder function among breast cancer survivors compared to matched controls: a case-control study. J Cancer Surviv 2023; 17:150-159. [PMID: 33495914 PMCID: PMC9970942 DOI: 10.1007/s11764-021-00995-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Persistent pain and loss of shoulder function are common adverse effects to breast cancer treatment, but the extent of these issues in comparison with healthy controls is unclear for survivors beyond 1.5 years after treatment. The purpose of this study was to benchmark differences in pressure pain thresholds (PPT), maximal isokinetic muscle strength (MIMS), and active range of motion (ROM) of females with persistent pain ≥1.5 years after breast cancer treatment (BCS) compared with pain-free matched controls (CON), and examine the presence of movement-evoked pain (MEP) during assessment of MIMS. METHODS The PPTs of 18 locations were assessed using a pressure algometer and a numeric rating scale was used to assess intensity of MEP. Active ROM and MIMS were measured using a universal goniometer and an isokinetic dynamometer, respectively. RESULTS A two-way analysis of variance revealed that PPTs across all locations, MIMS for horizontal shoulder extension/flexion and shoulder adduction, active ROM for shoulder flexion, horizontal shoulder extension, shoulder abduction, and external shoulder rotation were significantly lower for BCS compared with CON (P < 0.05). MEP was significantly higher for BCS and MEP intensity had a significant, negative correlation with PPTs (P < 0.01). DISCUSSION/CONCLUSION BCS with persistent pain ≥1.5 years after treatment demonstrates widespread reductions in PPTs and movement-specific reductions in MIMS and active ROM of the affected shoulder, along with MEP during physical performance assessment. IMPLICATIONS FOR CANCER SURVIVORS BCS with persistent pain ≥1.5 years after treatment shows signs of central sensitization and may benefit from individualized rehabilitation.
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Affiliation(s)
- G H F Rasmussen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - P Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, Sport and Health Research Institute, Biohealth Research Institute Granada, University of Granada, Granada, Spain
| | - M Voigt
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M Kristiansen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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12
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Singh JA. Making the current non-surgical treatments for knee osteoarthritis more effective: Solutions from a diverse patient group. Joint Bone Spine 2023; 90:105535. [PMID: 36706945 DOI: 10.1016/j.jbspin.2023.105535] [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: 05/31/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine patient perceived solutions to barriers to effective non-surgical knee osteoarthritis (OA) treatments in a diverse racial/ethnic group. METHODS Nominal groups were conducted with consecutive patients with knee OA at a medical center clinic, oversampling for African Americans with knee OA. Participants discussed potential solutions and rank-ordered their concerns. RESULTS Thirteen nominal groups with 46 knee OA patients were conducted with mean age, 60.8 years (standard deviation [sd], 10.0) and knee OA duration, 8.1 years (sd, 5.4); 22% were men, and 56% were African American. The following solutions were in the top three ranked solutions in 13 NGTs: (A) more research, effective and/or safer new medications/treatments, and joint cartilage restoration (8 groups; 15% votes [43/276]); (B) early diagnosis (2 groups; 7% votes [20/276]); (C) better and more effective communication (5 groups; 10% votes [29/276]); (D) public and patient education (4 groups; 8% votes [22/276]); (E) motivation and behavioral modification (4 groups; 9% votes [26/276]); (F) team approach (1 group; 1% votes [2/276]); (G) personalized medicine (6 groups; 8% votes [24/276]); (H) cheaper and more affordable medications and treatments (3 groups; 5% votes [15/276]). CONCLUSIONS A diverse group of participants with knee OA identified several solutions to barriers to the effectiveness of current knee OA treatments. This new knowledge can inform the development and implementation of future interventions to improve the outcomes of people with knee OA.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL 35233, USA; Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL 35294-0022, USA; Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL 35294-0022, USA.
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13
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Effects of mat Pilates on older adult women with knee osteoarthritis: A randomized controlled trial. J Bodyw Mov Ther 2023; 33:136-141. [PMID: 36775508 DOI: 10.1016/j.jbmt.2022.02.007] [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: 11/16/2020] [Revised: 08/27/2021] [Accepted: 02/04/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Osteoarthritis is the most common joint disorder in the world and its incidence is rising, and one of the most frequent causes of pain, loss of function and disability in adults. AIM The aim of this study was to evaluate the effects of Mat Pilates on health status, pain, stiffness, and functionality of older adult women with knee osteoarthritis (KOA). METHODS A randomized-controlled trial to preliminarily test an intervention protocol of Mat Pilates in older women with KOA on health status, pain, stiffness, and functionality. This study included 41 volunteers with age over 40 years, which mean was 52.1 ± 8.9 years, and were allocated into Mat Pilates and control groups. The protocol was developed to be performed in 60 min, twice a week; the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study 36 (SF-36) were used to assess pain, to evaluate functionality and stiffness. RESULTS The Mat Pilates group significantly improved the functional capacity assessed by SF-36 (33.12 ± 22.03 to 69.37 ± 22.43, p < 0.05), and by WOMAC (29.75 ± 6.92 to 9.75 ± 9.35, p < 0.05). The pain domain also improved in Mat Pilates group assessed by SF-36 (39.50 ± 12.89 to 71.75 ± 18.66, p < 0.05) and by WOMAC (8.00 ± 2.56 to 2.75 ± 3.01, p < 0.05). The total score of WOMAC (41.75 ± 10.39 to 14.25 ± 13.88, p < 0.05), and the general health status assessed by SF-36 (59.44 ± 18.07 to 82.75 ± 12.03, p < 0.05) only improved for Mat Pilates group. No differences were observed in outcomes for the control group in both questionnaires. CONCLUSION Our results show that Mat Pilates protocol can improve the health status, pain, and functionality of older women with KOA.
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Robinson EM, Clothier PJ, Slater H, Gupta A. A scoping review on the methods of assessment and role of resilience on function and movement-evoked pain when experiencing a musculoskeletal injury. BMC Musculoskelet Disord 2022; 23:1097. [PMID: 36522734 PMCID: PMC9753293 DOI: 10.1186/s12891-022-06058-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Resilience refers to an individual's ability to maintain effective functioning, by resisting, withstanding or recovering from stressors or adversity, including pain associated with physical injury (J Clin Psychol Med Settings 28:518-28, 2021). The aim of this scoping review is to determine the role of resilience in the experience of movement-evoked pain (MEP) and return to functional activity following a musculoskeletal injury. METHODS This review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the scoping review protocol of the Joanna Briggs Institute (JBI). Five databases and one grey literature database were searched using predetermined key words and index terms to capture published and unpublished records on the topic. Two authors independently screened the title and abstract of each record, with the full-text of eligible records being reviewed. Papers were eligible for inclusion if they examined the population, concept and context of interest, were written in English and the full text was available. Data were extracted from each eligible record to guide discussion of the available literature on this topic. RESULTS Of 4771 records, 2695 articles underwent screening based on their title and abstract. After title and abstract screening 132 articles were eligible for full text review, with 24 articles included in the final analysis. This review identified that psychological resilience has primarily been investigated in the context of a range of age-related pathologies. The choice of functional and movement-evoked pain assessments in the included studies were often guided by the pathology of interest, with some being general or injury specific. CONCLUSION This scoping review identified inconsistent conclusions regarding the role of resilience in the experience of MEP and the ability to return to function for older adults with a musculoskeletal injury. This scoping review highlights the need for longitudinal research to be conducted that allows a broader age range, including younger adults, to determine if multidimensional resilience may promote recovery form musculoskeletal injury.
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Affiliation(s)
- Elise M Robinson
- Western Sydney University, School of Health Sciences, PO Box 1797, Penrith, NSW, 2751, Australia.
| | - Peter J Clothier
- Western Sydney University, School of Health Sciences, PO Box 1797, Penrith, NSW, 2751, Australia
| | - Helen Slater
- Curtin University, Curtin School of Allied Health, enAble Institute, Bentley, Australia
| | - Amitabh Gupta
- Western Sydney University, School of Health Sciences, PO Box 1797, Penrith, NSW, 2751, Australia
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15
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Montesino-Goicolea S, Meng L, Rani A, Huo Z, Foster TC, Fillingim RB, Cruz-Almeida Y. Enrichment of genomic pathways based on differential DNA methylation profiles associated with knee osteoarthritis pain. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2022; 12:100107. [PMID: 36531611 PMCID: PMC9755025 DOI: 10.1016/j.ynpai.2022.100107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022]
Abstract
Our study aimed to identify differentially methylated regions (i.e., genomic region where multiple adjacent CpG sites show differential methylation) and their enriched genomic pathways associated with knee osteoarthritis pain (KOA). We recruited cognitively healthy middle to older aged (age 45-85) adults with (n = 182) and without (n = 31) self-reported KOA pain. We also extracted DNA from peripheral blood that was analyzed using MethylationEPIC arrays. The R package minfi (Aryee et al., 2014) was used to perform methylation data preprocessing and quality control. To investigate biological pathways impacted by differential methylation, we performed pathway enrichment analysis using Ingenuity Pathway Analysis (IPA) to identify canonical pathways and upstream regulators. Annotated genes within ± 5 kb of the putative differentially methylated regions (DMRs, p < 0.05) were subjected to the IPA analysis. There was no significant difference in age, sex, study site between no pain and pain group (p > 0.05). Non-Hispanic black individuals were overrepresented in the pain group (p = 0.003). At raw p < 0.05 cutoff, we identified a total of 19,710 CpG probes, including 13,951 hypermethylated CpG probes, for which DNA methylation level was higher in the groups with highest pain grades. We also identified 5,759 hypomethylated CpG probes for which DNA methylation level was lower in the pain groups with higher pain grades. IPA revealed that pain-related DMRs were enriched across multiple pathways and upstream regulators. The top 10 canonical pathways were linked to cellular signaling processes related to immune responses (i.e., antigen presentation, PD-1, PD-L1 cancer immunotherapy, B cell development, IL-4 signaling, Th1 and Th2 activation pathway, and phagosome maturation). Moreover, in terms of upstream regulators, NDUFAF3 was the most significant (p = 8.6E-04) upstream regulator. Our findings support previous preliminary work suggesting the importance of epigenetic regulation of the immune system in knee pain and the need for future work to understand the epigenetic contributions to chronic pain.
