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Ruan Y, Jin X, Ji H, Zhu C, Yang Y, Zhou Y, Yu G, Wang C, Tang Z. Water extract of Notopterygium incisum alleviates cold allodynia in neuropathic pain by regulation of TRPA1. JOURNAL OF ETHNOPHARMACOLOGY 2023; 305:116065. [PMID: 36587876 DOI: 10.1016/j.jep.2022.116065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Neuropathic pain can be debilitating and drastically affects the quality of life of those patients suffering from this condition. The Chinese herb Notopterygium incisum Ting ex H.T. Chang has long been used to disperse "cold". One under examined clinical feature of neuropathic pain is sensitivity to cold. Patients with neuropathic pain or arthritis usually describe a worsening of symptoms during the winter. AIMS OF THIS STUDY We proposed to test the hypothesis that Notopterygium incisum has a positive effect on the cold sensitivity found in neuropathic pain. MATERIALS AND METHODS In this study, we established chronic constriction injury (CCI) and cisplatin induced neuropathic pain mice models. Behavioral experiments and physiological examination methods were employed to investigate the effect of water extract of Notopterygium incisum (WN) on cold pain. RESULTS We found WN reduced cold pain and allyl isothiocyanate (AITC, Transient Receptor Potential A1 (TRPA1 agonist)) induced pain. WN inhibited AITC induced calcium response in HEK 293 cells transfected with TRPA1 and dorsal root ganglion (DRG) neurons. Moreover, we found that oral administration of WN reduced cold allodynia and mechanical allodynia caused by (CCI) and cisplatin induced neuropathic pain. We also observed that oral administration of WN decreased responses to AITC in DRG neurons as well as expression of TRPA1 in the WN treated neuropathic pain model. CONCLUSIONS The present study provide evidence that Notopterygium incisum alleviates cold allodynia in CCI and cisplatin induced neuropathic pain mouse models. WN alleviated neuropathic pain induced cold allodynia via directly modulating TRPA1. Our findings identify WN as a promising candidate for treating neuropathic pain that highlights a new mechanism of Notopterygium incisum on 'disperse cold'.
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Affiliation(s)
- Yonglan Ruan
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Xiang Jin
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Haiwang Ji
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Chan Zhu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Yan Yang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Yuan Zhou
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Guang Yu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Changming Wang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Zongxiang Tang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
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Margelli M, Segat A, Raule M, Giacchetti C, Zanoli G, Pellicciari L. A reliability study of a novel visual ischemic palpation scale in an experimental setting. Musculoskelet Sci Pract 2021; 54:102384. [PMID: 33992885 DOI: 10.1016/j.msksp.2021.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Manual palpation is an important part of the clinical examination and generally it has low reliability. The aim of this study was to assess the reliability of a novel method for discriminating 3 different levels of palpation force. METHODS This reliability study included 96 healthy physiotherapists and physiotherapy students, who have been taught a new palpation graduated procedure called Visual Ischemic Palpatory Scale (VIPS), aimed to classify the applied pressure based on the finger's ischemia. Force was recorded by a force measurement system putting sensor over a rigid surface. To study the characteristic of VIPS the analysis of variance (ANOVA), Spearman rank correlation coefficient, Intraclass Correlation Coefficient (ICC), Standard Error of Measurements (SEM), and Minimal Detectable Change (MDC) were calculated. RESULTS Three distinct degrees were found with distinct forces expression: 1st degree 76.04 g (95% CI 65.86-86.22), 2nd degree 307.87 g (95% CI 263.29-352.44) and 3rd degree 1319.48 g (CI 1204.73-1434.23). Male participants significantly recorded a greater force than females. Good to excellent reliability across degrees were found (0.89 [95% CI: 0.82-0.97]), and final agreement found that more than 65.6% of sample recorded a force in the cut-offs identified. SEM values became bigger as the recorded force increased and MDC were equal to 48.94 g, 188.73 g, and 379.24 g for 1st, 2nd, and 3rd degree, respectively. CONCLUSIONS VIPS would appear to have three distinct degrees, sex dependent, with specific force expression for each degree and a good to excellent intra-rater reliability, but a poor agreement between raters.
