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Le LHL, Brown VAV, Mol S, Azijli K, Kuijper MM, Becker L, Koopman SSHA. Sex differences in pain catastrophizing and its relation to the transition from acute pain to chronic pain. BMC Anesthesiol 2024; 24:127. [PMID: 38566044 PMCID: PMC10985981 DOI: 10.1186/s12871-024-02496-8] [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: 09/19/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND IMPORTANCE Differences exist between sexes in pain and pain-related outcomes, such as development of chronic pain. Previous studies suggested a higher risk for pain chronification in female patients. Furthermore, pain catastrophizing is an important risk factor for chronification of pain. However, it is unclear whether sex differences in catastrophic thinking could explain the sex differences in pain chronification. OBJECTIVES The aim of this study was to examine sex differences in pain catastrophizing. Additionally, we investigated pain catastrophizing as a potential mediator of sex differences in the transition of acute to chronic pain. DESIGN, SETTINGS AND PARTICIPANTS Adults visiting one of the 15 participating emergency departments in the Netherlands with acute pain-related complaints. Subjects had to meet inclusion criteria and complete questionnaires about their health and pain. OUTCOMES MEASURE AND ANALYSIS The outcomes in this prospective cohort study were pain catastrophizing (short form pain catastrophizing) and pain chronification at 90 days (Numeric Rating Scale ≥ 1). Data was analysed using univariate and multivariable logistic regression models. Finally, stratified regression analyses were conducted to assess whether differences in pain catastrophizing accounted for observed differences in pain chronification between sexes. MAIN RESULTS In total 1,906 patients were included. Females catastrophized pain significantly more than males (p < 0.001). Multiple regression analyses suggested that pain catastrophizing is associated with pain chronification in both sexes. CONCLUSIONS This study reported differences between sexes in catastrophic cognitions in the development of chronic pain. This is possibly of clinical importance to identify high-risk patients and ensure an early intervention to prevent the transition from acute to chronic pain.
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Affiliation(s)
- Linh H L Le
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Vanessa A V Brown
- Department of Emergency Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Sander Mol
- Department of Emergency Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Kaoutar Azijli
- Department of Emergency Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Leonie Becker
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Seppe S H A Koopman
- Department of Anaesthesiology, Maasstad Hospital, Maasstadweg 21 3079 DZ Rotterdam, Rotterdam, The Netherlands.
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González-de-la-Flor Á, Valera-Calero JA, García-Fernández P, López-de-Uralde-Villanueva I, Fernández-de-Las-Peñas C, Plaza-Manzano G. Clinical Presentation Differences Among Four Subtypes of Femoroacetabular Impingement: A Case-Control Study. Phys Ther 2024; 104:pzad179. [PMID: 38157293 DOI: 10.1093/ptj/pzad179] [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: 05/04/2023] [Revised: 08/21/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The aims of this study were to assess the psychological, functional, and physical differences between patients with femoroacetabular impingement (FAI) syndrome and individuals who were asymptomatic (controls) to analyze clinical differences among 4 subtypes of FAI (cam type, cam type with labral tear, pincer type, and pincer type with labral tear), to calculate the correlations among the variables described, and to identify risk factors contributing to the hip function variance. METHODS A case-control study was conducted at a hospital rehabilitation unit with a cohort of individuals who were asymptomatic (controls) and a cohort of patients with FAI. Sociodemographic characteristics, pain intensity, psychological health status, hip range of motion (RoM), hip isometric strength, and hip function were assessed. RESULTS A total of 69 controls and 69 patients with FAI were analyzed. Although sociodemographic characteristics were comparable between samples, poorer hip RoM, strength, and psychological health were found for the cases. FAI subtypes showed no significant pain intensity, psychological health, or RoM differences (except for hip adduction), but hip strength differed among FAI subtypes. Multiple significant correlations between psychological health, pain intensity, RoM, strength, and hip function were found. The variance values of the International Hip Outcome Tool, Hip Outcome Score (HOS) for daily living activities, and HOS for sports activities were partially explained (47.6%, 36.0%, and 21.6%, respectively) on the basis of kinesiophobia, hip strength, self-efficacy, and anxiety. CONCLUSION Patients with FAI showed poorer psychological health, hip RoM, and strength than individuals who were asymptomatic and had similar sociodemographic characteristics. FAI subtype influenced the patients' clinical presentations. Hip strength, kinesiophobia, anxiety, and self-efficacy should be targeted for improving hip function, as they have been demonstrated to be important contributors to hip disability. IMPACT This study demonstrated that pain catastrophizing, hip strength, and hip adduction differed among FAI subtypes. However, hip function and pain intensity were comparable between FAI subtypes.