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Affiliation(s)
- Soamy Montesino-Goicolea
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Lingsong Meng
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Asha Rani
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas C. Foster
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
- Corresponding author at: PO Box 103628, 1329 SW 16th Street, Ste 5180 (zip 32608), Gainesville, FL 32610, USA. https://price.ctsi.ufl.edu/about-the-center/staff/yenisel-cruz-almeida/
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16
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Wilson AT, Johnson AJ, Laffitte Nodarse C, Hoyos L, Lysne P, Peraza JA, Montesino-Goicolea S, Valdes-Hernandez PA, Somerville J, Bialosky JE, Cruz-Almeida Y. Experimental Pain Phenotype Profiles in Community-dwelling Older Adults. Clin J Pain 2022; 38:451-458. [PMID: 35656805 PMCID: PMC9202441 DOI: 10.1097/ajp.0000000000001048] [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: 01/20/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Pain sensitivity and the brain structure are critical in modulating pain and may contribute to the maintenance of pain in older adults. However, a paucity of evidence exists investigating the link between pain sensitivity and brain morphometry in older adults. The purpose of the study was to identify pain sensitivity profiles in healthy, community-dwelling older adults using a multimodal quantitative sensory testing protocol and to differentiate profiles based on brain morphometry. MATERIALS AND METHODS This study was a secondary analysis of the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study. Participants completed demographic and psychological questionnaires, quantitative sensory testing, and a neuroimaging session. A Principal Component Analysis with Varimax rotation followed by hierarchical cluster analysis identified 4 pain sensitivity clusters (the "pain clusters"). RESULTS Sixty-two older adults ranging from 60 to 94 years old without a specific pain condition (mean [SD] age=71.44 [6.69] y, 66.1% female) were analyzed. Four pain clusters were identified characterized by (1) thermal pain insensitivity; (2) high pinprick pain ratings and pressure pain insensitivity; (3) high thermal pain ratings and high temporal summation; and (4) thermal pain sensitivity, low thermal pain ratings, and low mechanical temporal summation. Sex differences were observed between pain clusters. Pain clusters 2 and 4 were distinguished by differences in the brain cortical volume in the parieto-occipital region. DISCUSSION While sufficient evidence exists demonstrating pain sensitivity profiles in younger individuals and in those with chronic pain conditions, the finding that subgroups of experimental pain sensitivity also exist in healthy older adults is novel. Identifying these factors in older adults may help differentiate the underlying mechanisms contributing to pain and aging.
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Affiliation(s)
- Abigail T. Wilson
- University of Central Florida, School of Kinesiology and Physical Therapy, College of Health Professions and Sciences, Orlando, FL, USA
| | - Alisa J. Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Chavier Laffitte Nodarse
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Lorraine Hoyos
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
| | - Paige Lysne
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Julio A. Peraza
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
- Department of Physics, Florida International University, Miami, FL, USA
| | - Soamy Montesino-Goicolea
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Pedro A. Valdes-Hernandez
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Jessie Somerville
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
| | - Joel E. Bialosky
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
- University of Florida Department of Physical Therapy, Gainesville, FL, USA
- Brooks Rehabilitation-College of Public Health and Health Professions Research Collaboration, Gainesville, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
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17
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Lipat AL, Clark DJ, Hass CJ, Cruz-Almeida Y. Gait subgroups among older adults with chronic pain differ in cerebellum and basal ganglia gray matter volumes. Exp Gerontol 2022; 163:111773. [PMID: 35341939 PMCID: PMC9948689 DOI: 10.1016/j.exger.2022.111773] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/05/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current literature regarding morphological gray matter atrophy in chronic pain is mixed, inhibiting our ability to understand neurological mechanisms of chronic pain. The inconsistent findings may be due to the presence of subgroups within the older adult chronic pain population that differ in gait performance, as gait and gray matter have been previously associated. These gait subgroups, however, have been inadequately characterized in prior work and have not been compared across gray matter measures. Therefore, the purpose of this study was to identify and characterize gait subgroups within the older adult chronic pain population, and to evaluate differences in gray matter measures between subgroups. METHODS The present study was a secondary analysis of the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study. A subset of older participants (n = 40) completed assessments to evaluate psychological status, cognitive abilities, pain characteristics, and spatiotemporal gait performance using an instrumented gait mat. Gray matter measures were obtained from a T1-weighted anatomical scan using Freesurfer's recon-all function. RESULTS After data reduction, a hierarchical cluster analysis identified three gait clusters: A Normal Gait cluster (n = 12), a Shuffle Gait cluster (n = 15), and an Unsteady Gait cluster (n = 13). Clusters differed in gait velocity, stride length, step width, double support percentages, and stride length variability. The Shuffle Gait cluster exhibited reduced gray matter volumes in the cerebellum, caudate, putamen, and pallidum, as well as a worse pain severity when compared to the Normal Gait cluster (p < 0.05). The Shuffle Gait cluster also had less gray matter in the cerebellum and caudate when compared to the Unsteady Gait cluster (p < 0.05). CONCLUSIONS Our results confirm the existence of gait subgroups among the older adult chronic pain population and gray matter differences observed between groups support the need for the consideration of subgroups within this population for future pain, mobility, and aging studies.
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Affiliation(s)
- Ania L Lipat
- Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA
| | - David J Clark
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL 32603, USA; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32610, USA
| | - Chris J Hass
- Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL 32610, USA; Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL 32610, USA.
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18
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Crow JA, Fillingim RB. Working toward mechanistic pain phenotyping in osteoarthritis. Osteoarthritis Cartilage 2022; 30:495-497. [PMID: 34875376 DOI: 10.1016/j.joca.2021.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 02/02/2023]
Affiliation(s)
- J A Crow
- University of Florida Pain Research and Intervention Center of Excellence, USA
| | - R B Fillingim
- University of Florida Pain Research and Intervention Center of Excellence, USA.
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19
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Cruz-Almeida Y, Johnson A, Meng L, Sinha P, Rani A, Yoder S, Huo Z, Foster TC, Fillingim RB. Epigenetic age predictors in community-dwelling adults with high impact knee pain. Mol Pain 2022; 18:17448069221118004. [PMID: 35968561 PMCID: PMC9380216 DOI: 10.1177/17448069221118004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Gerontological research reveals considerable interindividual variability in aging
phenotypes, and emerging evidence suggests that high impact chronic pain may be
associated with various accelerated biological aging processes. In particular,
epigenetic aging is a robust predictor of health-span and disability compared to
chronological age alone. The current study aimed to determine whether several
epigenetic aging biomarkers were associated with high impact chronic pain in
middle to older age adults (44–78 years old). Participants (n =
213) underwent a blood draw, demographic, psychosocial, pain and functional
assessments. We estimated five epigenetic clocks and calculated the difference
between epigenetic age and chronological age, which has been previously reported
to predict overall mortality risk, as well as included additional derived
variables of epigenetic age previously associated with pain. There were
significant differences across Pain Impact groups in three out of the five
epigenetic clocks examined (DNAmAge, DNAmPhenoAge and DNAmGrimAge), indicating
that pain-related disability during the past 6 months was associated with
markers of epigenetic aging. Only DNAmPhenoAge and DNAmGrimAge were associated
with higher knee pain intensity during the past 48 h. Finally, pain
catastrophizing, depressive symptomatology and more neuropathic pain symptoms
were significantly associated with an older epigenome in only one of the five
epigenetic clocks (i.e. DNAmGrimAge) after correcting for multiple comparisons
(corrected p’s < 0.05). Given the scant literature in
relation to epigenetic aging and the complex experience of pain, additional
research is needed to understand whether epigenetic aging may help identify
people with chronic pain at greater risk of functional decline and poorer health
outcomes.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, 3463University of Florida, Gainesville, FL, USA.,Institute on Aging, 3463University of Florida, Gainesville, FL, USA.,Center for Cognitive Aging & Memory, McKnight Brain Foundation, 3463University of Florida, Gainesville, FL, USA.,Department of Community Dentistry & Behavioral Science, College of Dentistry, 3463University of Florida, Gainesville, FL, USA.,Department of Neuroscience, College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Alisa Johnson
- Pain Research & Intervention Center of Excellence, 3463University of Florida, Gainesville, FL, USA.,Institute on Aging, 3463University of Florida, Gainesville, FL, USA.,Department of Community Dentistry & Behavioral Science, College of Dentistry, 3463University of Florida, Gainesville, FL, USA
| | - Lingsong Meng
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Puja Sinha
- Department of Neuroscience, College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Asha Rani
- Department of Neuroscience, College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Sean Yoder
- 25301Molecular Genomics Core Facility, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Thomas C Foster
- Institute on Aging, 3463University of Florida, Gainesville, FL, USA.,Center for Cognitive Aging & Memory, McKnight Brain Foundation, 3463University of Florida, Gainesville, FL, USA.,Department of Neuroscience, College of Medicine, 3463University of Florida, Gainesville, FL, USA.,Age-Related Memory Loss Program, McKnight Brain Foundation, 3463University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, 3463University of Florida, Gainesville, FL, USA.,Institute on Aging, 3463University of Florida, Gainesville, FL, USA.,Department of Community Dentistry & Behavioral Science, College of Dentistry, 3463University of Florida, Gainesville, FL, USA
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20
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Drevet S, Favier B, Brun E, Gavazzi G, Lardy B. Mouse Models of Osteoarthritis: A Summary of Models and Outcomes Assessment. Comp Med 2022; 72:3-13. [PMID: 34986927 DOI: 10.30802/aalas-cm-21-000043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Osteoarthritis (OA) is a multidimensional health problem and a common chronic disease. It has a substantial impact onpatient quality of life and is a common cause of pain and mobility issues in older adults. The functional limitations, lack of curative treatments, and cost to society all demonstrate the need for translational and clinical research. The use of OA models in mice is important for achieving a better understanding of the disease. Models with clinical relevance are needed to achieve 2 main goals: to assess the impact of the OA disease (pain and function) and to study the efficacy of potential treatments. However, few OA models include practical strategies for functional assessment of the mice. OA signs in mice incorporate complex interrelations between pain and dysfunction. The current review provides a comprehensive compilation of mousemodels of OA and animal evaluations that include static and dynamic clinical assessment of the mice, merging evaluationof pain and function by using automatic and noninvasive techniques. These new techniques allow simultaneous recordingof spontaneous activity from thousands of home cages and also monitor environment conditions. Technologies such as videographyand computational approaches can also be used to improve pain assessment in rodents but these new tools must first be validated experimentally. An example of a new tool is the digital ventilated cage, which is an automated home-cage monitor that records spontaneous activity in the cages.