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Affiliation(s)
- Michele Margelli
- Faculty of Medicine and Surgery, Department of Clinical Ccience and Translation Medicine, University of Rome Tor Vergata, Roma, Italy; Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; Studio Andreotti-Margelli Terapika, Ferrara, Italy.
| | | | - Maddalena Raule
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Caterina Giacchetti
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Gustavo Zanoli
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; Casa di Cura SM Maddalena, Occhiobello, Italy.
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Hot and cold knees: exploring differences in patella skin temperature in patients with patellofemoral pain. Physiotherapy 2020; 108:55-62. [PMID: 32711228 DOI: 10.1016/j.physio.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the distribution of patella skin temperature (Tsk) measurements and to explore the presence of temperature subgroups in patellofemoral pain (PFP) patients. DESIGN Cross-sectional observational study design. PARTICIPANTS One dataset of 58 healthy participants and 232 PFP patients from three different datasets. MAIN OUTCOME MEASURES Patella skin temperature, measured by physiotherapists using a low cost hand held digital thermometer. The distribution of patella skin temperature was assessed and compared across datasets. To objectively determine the clinically meaningful number of subgroups, we used the average silhouette method. Finite mixture models were then used to examine the presence of PFP temperature subgroups. Receiver operating characteristic curves were used to estimate optimal patella Tsk thresholds for allocation of participants into the identified subgroups. RESULTS In contrast to healthy participants, the patella skin temperature had an obvious bimodal distribution with wide dispersion present across all three PFP datasets. The fitted finite mixture model suggested three temperature subgroups (cold, normal and hot) that had been recommended by the average silhouette method with discrimination cut-off thresholds for subgroup membership based on receiver operating curve analysis of Cold=<30.0°C; Normal 30.0-35.2°C; Hot ≥35.2°C. CONCLUSION A low cost hand held digital thermometer appears to be a useful clinical tool to identify three PFP temperature subgroups. Further research is recommended to deepen understanding of these clinical findings and to explore the implications to different treatments.
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Glaviano NR, Bazett-Jones DM, Norte G. Gluteal muscle inhibition: Consequences of patellofemoral pain? Med Hypotheses 2019; 126:9-14. [DOI: 10.1016/j.mehy.2019.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/05/2019] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
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Levine D, Walker JR, Marcellin-Little DJ, Goulet R, Ru H. Detection of skin temperature differences using palpation by manual physical therapists and lay individuals. J Man Manip Ther 2018; 26:97-101. [PMID: 29686483 DOI: 10.1080/10669817.2018.1427908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objectives To evaluate the accuracy of detection of temperature differences among skin sites of lay individuals and manual physical therapists. Methods Forty-four manual physical therapists and 44 lay individuals were recruited. Subjects palpated two temperature-controlled surfaces that ranged in temperature between 30 and 35 °C and varied randomly by 1, 2, 3, 4, or 5 °C for 10 s. The subjects were then asked to identify the warmer pad. Results Accuracy increased with larger temperature differences. Accuracy of detection of 1 and 3 °C temperature differences was higher in manual physical therapists than lay individuals. Discussion Palpation can be used to accurately detecting temperature differences between sites and is more accurately performed by an experienced practitioner. Level of Evidence 3b.
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Affiliation(s)
- David Levine
- Department of Physical Therapy, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - J Randy Walker
- Department of Physical Therapy, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Denis J Marcellin-Little
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, CA, USA
| | - Ron Goulet
- Department of Mechanical Engineering, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Hongyu Ru
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Carlson VR, Boden BP, Sheehan FT. Patellofemoral Kinematics and Tibial Tuberosity-Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain. Am J Sports Med 2017; 45:1102-1109. [PMID: 28029800 PMCID: PMC6006511 DOI: 10.1177/0363546516679139] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent disorder among female adolescents. Overuse is frequently cited as the cause of pain for this population. What is currently unclear, however, is if the patella demonstrates abnormal tracking patterns relative to the femoral trochlear groove in female adolescents with PFP. PURPOSE The aim of this case-control study was to determine if abnormal patellar tracking patterns are present in female adolescents with PFP. The secondary aim was to identify if an increased tibial tuberosity-trochlear groove (TT-TG) distance is associated with the observed kinematic patterns. STUDY DESIGN Controlled laboratory study. METHODS Twenty female adolescent knees from 12 patients with PFP and 20 age-matched female knees from 13 healthy controls were recruited for this study. Patellofemoral kinematics (eg, lateral patellar displacement) during a repetitive knee extension-flexion maneuver was quantified by dynamic cine phase-contrast magnetic resonance imaging (MRI). Static MRI scans were used to determine the TT-TG distance. RESULTS Relative to the control cohort, female adolescents with PFP demonstrated significantly greater lateral displacement at 10° (3.2 mm; P < .001), 20° (2.3 mm; P < .001), and 30° (1.7 mm; P = .014) of knee flexion. A subgroup within this cohort (7 knees from 5 patients) demonstrated extreme lateral maltracking >2 SDs of the mean of the control cohort. This subgroup also demonstrated a greater TT-TG distance relative to the controls (Δ = 4.2 mm; P = .001). CONCLUSION This study demonstrates abnormal lateral patellar displacement in the absence of patellar tilt in female adolescents with PFP. Because all adolescents from both cohorts participated in impact sports, it appears that rigorous athletic training alone is inadequate to produce symptoms in this population. Rather, PFP may derive from a combination of physical activity in the context of pathological kinematics. CLINICAL RELEVANCE Abnormal patellar tracking patterns and abnormal static alignment have been shown to contribute to the etiology of patellofemoral pain in adults. This study demonstrates that pathologic patellar tracking patterns are present in adolescent females with patellofemoral pain.