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Affiliation(s)
- Ángel González-de-la-Flor
- Department of Physical Therapy and Sport Medicine, Hospital Universitario Quironsalud Madrid, Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pablo García-Fernández
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Nunes JC, Costa GPA, Weleff J, Rogan M, Compton P, De Aquino JP. Assessing pain in persons with opioid use disorder: Approaches, techniques and special considerations. Br J Clin Pharmacol 2024. [PMID: 38556851 DOI: 10.1111/bcp.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, because ongoing opioid use brings changes in pain responses and most pain assessment tools have not been validated for this population. In this narrative review, we discuss the fundamentals of pain assessment for populations with OUD. First, we describe the biological, psychological and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena may contribute to the pain experience in this population. We then review methods to assess pain, including (1) traditional self-reported methods, such visual analogue scales and structured questionnaires; (2) behavioural observations and physiological indicators; (3) and laboratory-based approaches, such as quantitative sensory testing. These methods are considered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. We highlight the substantial gaps that persist in this literature, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations on chronic opioid therapy but without OUD. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial backgrounds, clinicians will be better equipped to reduce these gaps.
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Affiliation(s)
- Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriel P A Costa
- Faculty of Medicine, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Rogan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Connecticut, USA
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Bellosta-López P, Doménech-García V, Ortiz-Lucas M, Lluch-Girbés E, Herrero P, Sterling M, Christensen SWM. Longitudinal Changes and Associations Between Quantitative Sensory Testing and Psychological Factors in Whiplash-Associated Disorders: A Systematic Review and Meta-Analyses-Based Data Synthesis. THE JOURNAL OF PAIN 2024; 25:12-30. [PMID: 37517451 DOI: 10.1016/j.jpain.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Whiplash-associated disorders (WAD) represent a multifactorial condition often accompanied by altered nociceptive processing and psychological factors. This systematic review on acute and chronic WAD aimed to investigate the relationship between quantitative sensory testing (QST) and psychological factors and quantify whether their trajectories over time follow a similar pattern to disability levels. Eight databases were searched until October 2022. When 2 prospective studies examined the same QST or psychological variable, data synthesis was performed with random-effects meta-analysis by pooling within-group standardized mean differences from baseline to 3-, 6-, and 12-month follow-ups. From 5,754 studies, 49 comprising 3,825 WAD participants were eligible for the review and 14 for the data synthesis. Altered nociceptive processing in acute and chronic WAD, alongside worse scores on psychological factors, were identified. However, correlations between QST and psychological factors were heterogeneous and inconsistent. Furthermore, disability levels, some QST measures, and psychological factors followed general positive improvement over time, although there were differences in magnitude and temporal changes. These results may indicate that altered psychological factors and increased local pain sensitivity could play an important role in both acute and chronic WAD, although this does not exclude the potential influence of factors not explored in this review. PERSPECTIVE: Acute WAD show improvements in levels of disability and psychological factors before significant improvements in nociceptive processing are evident. Facilitated nociceptive processing might not be as important as psychological factors in chronic WAD-related disability, which indicates that chronic and acute WAD should not be considered the same entity although there are similarities. Nonetheless, pressure pain thresholds in the neck might be the most appropriate measure to monitor WAD progression.
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Affiliation(s)
- Pablo Bellosta-López
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Víctor Doménech-García
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - María Ortiz-Lucas
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Pablo Herrero
- iHealthy Research Group. IIS Aragon/University of Zaragoza. Department of Physiatry and Nursing. Faculty of Health Sciences, Zaragoza, Spain
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Herston, Australia; Centre of Research Excellence, Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Steffan W M Christensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
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Alalawi A, Evans DW, Liew B, Peolsson A, Heneghan N, Rushton A, Peterson G, Barbero M, Falla D. Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders? J Clin Med 2022; 11:jcm11030555. [PMID: 35160006 PMCID: PMC8837121 DOI: 10.3390/jcm11030555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159-0.909) and 2-year (p = 0.029, 0.057-0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: -0.28-0.499) and 2 years (p = 0.401, -0.226-0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.
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Affiliation(s)
- Ahmed Alalawi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
- Physical Therapy Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - David W. Evans
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
| | - Bernard Liew
- School of Sport, Rehabilitation and Exercise Sciences, Faculty of Physiotherapy, University of Essex, Colchester CO4 3WA, UK;
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden; (A.P.); (G.P.)
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, SE-581 83 Linköping, Sweden
| | - Nicola Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden; (A.P.); (G.P.)