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21
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Carlesso LC, Law LF, Wang N, Nevitt M, Lewis CE, Neogi T. Association of Pain Sensitization and Conditioned Pain Modulation to Pain Patterns in Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 74:107-112. [PMID: 32882103 PMCID: PMC7925701 DOI: 10.1002/acr.24437] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/10/2020] [Accepted: 08/27/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the cross-sectional association of ascending pain mechanisms, implicated in pain sensitization, and descending pain modulation with pain patterns and unpredictability of pain. METHODS The Multicenter Osteoarthritis Study is a longitudinal cohort of older adults with or at risk of knee osteoarthritis. Peripheral and central ascending pain mechanisms were assessed using quantitative sensory tests, pressure pain thresholds using a handheld pressure algometer (knee/peripheral and wrist/central), and temporal summation using weighted probes (wrist/central). Descending modulation was assessed by conditioned pain modulation using pressure pain thresholds and a forearm ischemia test. Pain patterns were characterized based on responses to the Intermittent and Constant Osteoarthritis Pain questionnaire: 1) no intermittent or constant pain, 2) intermittent pain only, 3) constant pain only, and 4) combined constant and intermittent pain. A question regarding frequency assessed unpredictable pain. We assessed the association of quantitative sensory test measures to pain patterns using regression models with generalized estimating equations. RESULTS There were 2,794 participants (mean age 63.9 years, body mass index 29.5 kg/m2 , and 57% female). Lower pain sensitization by wrist pressure pain threshold (odds ratio [OR] 0.80 [95% confidence interval (95% CI) 0.68, 0.93]) and adequate conditioned pain modulation (OR 1.45 [95% CI 1.10, 1.92]) were associated with having constant ± intermittent pain compared with intermittent pain only. Higher pain sensitization (by pressure pain thresholds and temporal summation) was associated with a higher likelihood of unpredictable pain. CONCLUSION Knee pain patterns appear to be related to peripheral ± central facilitated ascending pain mechanisms and descending modulatory mechanisms. These findings highlight the need for a broader approach to understanding pain mechanisms by symptomatic disease progression.
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Affiliation(s)
- Lisa C. Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Laura Frey Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa city, Iowa, USA
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael Nevitt
- University of California, San Francisco, California, USA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama, USA
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts, USA
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22
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Leemans L, Nijs J, Antonis L, Wideman TH, Bandt HD, Franklin Z, Mullie P, Moens M, Joos E, Beckwée D. Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis. Braz J Phys Ther 2022; 26:100453. [PMID: 36279767 PMCID: PMC9597124 DOI: 10.1016/j.bjpt.2022.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined. OBJECTIVES The aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain. METHODS For this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS Meta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain. CONCLUSIONS Movement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.
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Affiliation(s)
- Lynn Leemans
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Corresponding author at: Rehabilitation Research Department and Pain in Motion International Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Physical Medicine and Physical Therapy, University Hospital Brussels, Belgium,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Luna Antonis
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Hester den Bandt
- Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Physical Therapy, University of Applied Sciences Rotterdam, Rotterdam, the Netherlands
| | - Zoe Franklin
- Department of Sport and Exercise Sciences, Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Patrick Mullie
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Belgian Defense, COS Well-Being, Queen Elisabeth Barracks, Evere, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Erika Joos
- Physical Medicine & Rehabilitation Department, UZ Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Department Rehabilitation Sciences and Physical Therapy
- Research Group MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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23
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Johnson AJ, Laffitte Nodarse C, Peraza JA, Valdes-Hernandez PA, Montesino-Goicolea S, Huo Z, Fillingim RB, Cruz-Almeida Y. Psychological profiles in adults with knee OA-related pain: a replication study. Ther Adv Musculoskelet Dis 2021; 13:1759720X211059614. [PMID: 34900003 PMCID: PMC8664321 DOI: 10.1177/1759720x211059614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Psychological factors have been associated with knee osteoarthritis pain severity and treatment outcomes, yet their combined contribution to phenotypic heterogeneity is poorly understood. In particular, empirically derived psychological profiles must be replicated before they can be targeted or considered for treatment studies. The objectives of this study were to (1) confirm previously identified psychological profiles using unsupervised clustering methods in persons with knee osteoarthritis pain, (2) determine the replicability of profiles using supervised machine learning in a different sample, and (3) examine associations with clinical pain, brain structure, and experimental pain. Methods Participants included two cohorts of individuals with knee osteoarthritis pain recruited as part of the multisite UPLOAD1 (n = 270, mean age = 56.8 ± 7.6, male = 37%) and UPLOAD2 (n = 164, mean age = 57.73 ± 7.8, male = 36%) studies. Similar psychological constructs (e.g. optimism, coping, somatization, affect, depression, and anxiety), sociodemographic and clinical characteristics, and somatosensory function were assessed across samples. UPLOAD2 participants also completed brain magnetic resonance imaging. Unsupervised hierarchical clustering analysis was first conducted in UPLOAD1 data to derive clusters, followed by supervised linear discriminative analysis to predict group membership in UPLOAD2 data. Associations among cluster membership and clinical variables were assessed, controlling for age, sex, education, ethnicity/race, study site, and number of pain sites. Results Four distinct profiles emerged in UPLOAD1 and were replicated in UPLOAD2. Identified psychological profiles were associated with psychological variables (ps < 0.001), and clinical outcomes (ps = 0.001-0.03), indicating good internal and external validation of the cluster solution. Significant associations between psychological profiles and somatosensory function and brain structure were also found. Conclusions This study highlights the importance of considering the biopsychosocial model in knee osteoarthritis pain assessment and treatment.