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Affiliation(s)
- Victor R. Carlson
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
| | | | - Frances T. Sheehan
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
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Holistic approach to understanding anterior knee pain. Clinical implications. Knee Surg Sports Traumatol Arthrosc 2014; 22:2275-85. [PMID: 24760163 DOI: 10.1007/s00167-014-3011-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 04/11/2014] [Indexed: 01/16/2023]
Abstract
Anterior knee pain is one of the most frequent reasons for consultation within knee conditions. The aetiology is not well known, which explains the sometimes unpredictable results of its treatment. Normally, when we see a patient in the office with anterior knee pain, we only study and focus on the knee. If we do this, we are making a big mistake. We must not forget to evaluate the pelvis and proximal femur, as well as the psychological factors that modulate the course of the illness. Both the pelvifemoral dysfunction as well as the psychological factors (anxiety, depression, catastrophization and kinesiophobia) must be included in our therapeutic targets of the multidisciplinary treatment of anterior knee pain. We must not only focus on the knee, we must remember to "look up" to fully understand what is happening and be able to solve this difficult problem. The aetiology of anterior knee pain is multifactorial. Therefore, diagnosis and treatment of patellofemoral disorders must be individualized. Our findings stress the importance of tailoring physiotherapy, surgery and psycho-educational interventions to each patient.
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Selfe J, Alexander J, Costello JT, May K, Garratt N, Atkins S, Dillon S, Hurst H, Davison M, Przybyla D, Coley A, Bitcon M, Littler G, Richards J. The effect of three different (-135°C) whole body cryotherapy exposure durations on elite rugby league players. PLoS One 2014; 9:e86420. [PMID: 24489726 PMCID: PMC3906033 DOI: 10.1371/journal.pone.0086420] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/13/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Whole body cryotherapy (WBC) is the therapeutic application of extreme cold air for a short duration. Minimal evidence is available for determining optimal exposure time. PURPOSE To explore whether the length of WBC exposure induces differential changes in inflammatory markers, tissue oxygenation, skin and core temperature, thermal sensation and comfort. METHOD This study was a randomised cross over design with participants acting as their own control. Fourteen male professional first team super league rugby players were exposed to 1, 2, and 3 minutes of WBC at -135°C. Testing took place the day after a competitive league fixture, each exposure separated by seven days. RESULTS No significant changes were found in the inflammatory cytokine interleukin six. Significant reductions (p<0.05) in deoxyhaemoglobin for gastrocnemius and vastus lateralis were found. In vastus lateralis significant reductions (p<0.05) in oxyhaemoglobin and tissue oxygenation index (p<0.05) were demonstrated. Significant reductions (p<0.05) in skin temperature were recorded. No significant changes were recorded in core temperature. Significant reductions (p<0.05) in thermal sensation and comfort were recorded. CONCLUSION Three brief exposures to WBC separated by 1 week are not sufficient to induce physiological changes in IL-6 or core temperature. There are however significant changes in tissue oxyhaemoglobin, deoxyhaemoglobin, tissue oxygenation index, skin temperature and thermal sensation. We conclude that a 2 minute WBC exposure was the optimum exposure length at temperatures of -135°C and could be applied as the basis for future studies.