- Centre for Clinical Research Sörmland, Uppsala University, SE-751 05 Uppsala, Sweden
| | - Marco Barbero
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland;
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
- Correspondence: ; Tel.: +44-(0)121-415-4220
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Brazenor GA, Malham GM, Teddy PJ. Can Central Sensitization after injury persist as an autonomous pain generator? - A comprehensive search for evidence. PAIN MEDICINE 2021; 23:1283-1298. [PMID: 34718773 DOI: 10.1093/pm/pnab319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a comprehensive search for evidence whether Central Sensitization following an injury can act as a persistent autonomous pain generator after the inducing injury has healed. METHODS We searched Medline on PubMed and the Cochrane Library, screening 3,572 abstracts, from which 937 full text articles were obtained, with 186 of these discarded as irrelevant to the question being posed. The remaining 751 articles were studied for evidence. RESULTS Fourteen publications were judged to provide weak evidence for the hypothesis of central sensitization as a persisting autonomous pain generator, but none addressed the question directly. No strong evidence for the affirmative answer was found.Sixty-two publications were judged to provide weak evidence for a negative answer, and nine judged to provide strong evidence.Unexpectedly, serious weaknesses were discovered in the literature underpinning the validity of the clinical diagnosis of Central Sensitization in man:(i) Inappropriate extrapolation, in many publications, of laboratory animal data to humans.(ii) Failure to demonstrate the absence of peripheral pain generators which might be perpetuating Central Sensitization.(iii) Many factors now shown to confound what is being measured by quantitative sensory testing, conditioned pain modulation, and Central Sensitization Inventory. CONCLUSIONS We found no evidence proving that central sensitization can persist as an autonomous pain generator after the initiating injury has healed.Our review has also shown that the evidential basis for the diagnosis of CS in individual patients is seriously in question.
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Affiliation(s)
| | | | - Peter J Teddy
- Royal Melbourne Hospital, Parkville, Victoria, Australia
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7
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The influence of sex and level of physical activity on maximum tolerance to mechanical pain. Braz J Anesthesiol 2021; 72:579-586. [PMID: 34627835 PMCID: PMC9515678 DOI: 10.1016/j.bjane.2021.09.019] [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: 10/16/2020] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background A difference in maximum tolerance to mechanical pain (MTMP) between the sexes is widely studied but there is still no consensus on whether the level of physical activity (PA) influences pain. Objectives To compare the MTMP between men and women with different levels of PA. Methods Sixty five individuals were divided in female (n = 35) and male group (n = 30). The main outcome measures were PA level and MTMP by pressure algometry. Pressure was applied three times on both sides at the following points: cervical (5th and 7th) and lumbar (3th and 5th) vertebrae; trapezius, rhomboid, gluteus, gastrocnemius, pectoralis major, tibialis anterior, and deltoid muscles, elbow, hand, knee, and ankle. Results It was observed that the PA level has little influence on the MTMP at all the assessed points and that men have greater MTMP than women. Conclusion Sex, not the PA level, influences the MTMP.
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Grundström H, Larsson B, Arendt-Nielsen L, Gerdle B, Kjølhede P. Pain catastrophizing is associated with pain thresholds for heat, cold and pressure in women with chronic pelvic pain. Scand J Pain 2021; 20:635-646. [PMID: 32383692 DOI: 10.1515/sjpain-2020-0015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/19/2020] [Indexed: 01/06/2023]
Abstract
Background and aims Psychological traits such as pain catastrophizing may play a role in the development of chronic pelvic pain (CPP). Pain catastrophizing is the tendency to amplify negative cognitive and emotional pain processes. The Pain Catastrophizing Scale (PCS) assesses elements of pain catastrophizing divided into three subgroups of factors (rumination, helplessness and magnification). Previous studies have shown associations between CPP and increased pain sensitivity, widespread generalized hyperalgesia, and decreased pain thresholds, but the relation between pain catastrophizing and specific pain thresholds has not yet been widely examined in this patient group. The aims of this study were (a) to determine if catastrophizing is increased in women with CPP compared with pain-free women, (b) to assess the importance of pain catastrophizing, psychological distress variables, and subjective pain sensitivity for pain thresholds of heat, cold and pressure in these two groups, and (c) to determine whether psychological variables or pain thresholds best contribute to the differentiation between CPP and controls. Methods Thirty-seven women with chronic pelvic pain who underwent diagnostic laparoscopy on the suspicion of endometriosis participated along with 55 healthy and pain-free controls. All underwent quantitative sensory testing on six locations on the body to determine heat (HPT), cold (CPT) and pressure (PPT) pain thresholds. The PCS, the Pain Sensitivity Questionnaire (PSQ), the Hospital Anxiety Depression Scale, (HADS) demographics and clinical data were collected prospectively. Principal component analysis and orthogonal partial least square regressions were used to assess the associations between PCS scores and pain thresholds. Results The women with CPP scored significantly higher on PCS than the healthy controls. PCS-helplessness, PCS-rumination and HADS-depression were significantly associated with pain thresholds for the whole group. In the CPP group, PCS-rumination, body mass index and PSQ were significant regressors for HPT and CPT. The PCS and the HADS subscales were strongly intercorrelated in women with CPP and were stronger regressors of group membership than the three pain thresholds. In the group of healthy control women, no relationships were found to be significant. The psychological variables were somewhat stronger significant regressors than pain thresholds (also significant) for group membership. Conclusions Women with CPP have significantly higher pain catastrophizing scores than women without CPP. The pain catastrophizing rumination factor is significantly associated with pain thresholds of heat and cold in CPP women. PCS and HADS are strongly intercorrelated and PSQ correlates positively with these variables. It seems that the psychological variables are important for group differentiation. Implications The results clearly indicate the need for a multimodal assessment (bio-psycho-social) of CPP patients including psychological symptoms such as catastrophizing, anxiety and depression. The registration of semi-objective pain thresholds captures both specific pain sensitivity information (mechanical pressure, cold or heat) and the degree of wide spread pain hypersensitivity. There is a need for future larger studies investigating whether certain profiles in the clinical presentations (including pain thresholds and psychological variables) are associated with outcomes after different types of interventions.