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Affiliation(s)
- Alisa J Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | - Julio A Peraza
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | | | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, PO Box 103628, 1329 SW 16th Street, Ste 5180, Gainesville, FL 32610, USA
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24
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Singh JA. "I wish it had a place to go": a nominal group study of barriers to the effectiveness of non-surgical treatments for knee osteoarthritis inclusive of minority populations. Arthritis Res Ther 2021; 23:291. [PMID: 34852836 PMCID: PMC8633910 DOI: 10.1186/s13075-021-02676-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To examine patient experience, views, and opinions regarding the ineffectiveness of the current knee osteoarthritis (OA) treatments. Methods Nominal groups were conducted with consecutive clinic patients with knee OA, oversampling African Americans. Patients discussed and rank-ordered their concerns. Results Fourteen nominal groups with 48 knee OA patients were conducted with a mean age of 60.6 years (standard deviation, 9.8) and a knee OA duration of 7.8 years (sd, 5.4); 25% were men, and 54% were African American. The most frequently cited highly ranked concerns for the ineffectiveness of current knee OA treatments were as follows: (1) medication-related—(A) side effects (3 groups; 4% vote), (B) limited efficacy (5 groups; 11% vote), (C) medication not targeting underlying disease (7 groups; 16% vote), (D) lack of personalized medication use (3 groups; 4% vote), (E) temporary benefit (3 groups; 6% vote), and (F) fear of addiction/natural treatment preference (2 groups; 3% vote); (2) exercise/physical therapy-related—(G) exacerbation of joint pain (1 group; 3% vote), (H) difficulty in doing exercises (2 groups; 2% vote), (I) lack of motivation (8 groups; 12% vote), (J) technical challenges/lack of personalized exercise regimens (1 group; 1% vote), and (K) cost (2 groups; 3% vote); and (3) weight loss-related—(L) difficulty in achieving weight loss (4 groups; 6% vote) and (M) motivation (1 group; 1% vote). Conclusions A representative sample of participants with knee OA identified several barriers to the effectiveness of current knee OA treatments. This new knowledge provides insights for making the current treatment options potentially more usable and/or more effective. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02676-8.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, Division of Epidemiology at School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
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25
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Cruz-Almeida Y, Coombes S, Febo M. Pain differences in neurite orientation dispersion and density imaging measures among community-dwelling older adults. Exp Gerontol 2021; 154:111520. [PMID: 34418483 PMCID: PMC9091979 DOI: 10.1016/j.exger.2021.111520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/07/2021] [Accepted: 08/13/2021] [Indexed: 01/29/2023]
Abstract
Neurite orientation dispersion and density imaging (NODDI) is a technique providing more detailed information on the microstructural bases of white matter. Given the previously reported white matter contributions to chronic pain, the present study aims to investigate pain-specific differences in NODDI measures across white matter tracts in a sample of community-dwelling older adults with (n = 29) and without (n = 18) chronic musculoskeletal pain. We further aimed to investigate associations between NODDI measures and clinical and experimental pain measures. As part of the Nepal study, a subset of older adults (>60 years old), underwent multiple laboratory sessions providing self-reported and experimental pain measures and a diffusion weighted neuroimaging sequence. Older adults with chronic musculoskeletal pain had a lower neurite density with less geometric complexity across a number of white matter tracts compared to older pain-free controls (corrected p's < 0.05). Lower neurite density was associated with greater self-reported pain intensity and anatomical pain sites, as well as greater experimental pain sensitivity (p's < 0.05). There were also significant pain-by-sex differences in neurite density and geometric complexity across multiple white matter tracts mainly around the hippocampus (corrected p's < 0.05). Finally, there were no pain differences with respect to extra-cellular water diffusion (corrected p's > 0.05). Our study demonstrates less geometric complexity in neurite density and architecture in chronic musculoskeletal pain, partly in a sex-dependent manner. An increased understanding of neurobiological mechanisms such as those measured by NODDI may contribute to the potential targeting of interventions in our older population suffering from chronic pain.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States of America; Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States of America; Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Stephen Coombes
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States of America; Department of Applied Kinesiology & Physiology, College of Health & Human Performance, University of Florida, Gainesville, FL, United States of America
| | - Marcelo Febo
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, United States of America
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26
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Rankin J, Rudy-Froese B, Hoyt C, Ramsahoi K, Gareau L, Howatt W, Carlesso LC. Quantitative Sensory Testing Protocols to Evaluate Central and Peripheral Sensitization in Knee OA: A Scoping Review. PAIN MEDICINE 2021; 23:526-557. [PMID: 34581816 DOI: 10.1093/pm/pnab285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/01/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This scoping review analyzed various quantitative sensory testing methodologies used in the assessment of sensitization and how sensitization is defined in people with knee osteoarthritis. DESIGN A scoping review. SETTING All clinical and research settings. SUBJECTS Non-surgical adults with knee osteoarthritis. METHODS This scoping review was guided by existing scoping review methodologies. Relevant studies were extracted from the following electronic databases: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Allied and Complementary Medicine Database and the Cumulative Index to Nursing Allied Health Literature. Abstract and full article screening and data extraction were performed in pairs. Information on quantitative sensory testing techniques and parameters was extracted and summarized in tables. General and technique specific definitions of sensitization were extracted from included texts. RESULTS Our search yielded 4199 articles, of which 50 were included in our review. The most common quantitative sensory test was pressure pain threshold. In total 28 unique testing sites were found speaking to the high degree of variability between studies. Sensitization was poorly defined with only 8 studies fully operationalizing it, 22 partially, and the remainder did not provide sufficient information to meet our criteria. CONCLUSION This scoping review has provided an overview of the most common methods of quantitative sensory testing being implemented in the assessment of nervous system sensitization to nociceptive signaling in people with knee osteoarthritis. This study provides a foundation for future development of quantitative sensory testing methodology for research and clinical practice in the osteoarthritis population.
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Affiliation(s)
- Jonathan Rankin
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | | | - Curtis Hoyt
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | - Keenu Ramsahoi
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | - Liam Gareau
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | - William Howatt
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | - Lisa C Carlesso
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada.,Université de Montréal, School of Rehabilitation, Montréal, Canada
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27
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Study Protocol Modeling Evoked Pain in Older African Americans With Knee Osteoarthritis. Nurs Res 2021; 70:391-398. [PMID: 33951704 DOI: 10.1097/nnr.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND African American (AA) older adults with knee osteoarthritis experience more severe chronic pain and advanced physical disability. One of the most prominent stimuli that provokes knee pain is movement. Research suggests that, compared to Whites, AAs report significantly higher movement-evoked pain (MEP) in the knee. However, little is known about the biopsychosocial-behavioral mechanisms underlying MEP. OBJECTIVES The aim of the study was to present a study protocol to (a) characterize the biopsychosocial-behavioral mechanisms that predict MEP in AAs with knee osteoarthritis and (b) develop a targeted, mechanism-based self-management intervention to reduce MEP and maximize movement. METHODS An observational, mixed-methods cohort study will enroll 90 AA/Black adults (ages 55-90 years) to understand intraindividual and interindividual effects on MEP. Participants will complete assessments of MEP, function and gait, biopsychosocial-behavioral questionnaires, quantitative sensory testing, and 7-day ecological momentary assessments of pain and related symptoms. For the qualitative phase, focus groups will be conducted to co-construct a mechanism-based pain self-management intervention. RESULTS We will develop phenotypes of MEP based on biopsychosocial-behavioral predictors and correlate measures of MEP with function. Our central hypothesis is that higher levels of MEP will predict lower self-reported function and poorer performance on functional tasks and that multiple biopsychosocial and behavioral factors will be associated with MEP and function. Predictors may serve as risk or protective factors for MEP and physical function. In targeting the biopsychosocial-behavioral mechanisms of MEP, we anticipate that older AAs may request that intervention components include culturally tailored self-management education, movement/physical activity training, treatment decision-making skills, coaching, spirituality, and social/kinship support. CONCLUSION Osteoarthritis is now the single most common cause of disability, mobility limitations, and persistent pain in older adults-especially AA older adults. To our knowledge, this will be the first study to systematically phenotype MEP in an older racial minority population with knee osteoarthritis and will be relevant for reducing knee pain and improving function.
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28
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Psychological Predictors of Perceived Age and Chronic Pain Impact in Individuals With and Without Knee Osteoarthritis. Clin J Pain 2021; 36:569-577. [PMID: 32398442 DOI: 10.1097/ajp.0000000000000842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Chronological age is a risk factor in chronic pain; however, aging research supports the premise that physical and psychological health may better predict perceived age. Given the lack of evidence on perceived age in the context of chronic pain, the current study presents novel findings about the relationship between perceived age, chronic pain impact, and psychological function in adults with and without knee osteoarthritis. METHODS This secondary analysis was part of an ongoing multisite observational cohort study to understand the progression of knee pain and disability. Community-dwelling adults (N=227) ages 45+ completed measures of trait resilience, trait positive and negative affect, pain catastrophizing, subjective perceptions of age, and the Graded Chronic Pain Scale. RESULTS On average, participants reported feeling 10 years younger than their chronological age; however, this effect was attenuated in individuals reporting high-impact pain. Lower perceived age was associated with lower pain impact (low pain/low disability), while higher perceived age correlated with higher pain impact (high pain/high disability) and more adverse psychological effects. Using hierarchical linear regression, high-impact pain and positive affect emerged as statistically significant predictors of perceived age, whereas no differences were observed among trait resilience, negative affect, or pain catastrophizing. DISCUSSION These findings highlight the importance of a biopsychosocial approach in understanding the intersection between psychological and physical factors associated with chronic pain. Addressing negative self-perceptions of aging, while simultaneously augmenting positive affect, through psychological therapies may mitigate pain and disability.
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29
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Allison C, Korey L, John Z S. A novel computational technique for the quantification of temporal summation in healthy individuals. Musculoskelet Sci Pract 2021; 54:102400. [PMID: 34022750 DOI: 10.1016/j.msksp.2021.102400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The pathophysiology of chronic musculoskeletal pain is linked to the neurophysiologic condition known as central sensitization. Developing reliable, sensitive and clinically feasible techniques for quantifying central sensitization is a timely priority for advancing the field of chronic pain diagnosis and management. OBJECTIVE To compare the sensitivity of the Windup Ratio, a commonly employed Quantitative Sensory Testing (QST) technique, to a novel approach, the Sumsquare method, for detecting changes in experimentally induced central sensitization. DESIGN Individual, randomized, controlled experimental study. METHODS A total of 37 subjects assigned to experimental (N = 18) and control (N = 19) groups. Central sensitization was experimentally induced in the C5-C6 spinal segments using topical capsaicin (0.075%); controls received a non-sensitizing placebo (Lubriderm). Windup (temporal summation) was assessed using weighted pinpricks (MRC Systems, Heidelberg, Germany) applied within regions of secondary hyperalgesia surrounding the topical capsaicin. A train of 10 stimuli was applied at baseline, 10, 20 and 30 min post-topical application and participants provided numeric pain ratings after each pinprick application. Sumsquare and Windup Ratio outcomes were calculated using the pain rating data. RESULTS Sumsquare outcome was significantly increased at all time points (10, 20, 30 min) post-sensitization (p < 0.05); in contrast, no differences in Windup Ratio from baseline were observed at any time point post-sensitization (p > 0.05). CONCLUSIONS Sumsquare outcome offers greater sensitivity than Windup Ratio for detecting changes in experimentally induced central sensitization. These findings introduce a novel method for assessing changes in central sensitization in patients presenting with chronic musculoskeletal pain hypersensitivity.