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Affiliation(s)
- James Selfe
- Allied Health Research Unit, University of Central Lancashire, Preston, United Kingdom
| | - Jill Alexander
- AHRu, University of Central Lancashire, Preston, United Kingdom
| | - Joseph T. Costello
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Karen May
- AHRu, University of Central Lancashire, Preston, United Kingdom
| | - Nigel Garratt
- SSTO, University of Central Lancashire, Preston, United Kingdom
| | - Stephen Atkins
- SENS, University of Central Lancashire, Preston, United Kingdom
| | | | - Howard Hurst
- SENS, University of Central Lancashire, Preston, United Kingdom
| | - Matthew Davison
- SENS, University of Central Lancashire, Preston, United Kingdom
| | - Daria Przybyla
- SENS, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Coley
- Wigan Warriors Rugby League, Central Park, Montrose Avenue, Wigan, United Kingdom
| | - Mark Bitcon
- Wigan Warriors Rugby League, Central Park, Montrose Avenue, Wigan, United Kingdom
| | - Greg Littler
- AHRu, University of Central Lancashire, Preston, United Kingdom
| | - Jim Richards
- AHRu, University of Central Lancashire, Preston, United Kingdom
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Selfe J, Callaghan M, Witvrouw E, Richards J, Dey MP, Sutton C, Dixon J, Martin D, Stokes M, Janssen J, Ritchie E, Turner D. Targeted interventions for patellofemoral pain syndrome (TIPPS): classification of clinical subgroups. BMJ Open 2013; 3:e003795. [PMID: 24065700 PMCID: PMC3787410 DOI: 10.1136/bmjopen-2013-003795] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Patellofemoral pain (PFP) can cause significant pain leading to limitations in societal participation and physical activity. An international expert group has highlighted the need for a classification system to allow targeted intervention for patients with PFP; we have developed a work programme systematically investigating this. We have proposed six potential subgroups: hip abductor weakness, quadriceps weakness, patellar hypermobility, patellar hypomobility, pronated foot posture and lower limb biarticular muscle tightness. We could not uncover any evidence of the relative frequency with which patients with PFP fell into these subgroups or whether these subgroups were mutually exclusive. The aim of this study is to provide information on the clinical utility of our classification system. METHODS AND ANALYSIS 150 participants will be recruited over 18 months in four National Health Services (NHS) physiotherapy departments in England. INCLUSION CRITERIA adults 18-40 years with PFP for longer than 3 months, PFP in at least two predesignated functional activities and PFP elicited by clinical examination. EXCLUSION CRITERIA prior or forthcoming lower limb surgery; comorbid illness or health condition; and lower limb training or pregnancy. We will record medical history, demographic details, pain, quality of life, psychomotor movement awareness and knee temperature. We will assess hip abductor and quadriceps weakness, patellar hypermobility and hypomobility, foot posture and lower limb biarticular muscle tightness. The primary analytic approach will be descriptive. We shall present numbers and percentages of participants who meet the criteria for membership of (1) each of the subgroups, (2) none of the subgroups and (3) multiple subgroups. Exact (binomial) 95% CIs for these percentages will also be presented. ETHICS AND DISSEMINATION This study has been approved by National Research Ethics Service (NRES) Committee North West-Greater Manchester North (11/NW/0814) and University of Central Lancashire (UCLan) Built, Sport, Health (BuSH) Ethics Committee (BuSH 025). An abstract has been accepted for the third International Patellofemoral Pain Research Retreat, Vancouver, September 2013.
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Affiliation(s)
- James Selfe
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - Michael Callaghan
- Centre for Rehabilitation Science, Manchester University, Manchester, UK
| | - Erik Witvrouw
- Department of Rehabilitation, Ghent University, Ghent, Belgium
- Aspetar, Doha, Qatar
| | - James Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - Maria Paola Dey
- Postgraduate Medicine and Dentistry, University of Central Lancashire, Preston, UK
| | - Chris Sutton
- School of Health, University of Central Lancashire, Preston, UK
| | - John Dixon
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Denis Martin
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Maria Stokes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jessie Janssen
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - Elizabeth Ritchie
- Department of Physiotherapy, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - David Turner
- Health Economics Group, University of East Anglia, Norwich, UK
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