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Affiliation(s)
- Hanna Grundström
- Department of Obstetrics and Gynaecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interactions, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Harada GK, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, Goldberg E, An HS, Samartzis D. Cervical spine MRI phenotypes and prediction of pain, disability and adjacent segment degeneration/disease after ACDF. J Orthop Res 2021; 39:657-670. [PMID: 32159238 DOI: 10.1002/jor.24658] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Degenerative spine imaging findings have been extensively studied in the lumbar region and are associated with pain and adverse clinical outcomes after surgery. However, few studies have investigated the significance of these imaging "phenotypes" in the cervical spine. Patients with degenerative cervical spine pathology undergoing anterior cervical discectomy and fusion (ACDF) from 2008 to 2015 were retrospectively and prospectively assessed using preoperative MRI for disc degeneration, narrowing, and displacement, high-intensity zones, endplate abnormalities, Modic changes, and osteophyte formation from C2-T1. Points were assigned for these phenotypes to generate a novel Cervical Phenotype Index (CPI). Demographics were evaluated for association with phenotypes and the CPI using forward stepwise regression. Bootstrap sampling and multiple imputations assessed phenotypes and the CPI in association with patient-reported outcomes (Neck Disability Index [NDI], Visual Analog Scale [VAS]-neck, VAS-arm) and adjacent segment degeneration (ASDeg) and disease (ASDz). Of 861 patients, disc displacement was the most common (99.7%), followed by osteophytes (92.0%) and endplate abnormalities (57.3%). Most findings were associated with age and were identified at similar cervical vertebral levels; at C5-C7. Imaging phenotypes demonstrated both increased and decreased associations with adverse patient-reported outcomes and ASDeg/Dz. However, the CPI consistently predicted worse NDI (P = .012), VAS-neck (P = .007), and VAS-arm (P = .013) scores, in addition to higher odds of ASDeg (P = .002) and ASDz (P = .004). The CPI was significantly predictive of postoperative symptoms of pain/disability and ASDeg/Dz after ACDF, suggesting that the totality of degenerative findings may be more clinically relevant than individual phenotypes and that this tool may help prognosticate outcomes after surgery.
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Affiliation(s)
- Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Edward Goldberg
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wideman TH. A Cumulative Impact of Psychological and Sensitization Risk Factors on Pain-Related Outcomes. Pain Pract 2021; 21:523-535. [PMID: 33316140 DOI: 10.1111/papr.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Risk constructs based on psychological risk factors (eg, pain catastrophizing, PC) and sensitization risk factors (eg, pressure pain threshold, PPT) are important in research and clinical practice. Most research looks at individual constructs but does not consider how different constructs might interact within the same individual. An evaluation of the cumulative impact of psychological and sensitization risk factors on pain-related outcomes may help guide us in the risk assessment of patients with pain conditions. The aim of this study is to evaluate the cumulative impact of these psychological (PC) and sensitization (PPT) risk factors on pain-related outcomes (activity avoidance, pain severity, and disability) considering covariates. METHODS We included 109 participants (70.60% women; mean ± SD age 53.6 ± 12.3 years) with chronic musculoskeletal pain for data analysis, who completed all measures of this study. Participants completed a single testing session that included measures of risk factors (PC and PPT) and pain-related outcomes (self-reported avoidance, functional avoidance, disability, and pain severity). Subgroups were constructed by dichotomizing of PC and PPT scores, resulting in four groups: (1) low catastrophizing and low sensitivity (N = 26), (2) high catastrophizing and low sensitivity (N = 27), (3) low catastrophizing and high sensitivity (N = 25), and (4) high catastrophizing and high sensitivity (N = 31). RESULTS One-way analysis of variance (ANOVA) revealed significant group differences (P < 0.05, η2 = 0.08 to 0.14) in all outcomes of this study (except functional avoidance), and post hoc analysis indicated the significant differences are between group 1 and 4. A cumulative impact is reflected by large effect sizes between group 1 and 4 (d = 0.8 to 1). The group 2 and 3 (one risk dimension groups: either high-PC or high-PPT) represent 47% of the total participants. CONCLUSIONS The study suggests both higher level of PC and pressure sensitivity have a cumulative impact on risk screening for pain-related outcomes, considering gender in functional avoidance (task-related outcome). A clinical presentation with high-PC (one dimension of risk) is not associated with high-PPT (another dimension of risk). This finding has important clinical and theoretical implications.