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Affiliation(s)
- Clouse Allison
- Human Health and Nutritional Science, University of Guelph, Guelph, Canada
| | - Loi Korey
- Human Health and Nutritional Science, University of Guelph, Guelph, Canada
| | - Srbely John Z
- Human Health and Nutritional Science, University of Guelph, Guelph, Canada.
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30
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Johnson AJ, Vasilopoulos T, Booker SQ, Cardoso J, Terry EL, Powell-Roach K, Staud R, Kusko DA, Addison AS, Redden DT, Goodin BR, Fillingim RB, Sibille KT. Knee pain trajectories over 18 months in non-Hispanic Black and non-Hispanic White adults with or at risk for knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:415. [PMID: 33952243 PMCID: PMC8101224 DOI: 10.1186/s12891-021-04284-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Pain is the hallmark symptom of knee osteoarthritis (OA), and varies widely across individuals. Previous research has demonstrated both fluctuating and stable pain trajectories in knee OA using various time periods. Changes in pain assessed quarterly (i.e. 3-month intervals) in knee OA are relatively unknown. The current study aimed to investigate temporal variations in pain over a one and a half year period (18 months) based on quarterly characteristic pain assessments, and to examine differences in pain patterns by sociodemographic and baseline pain characteristics. METHODS The sample included a prospective cohort of 188 participants (mean age 58 years; 63% female; 52% non-Hispanic Black) with or at risk for knee OA from an ongoing multisite investigation of ethnic/race group differences. Knee pain intensity was self-reported at baseline and quarterly over an18-month period. Baseline pain assessment also included frequency, duration, and total number of pain sites. Group-based trajectory modeling was used to identify distinct pain trajectories. Multinomial logistic regression was used to examine associations between sociodemographic characteristics, risk factors, and pain trajectory groups. RESULTS Pain trajectories were relatively stable among a sample of adults with knee pain. Four distinct pain trajectories emerged in the overall sample, with the largest proportion of participants (35.1%) classified in the moderate-high pain group. There were significant relationships between age, education, income, ethnicity/race and trajectory group; with younger, less educated, lower income, and non-Hispanic Black participants had a greater representation in the highest pain trajectory group. CONCLUSIONS Pain remained stable across a one and a half-year period in adults with or at risk for knee osteoarthritis, based on quarterly assessments. Certain sociodemographic variables (e.g. ethnicity/race, education, income, age) may contribute to an increased risk of experiencing greater pain.
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Affiliation(s)
- Alisa J. Johnson
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, PO Box 100242, Gainesville, FL 32610 USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL USA
| | - Staja Q. Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Josue Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
| | - Ellen L. Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Roland Staud
- Department of Rheumatology, College of Medicine, University of Florida, Gainesville, FL USA
| | - Daniel A. Kusko
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - Adriana S. Addison
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - David T. Redden
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL USA
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, PO Box 100242, Gainesville, FL 32610 USA
| | - Kimberly T. Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Aging & Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL USA
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Gaynor SM, Bortsov A, Bair E, Fillingim RB, Greenspan JD, Ohrbach R, Diatchenko L, Nackley A, Tchivileva IE, Whitehead W, Alonso AA, Buchheit TE, Boortz-Marx RL, Liedtke W, Park JJ, Maixner W, Smith SB. Phenotypic profile clustering pragmatically identifies diagnostically and mechanistically informative subgroups of chronic pain patients. Pain 2021; 162:1528-1538. [PMID: 33259458 PMCID: PMC8049946 DOI: 10.1097/j.pain.0000000000002153] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022]
Abstract
ABSTRACT Traditional classification and prognostic approaches for chronic pain conditions focus primarily on anatomically based clinical characteristics not based on underlying biopsychosocial factors contributing to perception of clinical pain and future pain trajectories. Using a supervised clustering approach in a cohort of temporomandibular disorder cases and controls from the Orofacial Pain: Prospective Evaluation and Risk Assessment study, we recently developed and validated a rapid algorithm (ROPA) to pragmatically classify chronic pain patients into 3 groups that differed in clinical pain report, biopsychosocial profiles, functional limitations, and comorbid conditions. The present aim was to examine the generalizability of this clustering procedure in 2 additional cohorts: a cohort of patients with chronic overlapping pain conditions (Complex Persistent Pain Conditions study) and a real-world clinical population of patients seeking treatment at duke innovative pain therapies. In each cohort, we applied a ROPA for cluster prediction, which requires only 4 input variables: pressure pain threshold and anxiety, depression, and somatization scales. In both complex persistent pain condition and duke innovative pain therapies, we distinguished 3 clusters, including one with more severe clinical characteristics and psychological distress. We observed strong concordance with observed cluster solutions, indicating the ROPA method allows for reliable subtyping of clinical populations with minimal patient burden. The ROPA clustering algorithm represents a rapid and valid stratification tool independent of anatomic diagnosis. ROPA holds promise in classifying patients based on pathophysiological mechanisms rather than structural or anatomical diagnoses. As such, this method of classifying patients will facilitate personalized pain medicine for patients with chronic pain.
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Affiliation(s)
- Sheila M. Gaynor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrey Bortsov
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Eric Bair
- Center for Pain Research and Innovation, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Joel D. Greenspan
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
- Brotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
| | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain; Department of Anesthesia, School of Medicine, School of Dentistry, McGill University, Montréal, Quebec, Canada
| | - Andrea Nackley
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina
| | - Inna E. Tchivileva
- Center for Pain Research and Innovation, Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William Whitehead
- Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aurelio A. Alonso
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Duke Innovative Pain Therapies, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Thomas E. Buchheit
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Anesthesiology Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Richard L. Boortz-Marx
- Pain Medicine Division, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Wolfgang Liedtke
- Duke Innovative Pain Therapies, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Neurobiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jongbae J. Park
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - William Maixner
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Shad B. Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina, USA
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Nishigami T, Tanaka S, Mibu A, Imai R, Wand BM. Knee-related disability was largely influenced by cognitive factors and disturbed body perception in knee osteoarthritis. Sci Rep 2021; 11:5835. [PMID: 33712725 PMCID: PMC7970993 DOI: 10.1038/s41598-021-85307-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to explore the existence of subgroups in a cohort of people with knee osteoarthritis (OA) based upon data from multiple pain-related variables and to profile identified clusters according to levels of pain intensity and knee-related disability. Three hundred and three people with knee OA were recruited. Latent profile analysis was used to confirm the optimal number of knee OA subgroups. Body mass index, radiographic knee OA severity, pain catastrophizing, pain related self-efficacy, and knee specific self-perception, were incorporated into the model. Cluster, demographic and clinical variables were compared between the resulting classes. Four distinct classes were identified. Cluster 1 (28.7%) represented early radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 2 (18.8%) showed advanced radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 3 (34.3%) represented various levels of radiographic OA, and the lowest pain intensity, disability and cognitive and perceptual dysfunction. Cluster 4 (18.1%) represented various levels of radiographic OA, the highest disability and cognitive and perceptual dysfunction. Considering cognitive factors and disturbed body perception may help to explain the phenomenon of the discrepancy between the knee-related disability and the severity of radiographic knee OA.
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Affiliation(s)
- Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-tyou, Mihara, Hiroshima, 723-0053, Japan.
| | - So Tanaka
- Department of Rehabilitation, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagikawachi, Minami-ku, Fukuoka, Fukuoka, 815-0063, Japan
| | - Akira Mibu
- Department of Physical Therapy, Konan Women's University, 6-2-23 Morikita-machi, Higashinada-ku, Kobe, Hyogo, 658-0001, Japan
| | - Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka, Osaka, 597-0104, Japan
| | - Benedict Martin Wand
- School of Physiotherapy, The University of Notre Dame Australia, 32 Mouat St, Fremantle, WA, 6160, Australia
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Terry EL, Booker SQ, Cardoso JS, Sibille KT, Bartley EJ, Glover TL, Vaughn IA, Thompson KA, Bulls HW, Addison AS, Staud R, Hughes LB, Edberg JC, Redden DT, Bradley LA, Goodin BR, Fillingim RB. Neuropathic-Like Pain Symptoms in a Community-Dwelling Sample with or at Risk for Knee Osteoarthritis. PAIN MEDICINE 2021; 21:125-137. [PMID: 31150093 DOI: 10.1093/pm/pnz112] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize neuropathic-like pain among individuals with or at risk for knee osteoarthritis. SUBJECTS One hundred eighty-four individuals who self-identified as non-Hispanic black or non-Hispanic white and presented with unilateral or bilateral knee pain. DESIGN Neuropathic-like pain was assessed using the painDETECT, and those with high vs low neuropathic-like pain were compared on clinical pain, psychological symptoms, physical function, and quantitative sensory testing. Analyses were unadjusted, partially and fully adjusted for relevant covariates. RESULTS Thirty-two (17.4%) participants reported experiencing neuropathic-like pain features above the painDETECT clinical cut-score. The neuropathic-like pain group reported significantly greater pain severity on all measures of clinical pain and higher levels of psychological symptoms when fully adjusted for covariates, but no differences emerged for disability and lower extremity function. The neuropathic-like pain group also reported greater overall heat pain ratings during the heat pain threshold and increased temporal summation of heat pain in the fully adjusted model. Additionally, those with neuropathic-like pain symptoms reported greater painful after-sensations following heat pain temporal summation in all analyses. No significant group differences in pressure pain threshold emerged at any of the testing sites. In contrast, temporal summation of mechanical pain was significantly greater at both the index knee and the ipsilateral hand for the neuropathic-like pain group in all analyses. CONCLUSIONS Participants with or at risk for knee osteoarthritis who reported high neuropathic-like pain experienced significantly greater clinical pain and increased heat and mechanical temporal summation at the index knee and other body sites tested, suggesting central sensitization.