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Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Andrea Aternali
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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11
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Bouffard J, Weber Z, Pearsall L, Emery K, Côté JN. Similar effects of fatigue induced by a repetitive pointing task on local and remote light touch and pain perception in men and women. PLoS One 2020; 15:e0244321. [PMID: 33338075 PMCID: PMC7748284 DOI: 10.1371/journal.pone.0244321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/07/2020] [Indexed: 01/21/2023] Open
Abstract
Background Women involved in repetitive, fatiguing, jobs develop more neck and/or shoulder musculoskeletal disorders than men. Sex differences in the pain response to exercise could contribute to the higher prevalence of neck/shoulder musculoskeletal disorders in women. The objective of this study was to assess sex differences in pain sensitivity following a fatiguing upper limb task. Relationships between measures of fatigue and of the sensitivity to nociceptive and to non-nociceptive stimulations were also explored. Methods Thirty healthy adults (15 women) performed a fatiguing repetitive pointing task with their dominant arm. Upper limb electromyography was recorded from the dominant upper trapezius, anterior deltoid and bicep brachii and from the contralateral tibialis anterior. Before and immediately after the repetitive pointing task, pressure pain and light touch sensitivity thresholds were measured over the same muscles. Results Electromyographic signs of fatigue were observed only in the anterior deltoid and biceps brachii muscles. Pressure pain thresholds over both muscles increased slightly (effect size ≤ 0.34), but no changes occurred over the upper trapezius and the tibialis anterior. Light touch thresholds increased moderately to importantly after the repetitive pointing task over all four muscles (effect sizes = 0.58 to 0.87). No sex differences were observed in any sensory variable. Moreover, no or weak correlations (r = -0.27 to 0.39) were observed between electromyographical signs of fatigue, light touch threshold and pressure pain threshold variables. Conclusions We observed sex-independent effects of a repetitive upper limb task on the sensitivity to painful and to nonpainful stimuli. Moreover, the hypoalgesia induced by the repetitive pointing task was weak and localized, and did not directly correlate with the induced muscle fatigue. Results suggest that fatigue-related changes in the sensitivity to noxious and innocuous stimuli could not explain women’s greater prevalence of neck/shoulder musculoskeletal disorders.
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Affiliation(s)
- Jason Bouffard
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Occupational Biomechanics and Ergonomics Laboratory, Michael Feil and Ted Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
- * E-mail:
| | - Zachary Weber
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Occupational Biomechanics and Ergonomics Laboratory, Michael Feil and Ted Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Lyndsey Pearsall
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Occupational Biomechanics and Ergonomics Laboratory, Michael Feil and Ted Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Kim Emery
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Occupational Biomechanics and Ergonomics Laboratory, Michael Feil and Ted Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Julie N. Côté
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Occupational Biomechanics and Ergonomics Laboratory, Michael Feil and Ted Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
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12
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Goudman L, Daenen L, Mouraux A, Nijs J, Cras P, Roussel N, Moens M, Coppieters I, Huysmans E, De Kooning M. Processing of Laser-Evoked Potentials in Patients with Chronic Whiplash-Associated Disorders, Chronic Fatigue Syndrome, and Healthy Controls: A Case-Control Study. PAIN MEDICINE 2020; 21:2553-2563. [PMID: 32289826 DOI: 10.1093/pm/pnaa068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Laser-evoked potentials (LEPs) are among the reliable neurophysiological tools to investigate patients with neuropathic pain, as they can provide an objective account of the functional status of thermo-nociceptive pathways. The goal of this study was to explore the functioning of the nociceptive afferent pathways by examining LEPs in patients with chronic whiplash-associated disorders (cWAD), patients with chronic fatigue syndrome (CFS), and healthy controls (HCs). DESIGN Case-control study. SETTING A single medical center in Belgium. SUBJECTS The LEPs of 21 patients with cWAD, 19 patients with CFS, and 18 HCs were analyzed in this study. METHODS All participants received brief nociceptive CO2 laser stimuli applied to the dorsum of the left hand and left foot while brain activity was recorded with a 32-channel electroencephalogram (EEG). LEP signals and transient power modulations were compared between patient groups and HCs. RESULTS No between-group differences were found for stimulus intensity, which was supraliminal for Aδ fibers. The amplitudes and latencies of LEP wave components N1, N2, and P2 in patients with cWAD and CFS were statistically similar to those of HCs. There were no significant differences between the time-frequency maps of EEG oscillation amplitude between HCs and both patient populations. CONCLUSIONS EEG responses of heat-sensitive Aδ fibers in patients with cWAD and CFS revealed no significant differences from the responses of HCs. These findings thus do not support a state of generalized central nervous system hyperexcitability in those patients.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Liesbeth Daenen
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Knowledge, Information and Research Center (KIR), Group Idewe, Louvain, Belgium
| | - Andre Mouraux
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Patrick Cras
- Laboratory of Neurology, Translational Neurosciences, University of Antwerp, Wilrijk, Belgium.,Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Campus, Drie Eiken, Wilrijk, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Margot De Kooning
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
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13
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Meta-analysis of the psychometric properties of the Pain Catastrophizing Scale and associations with participant characteristics. Pain 2020; 160:1946-1953. [PMID: 30694929 DOI: 10.1097/j.pain.0000000000001494] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aims of this study were to review the psychometric properties of the widely used Pain Catastrophizing Scale (PCS) using meta-analytic methods and to investigate the relationship between PCS scores and participant characteristics. A systematic search from 1995 found 229 experimental, quasi-experimental, and correlational studies that report PCS scores. Multivariate regression explored variables related to pain catastrophizing and participant demographics. Across studies, good internal reliability (α = 0.92, 95% confidence interval 0.91-0.93) and test-retest reliability scores (Spearman ρ = 0.88, 95% confidence interval 0.83-0.93) were found for PCS total scores but not for subscales. Pain Catastrophizing Scale scores were unrelated to age or sex, but strongly related to participants' pain type, highest in those with generalized pain. Language of the PCS also affected PCS scores, with further research necessary to determine linguistic, cultural, or methodological (eg, sampling strategy) influences. Study type influenced PCS scores with nonrandomized controlled trials reporting higher PCS scores than other study types, but results were confounded with pain diagnosis, as controlled trials were more likely than quasi-experimental studies to recruit clinical samples. The meta-analytic results provide insights into demographic influences on pain catastrophizing scores and highlight areas for further research. The advantages of systematic review and meta-analytic methods to achieve greater understanding and precision of psychometric properties-in this case, of the PCS-are applicable to other widely used outcome tools.
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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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15
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Yoon S, Lefrançois-Daignault T, Côté JN. Effects of cycling while typing on upper limb and performance characteristics. APPLIED ERGONOMICS 2019; 80:161-167. [PMID: 31280800 DOI: 10.1016/j.apergo.2019.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/16/2019] [Accepted: 05/24/2019] [Indexed: 06/09/2023]
Abstract
Active computer workstations may help reduce workplace sedentarism. However, their impact on the upper limb musculoskeletal system is unknown. Subjects participated in two 60-min computer laptop-based Bike-and-Type sessions at different cycling intensities (LOW, HIGH). Upper trapezius and wrist extensor muscle blood flow, sensitivity and pain thresholds, and typing performance were measured intermittently. Neck/shoulder discomfort increased over time (p < 0.001), and was higher in the HIGH intensity (p = 0.036). Blood flow to the trapezius (p = 0.041) and wrist (p = 0.021) muscles were higher during HIGH, and wrist blood flow increased over time (p = 0.01). Trapezius sensitivity threshold significantly decreased over time (p = 0.003). There were no effects on pressure pain thresholds (interaction p = 0.091). Average typing speed was greater during HIGH (p = 0.046) and increased over time (p < 0.001). Time spent biking while typing effectively improved performance, which may facilitate muscle regeneration, although effects depend on biking intensity.
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Affiliation(s)
- SangHoon Yoon
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue West, Montreal, Quebec, H2W 1S4, Canada
; Feil & Oberfeld/CRIR Research Center, Jewish Rehabilitation Hospital, 3205 Alton, Goldbloom Place, Laval, Quebec, H7V 1R2, Canada
| | - Thierry Lefrançois-Daignault
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue West, Montreal, Quebec, H2W 1S4, Canada
; Feil & Oberfeld/CRIR Research Center, Jewish Rehabilitation Hospital, 3205 Alton, Goldbloom Place, Laval, Quebec, H7V 1R2, Canada
| | - Julie N Côté
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue West, Montreal, Quebec, H2W 1S4, Canada
; Feil & Oberfeld/CRIR Research Center, Jewish Rehabilitation Hospital, 3205 Alton, Goldbloom Place, Laval, Quebec, H7V 1R2, Canada.
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Otto A, Emery K, Côté JN. Sex differences in perceptual responses to experimental pain before and after an experimental fatiguing arm task. Biol Sex Differ 2019; 10:39. [PMID: 31391124 PMCID: PMC6686397 DOI: 10.1186/s13293-019-0253-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/23/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The incidence and prevalence of musculoskeletal disorders (MSDs) is about twice as high in women compared to men, and those of the neck/shoulder region are particularly high among women. Fatigue and responses towards pain are known risk factor for MSDs. However, women have been shown to be less fatigable than men, but more sensitive to experimental pain. From a general standpoint, sex differences in the relationships between the fatigue and pain pathways are poorly understood. This may be due to differences in how men and women conceptually define the sensations of fatigue and pain. The objective of this study was to compare physical and verbal descriptors of fatigue and pain between men and women undergoing an experimental protocol where fatigue and pain were manipulated. METHODS Healthy adult volunteers (14 men and 14 women) underwent experimental pain tests to identify pressure pain threshold (PPT) at biceps brachii (BIC), anterior deltoid (AD), and upper trapezius (UT) followed by the Short-form McGill Pain Questionnaire (SF-MPQ) and Pain Catastrophizing Scale (PCS) before and after a repetitive arm task performed at shoulder height until reaching a rating of neck/shoulder perceived exertion, using the Borg Category Ratio 10 (CR10), greater than 8/10. PPT and MPQ data were analyzed using repeated measures analyses of variance (ANOVA) (time × sex). Correlational analyses were used to investigate relationships between pain measures with time and fatigue. RESULTS UT PPT was reduced following the fatiguing task (p ≤ 0.01). Men overall reported higher AD PPT levels compared to women (p ≤ 0.05). MPQ and PCS magnification scores were significantly higher after the fatiguing task (p ≤ 0.05), with no sex differences. Time to fatigue correlated with changes in AD PPT in men and with PCS scores in women. CONCLUSIONS Findings suggest that mechanisms underlying the sensation of acute pain following a repetitive shoulder height task are closely linked with PPT changes in shoulder stabilizers (UT) irrespective of sex, and more so with physical pain responses in men and in attitudes towards pain in women. Sex differences in pain perception may contribute to a better understanding of sex-specific mechanisms underlying neck/shoulder MSDs.