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Affiliation(s)
- Ellen L Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Josue S Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Toni L Glover
- College of Nursing, University of Florida, Gainesville, Florida
| | - Ivana A Vaughn
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kathryn A Thompson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Adriana S Addison
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roland Staud
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Laura B Hughes
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey C Edberg
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David T Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laurence A Bradley
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
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Fullwood D, Means S, Merriwether EN, Chimenti RL, Ahluwalia S, Booker SQ. Toward Understanding Movement-evoked Pain (MEP) and its Measurement: A Scoping Review. Clin J Pain 2021; 37:61-78. [PMID: 33093342 PMCID: PMC7708514 DOI: 10.1097/ajp.0000000000000891] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Individuals with chronic pain conditions often report movement as exacerbating pain. An increasing number of researchers and clinicians have recognized the importance of measuring and distinguishing between movement-evoked pain (MEP) and pain at rest as an outcome. This scoping review maps the literature and describes MEP measurement techniques. MATERIALS AND METHODS The scoping review utilized 6 databases to identify original studies that targeted pain or movement-related outcomes. Our search returned 7322 articles that were screened by title and abstract by 2 reviewers. The inclusion criteria focused on the measurement of MEP before, during, and after movement tasks in adults with chronic pain. Studies of children below 18 years of age or with nonhuman animals, case studies, qualitative studies, book chapters, cancer-related pain, non-English language, and abstracts with no full publish text were excluded from the study. RESULTS Results from 38 studies revealed great variation in the measurement of MEP, while almost all of the studies did not provide an explicit conceptual or operational definition for MEP. In addition, studies collectively illuminated differences in MEP compared with rest pain, movement provocation methods, and pain intensity as the primary outcome. DISCUSSION These results have clinically significant and research implications. To advance the study of MEP, we offer that consistent terminology, standardized measurement (appropriate for pain type/population), and clear methodological processes be provided in research publications. On the basis of the findings, we have put forth a preliminary definition of MEP that may benefit from the continued scholarly dialog.
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Affiliation(s)
- Dottington Fullwood
- Department of Aging and Geriatric Research, College of Medicine, The University of Florida, Gainesville, FL 32610
| | - Sydney Means
- Department of Aging and Geriatric Research, College of Medicine, The University of Florida, Gainesville, FL 32610
| | - Ericka N. Merriwether
- Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10010
| | - Ruth L. Chimenti
- Department of Physical Therapy & Rehabilitation Science, The University of Iowa, Iowa City, IA 52242
| | - Simar Ahluwalia
- Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10010
| | - Staja Q. Booker
- Department of Biobehavioral Nursing Science, College of Nursing, The University of Florida, Gainesville, FL 32610
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35
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Anton SD, Cruz-Almeida Y, Singh A, Alpert J, Bensadon B, Cabrera M, Clark DJ, Ebner NC, Esser KA, Fillingim RB, Goicolea SM, Han SM, Kallas H, Johnson A, Leeuwenburgh C, Liu AC, Manini TM, Marsiske M, Moore F, Qiu P, Mankowski RT, Mardini M, McLaren C, Ranka S, Rashidi P, Saini S, Sibille KT, Someya S, Wohlgemuth S, Tucker C, Xiao R, Pahor M. Innovations in Geroscience to enhance mobility in older adults. Exp Gerontol 2020; 142:111123. [PMID: 33191210 PMCID: PMC7581361 DOI: 10.1016/j.exger.2020.111123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology - or geroscience - has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.
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Affiliation(s)
- Stephen D Anton
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Yenisel Cruz-Almeida
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Arashdeep Singh
- University of Florida, Department of Pharmacodynamics, College of Pharmacy, 1345 Center Drive, Gainesville, FL 32610, United States.
| | - Jordan Alpert
- University of Florida, College of Journalism and Communications, Gainesville, FL 32610, United States.
| | - Benjamin Bensadon
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Melanie Cabrera
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - David J Clark
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Natalie C Ebner
- University of Florida, Department of Psychology, 945 Center Drive, Gainesville, FL 32611, United States.
| | - Karyn A Esser
- University of Florida, Department of Physiology and Functional Genomics, 1345 Center Drive, Gainesville, FL, United States.
| | - Roger B Fillingim
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Soamy Montesino Goicolea
- University of Florida, Department of Community Dentistry and Behavioral Science, 1329 SW Archer Road, Gainesville, FL 32610, United States.
| | - Sung Min Han
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Henrique Kallas
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Alisa Johnson
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Christiaan Leeuwenburgh
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Andrew C Liu
- University of Florida, Department of Physiology and Functional Genomics, 1345 Center Drive, Gainesville, FL, United States.
| | - Todd M Manini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Michael Marsiske
- University of Florida, Department of Clinical & Health Psychology, 1225 Center Drive, Gainesville, FL 32610, United States.
| | - Frederick Moore
- University of Florida, Department of Surgery, Gainesville, FL 32610, United States.
| | - Peihua Qiu
- University of Florida, Department of Biostatistics, Gainesville, FL 32611, United States.
| | - Robert T Mankowski
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Mamoun Mardini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Christian McLaren
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Sanjay Ranka
- University of Florida, Department of Computer & Information Science & Engineering, Gainesville, FL 32611, United States.
| | - Parisa Rashidi
- University of Florida, Department of Biomedical Engineering. P.O. Box 116131. Gainesville, FL 32610, United States.
| | - Sunil Saini
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Kimberly T Sibille
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Shinichi Someya
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Stephanie Wohlgemuth
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Carolyn Tucker
- University of Florida, Department of Psychology, 945 Center Drive, Gainesville, FL 32611, United States.
| | - Rui Xiao
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
| | - Marco Pahor
- University of Florida, Department of Aging and Geriatric Research, 2004 Mowry Road, Gainesville, FL 32611, United States.
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Pain relief for osteoarthritis through combined treatment (PROACT): Protocol for a randomized controlled trial of mindfulness meditation combined with transcranial direct current stimulation in non-Hispanic black and white adults with knee osteoarthritis. Contemp Clin Trials 2020; 98:106159. [PMID: 32992020 DOI: 10.1016/j.cct.2020.106159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
Knee osteoarthritis (OA) is a leading cause of late life pain and disability, and non-Hispanic black (NHB) adults experience greater OA-related pain and disability than non-Hispanic whites (NHWs). Recent evidence implicates psychosocial stress, cognitive-attentional processes, and altered central pain processing as contributors to greater OA-related pain and disability among NHBs. To address these ethnic/race disparities, this clinical trial will test whether a mindfulness intervention (Breathing and Attention Training, BAT) combined with transcranial direct current stimulation (tDCS) will enhance pain modulatory balance and pain-related brain function, reduce clinical pain, and attenuate ethnic differences therein, among NHBs and NHWs with knee OA. Participants will complete assessments of clinical pain, function, psychosocial measures, and quantitative sensory testing (QST), including mechanical temporal summation and conditioned pain modulation. Neuroimaging will be performed to examine pain-related brain structure and function. Then, participants will be randomized to one of four groups created by crossing two BAT conditions (Real vs. Sham) with two tDCS conditions (Real vs. Sham). Participants will then undergo five treatment sessions during which the assigned BAT and tDCS interventions will be delivered concurrently for 20 min over one week. After the fifth intervention session, participants will undergo assessments of clinical pain and function, QST and neuroimaging identical to the pretreatment measures, and monthly follow-up assessments of pain will be conducted for three months. This will be the first study to determine whether mindfulness and tDCS treatments will show additive or synergistic effects when combined, and whether treatment effects differ across ethnic/race groups.
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Burrows NJ, Barry BK, Sturnieks DL, Booth J, Jones MD. The Relationship Between Daily Physical Activity and Pain in Individuals with Knee Osteoarthritis. PAIN MEDICINE 2020; 21:2481-2495. [DOI: 10.1093/pm/pnaa096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Objective
Investigate the association between physical activity and pain severity in individuals with knee osteoarthritis.
Design
Cross-sectional; systematic review with meta-analyses.
Methods
Thirty-one participants with knee osteoarthritis underwent assessment of symptoms via self-report questionnaires and quantitative sensory testing. Following testing, physical activity and symptoms were monitored for seven days using accelerometers and logbooks. Cross-correlation analyses were performed on fluctuations in symptoms and physical activity across the week to detect the relative timing of the strongest association between pain and activity. These data were complemented by meta-analyses of studies that examined correlations between pain from knee osteoarthritis and physical activity or fitness.
Results
Pain severity at baseline correlated with moderate to vigorous physical activity (r2 = 0.161–0.212, P < 0.05), whereby participants who were more physically active had less pain. Conversely, the peak of the cross-correlation analyses was most often positive and lagging, which indicated that pain was increased subsequent to periods of increased activity. These superficially discrepant findings were supported by the results of a meta-analysis of 13 studies and 9,363 participants, which identified significant heterogeneity for associations between physical activity and pain (I2 = 91%). Stronger inverse associations were found between fitness and pain.