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Affiliation(s)
- Annamaria Otto
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada.,Feil & Oberfeld/CRIR Research Center, Jewish Rehabilitation Hospital, Laval, Canada
| | - Kim Emery
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada.,Feil & Oberfeld/CRIR Research Center, Jewish Rehabilitation Hospital, Laval, Canada
| | - Julie N Côté
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada. .,Feil & Oberfeld/CRIR Research Center, Jewish Rehabilitation Hospital, Laval, Canada.
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17
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Lee YH, Lee KM, Auh QS, Hong JP. Sex-related differences in symptoms of temporomandibular disorders and structural changes in the lateral pterygoid muscle after whiplash injury. J Oral Rehabil 2019; 46:1107-1120. [PMID: 31228222 DOI: 10.1111/joor.12845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022]
Abstract
Whiplash injury is an initiating or aggravating factor of temporomandibular disorder (TMD). Although there are sex-related differences in the mechanism of pain perception and pain control, there is a lack of research on differences in TMD after whiplash injury. We aimed to evaluate sex-related differences in the clinical symptoms and magnetic resonance imaging (MRI) findings of patients with TMD attributed to whiplash injury. This retrospective, cross-sectional study included 100 patients (50 women; 50 men; mean age, 37.60 years) who visited our oro-facial pain clinic with symptoms of TMD after whiplash injury. All patients underwent detailed evaluations for history of trauma, and their clinical and MRI findings were comprehensively assessed. Women with TMD after whiplash injury perceived more pain and presented more tenderness upon palpation than did men with TMD. In addition, women showed higher volume (58% vs 26%) and signal changes (54% vs 20%) in the lateral pterygoid muscle (LPM) and more anterior disc displacement without reduction (ADDWoR) (40% vs 20%) than did men. The presence of ADDWoR (odds ratio, 10.58; P = 0.007) and condylar degeneration (odds ratio, 9.30; P = 0.015) predicted LPM volume; stressful conditions (beta = 1.34; P = 0.011) correlated with increased visual analogue scale scores, and sleep problem was associated with an increased palpation index (PI) (beta = 0.42; P < 0.001) and neck PI (beta = 0.49; P < 0.001) scores only in women. Our results showed sex-specific differences in pain intensity, distribution of clinical and abnormal MRI findings, and their relationships, and these differences should be considered when treating patients with TMD.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Dongdaemun-gu, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Dongdaemun-gu, Seoul, Korea
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Dongdaemun-gu, Seoul, Korea
| | - Jyung-Pyo Hong
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Dongdaemun-gu, Seoul, Korea
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Alqarni A, Manlapaz D, Baxter D, Tumilty S, Mani R. Test procedures to assess somatosensory abnormalities in individuals with neck pain: a systematic review of psychometric properties. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1512737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Abdullah Alqarni
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Donald Manlapaz
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Baxter
- 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
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Lam OT, Dumas JP, Simon CB, Tousignant-Laflamme Y. McKenzie mechanical syndromes coincide with biopsychosocial influences, including central sensitization: a descriptive study of individuals with chronic neck pain. J Man Manip Ther 2018; 26:157-169. [PMID: 30042630 PMCID: PMC6055962 DOI: 10.1080/10669817.2018.1439672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Mechanical diagnosis and therapy (MDT) aims to assess and classify patients into theoretically mutually exclusive subgroups, in order to direct treatment. However, the latest evidence for biopsychosocial influence-central sensitization (CS) and psychological distress-have not been assessed in conjunction with MDT. OBJECTIVES (1) Determine the percentage of patients categorized into the MDT subgroups; (2) characterize the biopsychosocial clinical profile (presence of CS and psychological distress); and (3) identify associations between pain, disability, and biopsychosocial influences among this cohort. METHODS Eighty four patients with chronic neck pain were recruited by 10 certified MDT therapists using a convenience (consecutive) sampling method. Patients were evaluated using MDT principles and also completed an online survey to measure CS (using the Central Sensitization Inventory [CSI]), pain catastrophizing and kinesiophobia. RESULTS The proportions of the subgroups derangement (DER), dysfunction, postural and 'other' were 74.4, 2.4, 1.2, 20.7%, respectively. CS was observed in 62% of our sample (CSI score ≥ 40). CS was also observed in 64.7% of patients of the DER subgroup. Almost half of our sample (47.8%) demonstrated the co-occurrence of CS and DER, while 38% presented with DER syndrome, CS, and kinesiophobia. CONCLUSION The majority of our patients were classified as DER; they also presented with high levels of CS and/or psychological distress. This suggests that MDT mechanical subgroups, particularly DER, can present with co-occurring biopsychosocial influences. Without assessing CS and psychological distress, MDT therapists may miss crucial information. Further research is required to determine the optimal management of patients presenting with mechanical and non-mechanical drivers of pain.