Conclusions
Associations between physical activity and pain in people with knee osteoarthritis are variable and dynamic. These results reflect the beneficial impact of an active lifestyle and accompanying higher fitness. Yet, the side effect of acute periods of physical activity to transiently exacerbate pain may influence the behavior of some people to avoid activity because of pain.
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Affiliation(s)
- Nicholas J Burrows
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Benjamin K Barry
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- St Lucia Clinical Unit, University of Queensland, Brisbane, Australia
| | - Daina L Sturnieks
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - John Booth
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Matthew D Jones
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
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38
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Carlesso LC, Neogi T. Understanding the Complexity of Pain in Osteoarthritis Through the Use of Pain Phenotyping: Current Evidence. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00144-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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Clark DJ, Manini TM, Ferris DP, Hass CJ, Brumback BA, Cruz-Almeida Y, Pahor M, Reuter-Lorenz PA, Seidler RD. Multimodal Imaging of Brain Activity to Investigate Walking and Mobility Decline in Older Adults (Mind in Motion Study): Hypothesis, Theory, and Methods. Front Aging Neurosci 2020; 11:358. [PMID: 31969814 PMCID: PMC6960208 DOI: 10.3389/fnagi.2019.00358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022] Open
Abstract
Age-related brain changes likely contribute to mobility impairments, but the specific mechanisms are poorly understood. Current brain measurement approaches (e.g., functional magnetic resonance imaging (fMRI), functional near infrared spectroscopy (fNIRS), PET) are limited by inability to measure activity from the whole brain during walking. The Mind in Motion Study will use cutting edge, mobile, high-density electroencephalography (EEG). This approach relies upon innovative hardware and software to deliver three-dimensional localization of active cortical and subcortical regions with good spatial and temporal resolution during walking. Our overarching objective is to determine age-related changes in the central neural control of walking and correlate these findings with a comprehensive set of mobility outcomes (clinic-based, complex walking, and community mobility measures). Our hypothesis is that age-related walking deficits are explained in part by the Compensation Related Utilization of Neural Circuits Hypothesis (CRUNCH). CRUNCH is a well-supported model that describes the over-recruitment of brain regions exhibited by older adults in comparison to young adults, even at low levels of task complexity. CRUNCH also describes the limited brain reserve resources available with aging. These factors cause older adults to quickly reach a ceiling in brain resources when performing tasks of increasing complexity, leading to poor performance. Two hundred older adults and twenty young adults will undergo extensive baseline neuroimaging and walking assessments. Older adults will subsequently be followed for up to 3 years. Aim 1 will evaluate whether brain activity during actual walking explains mobility decline. Cross sectional and longitudinal designs will be used to study whether poorer walking performance and steeper trajectories of decline are associated with CRUNCH indices. Aim 2 is to harmonize high-density EEG during walking with fNIRS (during actual and imagined walking) and fMRI (during imagined walking). This will allow integration of CRUNCH-related hallmarks of brain activity across neuroimaging modalities, which is expected to lead to more widespread application of study findings. Aim 3 will study central and peripheral mechanisms (e.g., cerebral blood flow, brain regional volumes, and connectivity, sensory function) to explain differences in CRUNCH indices during walking. Research performed in the Mind in Motion Study will comprehensively characterize the aging brain during walking for developing new intervention targets.
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Affiliation(s)
- David J Clark
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Daniel P Ferris
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Chris J Hass
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Babette A Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | | | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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Miaskowski C, Blyth F, Nicosia F, Haan M, Keefe F, Smith A, Ritchie C. A Biopsychosocial Model of Chronic Pain for Older Adults. PAIN MEDICINE 2019; 21:1793-1805. [DOI: 10.1093/pm/pnz329] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abstract
Population
Comprehensive evaluation of chronic pain in older adults is multifaceted.
Objective and Methods
Research on chronic pain in older adults needs to be guided by sound conceptual models. The purpose of this paper is to describe an adaptation of the Biopsychosocial Model (BPS) of Chronic Pain for older adults. The extant literature was reviewed, and selected research findings that provide the empiric foundation for this adaptation of the BPS model of chronic pain are summarized. The paper concludes with a discussion of specific recommendations for how this adapted model can be used to guide future research.
Conclusions
This adaptation of the BPS model of chronic pain for older adults provides a comprehensive framework to guide future research in this vulnerable population.
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Affiliation(s)
| | - Fiona Blyth
- School of Medicine, The University of Sydney, Sydney, Australia
| | - Francesca Nicosia
- School of Medicine, University of California, San Francisco, California
| | - Mary Haan
- School of Medicine, University of California, San Francisco, California
| | - Frances Keefe
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Alexander Smith
- School of Medicine, University of California, San Francisco, California
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California
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Booker SQ, Herr K, Fillingim RB. The Reciprocal Relationship of Pain and Movement in African American Older Adults With Multi-Joint Osteoarthritis. Res Gerontol Nurs 2019; 13:1-11. [PMID: 31834412 DOI: 10.3928/19404921-20191202-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Abstract
Pain with movement is a common issue for older adults with osteoarthritis; however, there has been insufficient attention within populations at increased risk for disabling pain, such as African American older adults. Accordingly, using a mixed methods approach, the purpose of the current study is to describe the nature of chronic joint pain and movement and its impact on physical function in African American older adults with symptomatic osteoarthritis. The authors accrued a sample of 110 African American older adults who completed cross-sectional surveys; from this sample, the authors interviewed 18 participants. Findings suggest that patterns of movement are uniquely influenced by pain. Specifically, three dynamic themes emerged: The Impact of Pain on Movement; The Importance and Impact of Movement on Pain; and The Adaptation of Personal Behaviors to Minimize Pain With Movement. Function-focused nursing care rests on addressing challenges and opportunities that African American older adults face in maintaining healthy movement when managing osteoarthritis pain. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Relationships Between Psychological, Social, Physical Activity, and Sleep Measures and Somatosensory Function in Individuals With Spinal Pain: A Systematic Review and Meta-analysis. Clin J Pain 2019; 36:124-134. [PMID: 31764166 DOI: 10.1097/ajp.0000000000000775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Somatosensory abnormalities are linked to clinical pain outcomes in individuals with spinal pain. However, a range of factors might confound the relationship between altered somatosensory function and clinical pain outcomes. This systematic review aimed to evaluate the literature to assess the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function (assessed via sensory psychophysical testing) among individuals with spinal pain. METHODS A comprehensive literature search was performed in 6 electronic databases from their inception to June 2018. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for the Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. RESULTS Among the 17 factors identified in the included studies, pain catastrophizing, depression, and pain-related fear have significant negative (small to fair) associations with pain thresholds. A "very low" to "moderate" quality of evidence was found for all the investigated factors. Subgroup analysis showed a smaller effect size for pain catastrophizing/fear of movement and pain thresholds in individuals with low back pain. CONCLUSIONS Psychological factors are associated negatively with pain thresholds and they need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with spinal pain.
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Vårbakken K, Lorås H, Nilsson KG, Engdal M, Stensdotter AK. Relative difference among 27 functional measures in patients with knee osteoarthritis: an exploratory cross-sectional case-control study. BMC Musculoskelet Disord 2019; 20:462. [PMID: 31638971 PMCID: PMC6805424 DOI: 10.1186/s12891-019-2845-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/20/2019] [Indexed: 12/27/2022] Open
Abstract
Background To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient’s situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures’ selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61 years, 64% women) referred by general physicians to a hospital’s osteoarthritis-school, and 31 healthy participants (mean age 55 years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen’s d. For non-parametric data, ds were estimated by p-values and sample sizes according to statistical formulas. Finally, all ds were ranked and interpreted after Hopkins’ scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results Very large differences between patients and controls were found on the Pain numeric rating scale1, the Knee Injury and Osteoarthritis Scale (KOOS, all subscales)2, as well as the Örebro Musculoskeletal psychosocial scale3 (P < 0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test4 and Accelerometer registered vigorous-intensity physical activity in daily life5 (P < 0.001). Respectively, these measures clustered on ICF as follows: 1body function, 2all three ICF-dimensions, 3body function and participation, 4activity, and 5participation. Limitations The limited sample excluded elderly patients with severe obesity. Conclusions Very large differences across all ICF dimensions were indicated for the KOOS and Örebro questionnaires together for patients aged 45–70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions.
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Affiliation(s)
- K Vårbakken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway. .,Faculty of Medicine and Health Sciences, NTNU, Health og Social building, 7491, Trondheim, Norway.
| | - H Lorås
- Department of Physical Education and Sport Science, Nord University, Levanger, Norway
| | - K G Nilsson
- Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - M Engdal
- Department of Physiotherapy, Clinic of Clinical Services, Trondheim University Hospital, Trondheim, Norway
| | - A K Stensdotter
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Medicine and Health Sciences, NTNU, Health og Social building, 7491, Trondheim, Norway
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Booker S, Cardoso J, Cruz-Almeida Y, Sibille KT, Terry EL, Powell-Roach KL, Riley JL, Goodin BR, Bartley EJ, Addison AS, Staud R, Redden D, Bradley L, Fillingim RB. Movement-evoked pain, physical function, and perceived stress: An observational study of ethnic/racial differences in aging non-Hispanic Blacks and non-Hispanic Whites with knee osteoarthritis. Exp Gerontol 2019; 124:110622. [PMID: 31154005 PMCID: PMC6660381 DOI: 10.1016/j.exger.2019.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a pervasive musculoskeletal condition, often exacerbated by movement-evoked pain (MEP). Despite established research demonstrating significant racial differences in OA pain, few studies have investigated ethnic/racial group differences in MEP and lower extremity function and their association with psychosocial factors, such as perceived stress. Therefore, the primary aims were: (1) to identify ethnic/racial group differences in persons with or at risk for knee OA pain based on MEP, physical performance, and perceived stress measures, and (2) to determine if perceived stress explains the relationship between MEP and function in non-Hispanic Blacks (NHBs) and non-Hispanic Whites (NHWs). METHODS A total of 162 NHB and NHW community-dwelling older adults (50-78 years of age) were included in this analysis from the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD) cross-sectional cohort study. Demographic, anthropometric, pain and functional parameters were assessed using a battery of validated instruments. Descriptive statistics, parametric, and multivariate analyses were conducted to determine ethnic/racial differences in perceived stress, MEP, and function. RESULTS Our results support the hypothesis that among persons with knee OA pain, NHBs have significantly greater MEP and lower functional level, despite similar levels of perceived stress. However, perceived stress was more strongly related to MEP in NHB compared to NHWs. Differences in function were limited to walking speed, where NHWs demonstrated faster gait speed. CONCLUSIONS Our cross-sectional study demonstrated important ethnic/racial differences in MEP and function. Also, perceived stress had a stronger effect on MEP in NHBs, suggesting that perceived stress may more strongly influence pain with physical movement among NHB adults. MEP may be a clinically important pain outcome to measure in persons with OA, and these data warrant future research on the impact of stress on pain and functional outcomes in older adults, particularly in NHBs.
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Affiliation(s)
- Staja Booker
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA.
| | - Josue Cardoso
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Yenisel Cruz-Almeida
- The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA; The University of Florida, Department of Aging & Geriatric Research, College of Medicine, Gainesville, FL 32611, USA
| | - Kimberly T Sibille
- The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA; The University of Florida, Department of Aging & Geriatric Research, College of Medicine, Gainesville, FL 32611, USA
| | - Ellen L Terry
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Keesha L Powell-Roach
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Joseph L Riley
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Burel R Goodin
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL 35294, USA
| | - Emily J Bartley
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | | | - Roland Staud
- The University of Florida, Department of Medicine, Gainesville, FL 32608, USA
| | - David Redden
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL 35294, USA; University of Alabama at Birmingham, Department Medicine and Rheumatology, Birmingham, AL 35294, USA
| | - Laurence Bradley
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Roger B Fillingim
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
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Othman R, Jayakaran P, Tumilty S, Swain N, Mani R. Predictive relationship between psychological, social, physical activity, and sleep measures and somatosensory function in individuals with musculoskeletal pain: a systematic review and meta-analysis protocol. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1648715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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At the Intersection of Ethnicity/Race and Poverty: Knee Pain and Physical Function. J Racial Ethn Health Disparities 2019; 6:1131-1143. [PMID: 31292922 DOI: 10.1007/s40615-019-00615-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) disproportionately affects racial and ethnic minorities. Non-Hispanic Blacks (NHB) report a higher prevalence and severity of knee OA symptoms than their non-Hispanic White (NHW) counterparts. The role of poverty in explaining this disparity remains unclear. OBJECTIVE The overall aim of this cross-sectional study was to determine whether ethnic/racial differences in knee pain and physical function varied according to poverty status. DESIGN NHB and NHW adults with or at risk of knee OA self-reported sociodemographic information, and completed the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) and the Short Physical Performance Battery (SPPB). Annual income was adjusted for number of household occupants to determine poverty status (i.e., living above versus below poverty line). RESULTS Findings revealed 120 individuals living above the poverty line (49% NHB, 77% NHW) and 71 individuals living below the poverty line (51% NHB, 23% NHW). Adjusted multivariable models revealed significant ethnic/race by poverty status interactions for knee pain (p = 0.036) and physical function (p = 0.032) on the WOMAC, as well as physical function on the SPPB (p = 0.042). Post hoc contrasts generally revealed that NHW adults living above the poverty line experienced the least severe knee pain and best physical function, while NHB adults living below the poverty line experienced the most severe knee pain and poorest physical function. CONCLUSIONS Results of the present study add to the literature by emphasizing the importance of considering poverty and/or other indicators of socioeconomic status in studies examining ethnic/racial disparities in pain and physical function.
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Corbett DB, Simon CB, Manini TM, George SZ, Riley JL, Fillingim RB. Movement-evoked pain: transforming the way we understand and measure pain. Pain 2019; 160:757-761. [PMID: 30371555 PMCID: PMC6424644 DOI: 10.1097/j.pain.0000000000001431] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Duane B. Corbett
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
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Butera KA, Roff SR, Buford TW, Cruz-Almeida Y. The impact of multisite pain on functional outcomes in older adults: biopsychosocial considerations. J Pain Res 2019; 12:1115-1125. [PMID: 30992680 PMCID: PMC6445225 DOI: 10.2147/jpr.s192755] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Multisite pain, or pain that occurs simultaneously at >1 anatomical site, is more prevalent than single-site pain. While multisite pain affects over half of older adults, it remains an understudied pain entity that may have important functional implications in an aging population. Greater understanding of this complex pain entity from a biopsychosocial perspective is critical for optimizing clinical and functional outcomes in older adults with pain. Therefore, the primary purpose of this review is to summarize the relationship between multisite pain and functional outcomes in older adults to further elucidate the impact of multisite pain as a distinct entity within this population. A comprehensive literature search revealed 17 peer-reviewed articles. Multisite pain in older individuals is associated with reductions in several physical function domains: 1) lower-extremity mobility; 2) upper-extremity impairments; 3) balance and increased fall risk; and 4) general disability and poor physical function. Further, multisite pain in older individuals is associated with psychological dysfunction (eg, anxiety and depressive symptoms) and social factors (eg, income and education). Overall, this review highlights the scant literature investigating the functional implications of multisite pain in an aging population. Further, while multisite pain appears to have functional consequences, the neurobiological mechanisms contributing to this relationship are unknown. Thus, how this pain characteristic may contribute to the variability in pain-related functional outcomes among older adults is not clear. Future investigations are strongly warranted to advance the understanding of multisite pain and its broad impact on physical and psychosocial function in older adults.
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Affiliation(s)
- Katie A Butera
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Shannon R Roff
- Charles River Laboratories Inc., Frederick, MD 21701, USA
| | - Thomas W Buford
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Yenisel Cruz-Almeida
- Department of Aging & Geriatric Research, Institute on Aging, Pain Research & Intervention Center of Excellence, Center for Cognitive Aging & Memory, University of Florida, Gainesville, FL 32610, USA,
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Boyer KA, Hafer JF. Gait mechanics contribute to exercise induced pain flares in knee osteoarthritis. BMC Musculoskelet Disord 2019; 20:107. [PMID: 30871519 PMCID: PMC6419357 DOI: 10.1186/s12891-019-2493-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/05/2019] [Indexed: 01/05/2023] Open
Abstract
Background Exercise-induced pain flares represent a significant barrier for individuals with knee osteoarthritis to meet physical activity recommendations. There is a need to understand factors that contribute to pain flares and the potential for the motor system to adapt and reduce joint loading should a flare occur. The study aim was to examine the impact of a bout of exercise on self-reported pain, walking mechanics and muscle co-contraction for participants with knee osteoarthritis. Methods Thirty-six adults (17 healthy older and 19 knee osteoarthritis) participated in this study. Self-reported pain, joint mechanics and muscle co-activation during gait at two self-selected speeds were collected before and after a 20-min preferred pace treadmill walk (20MTW). Results Eight of nineteen osteoarthritis participants had a clinically significant pain flare response to the 20MTW. At baseline the participants that did not experience a pain flare had smaller knee flexion and total reaction moments compared to both the participants with pain flares (p = 0.02; p = 0.05) and controls (p < 0.001; p < 0.001). In addition, the 2nd peak knee adduction (p = 0.01) and internal rotation (p = 0.001) moments were smaller in the no flares as compared to controls. The pain flare participants differed from controls with smaller knee internal rotation moments (p = 0.03), but greater relative hamstrings (vs. quadriceps) and medial (vs. lateral) muscle activation (p = 0.04, p = 0.04) compared to both controls and no flare participants (p = 0.04, p = 0.007). Following the 20MTW there were greater decreases in the 1st and 2nd peak knee adduction (p = 0.03; p = 0.02), and internal rotation (p = 0.002) moments for the pain flare as compared to the no flare group. In addition, for the pain flare as compared to controls, greater decreases in the knee flexion (p = 0.03) and internal rotation (p = 0.005) moments were found. Conclusions Individuals who adapt their gait to reduce knee joint loads may be less susceptible to exercise-induced pain flares. This highlights a potential role of gait biomechanics in short-term osteoarthritis pain fluctuations. The results also suggest that despite the chronic nature of osteoarthritis pain, the motor system’s ability to respond to nociceptive stimuli remains intact. Electronic supplementary material The online version of this article (10.1186/s12891-019-2493-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine A Boyer
- Department of Kinesiology, University of Massachusetts-Amherst, 110 Totman Building 30 Eastman Lane, Amherst, MA, 01003, USA. .,University of Massachusetts-Amherst, Mechanical and Industrial Engineering, Amherst, USA. .,Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, USA.
| | - Jocelyn F Hafer
- Department of Kinesiology, University of Massachusetts-Amherst, 110 Totman Building 30 Eastman Lane, Amherst, MA, 01003, USA.,School of Kinesiology, University of Michigan, Central Campus Recreation Building, 401 Washtenaw Avenue, Ann Arbor, MI, 48109, USA
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