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Affiliation(s)
- Olivier T. Lam
- Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, Canada
| | - Jean-Pierre Dumas
- Faculty of Medicine and Health Science, School of Rehabilitation, Physiotherapy Program, Université de Sherbrooke, Sherbrooke, Canada
| | - Corey B. Simon
- Physical Therapy Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Yannick Tousignant-Laflamme
- Faculty of Medicine and Health Science, School of Rehabilitation, Physiotherapy Program, Université de Sherbrooke, Sherbrooke, Canada
- Clinical Research Center of the CHUS, Université de Sherbrooke, Sherbrooke, Canada
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Malfliet A, Kregel J, Coppieters I, De Pauw R, Meeus M, Roussel N, Cagnie B, Danneels L, Nijs J. Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial. JAMA Neurol 2018; 75:808-817. [PMID: 29710099 PMCID: PMC6145763 DOI: 10.1001/jamaneurol.2018.0492] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/11/2018] [Indexed: 12/28/2022]
Abstract
Importance Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. Objective To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain. Design, Setting, and Participants Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months. Interventions Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy). Main Outcomes and Measures Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health). Results There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014). Conclusions and Relevance Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population. Trial Registration clinicaltrials.gov Identifier: NCT02098005.
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Affiliation(s)
- Anneleen Malfliet
- Research Foundation–Flanders, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Jeroen Kregel
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Robby De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
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Do Changes in Sensory Processing Precede Low Back Pain Development in Healthy Individuals? Clin J Pain 2018; 34:525-531. [DOI: 10.1097/ajp.0000000000000563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Wijenberg MLM, Stapert SZ, Verbunt JA, Ponsford JL, Van Heugten CM. Does the fear avoidance model explain persistent symptoms after traumatic brain injury? Brain Inj 2017; 31:1597-1604. [DOI: 10.1080/02699052.2017.1366551] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Melloney L. M. Wijenberg
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Limburg, The Netherlands
| | - Sven Z. Stapert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Jeanine A. Verbunt
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Jennie L. Ponsford
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, Victoria, Australia
| | - Caroline M. Van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Limburg, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Pallegama RW, Ariyasinghe S, Perera ED, Treede RD. Influence of Catastrophizing and Personality Traits on Recalled Ratings of Acute Pain Experience in Healthy Young Adults. PAIN MEDICINE 2017; 18:49-60. [PMID: 27282592 DOI: 10.1093/pm/pnw123] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective To investigate whether pain catastrophizing and personality traits bias recalled ratings of acute pain in an experimental tonic pain model. Subjects and Setting Fifty-six undergraduates (14 males) recruited from the University of Peradeniya (mean age 21.7 ± 0.8 SD years). Design and Methods Participants completed the Pain Catastrophizing Scale and the Eysenck Personality Questionnaire. They were subjected to two cold pressor tests (dominant and non-dominant hands) and pain threshold, maximum pain intensity, and pain tolerance were recorded. One-week later, the maximum pain intensities of both hands were recalled and percentage distortions in recalling were calculated. Based on a 180 s cutoff, two participants were considered pain-insensitive during the test and were excluded from the analysis. Results The maximum pain intensity was recalled with a moderate accuracy (Intraclass Correlation Coefficients = 0.68 for dominant and 0.59 for non-dominant hands). Hierarchical multiple regression analyses revealed that maximum pain intensity ( P < 0.001) and pain catastrophizing ( P < 0.001) contributed significantly to recalled pain intensity, and only pain catastrophizing contributed significantly ( P < 0.001) to percentage distortion in recalling with positive β-coefficients. Participants who consistently overrated pain for both hands in recalling scored significantly higher on catastrophizing ( P < 0.001). Conclusion This study demonstrated that memory for painful events in healthy subjects was reasonably accurate over a period of 1 week. Pain catastrophizing biased pain recall, whereas among personality traits only neuroticism exhibited a weak positive association with the recalled ratings.
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Affiliation(s)
- Ranjith Wasantha Pallegama
- Division of Physiology, Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
| | - Sajjiv Ariyasinghe
- Division of Physiology, Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
| | - Eranthi Dinoka Perera
- Division of Physiology, Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
| | - Rolf-Detlef Treede
- Lehrstuhl Für Neurophysiologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
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Raittio L, Launonen A, Hevonkorpi T, Luokkala T, Kukkonen J, Reito A, Sumrein B, Laitinen M, Mattila VM. Comparison of volar-flexion, ulnar-deviation and functional position cast immobilization in the non-operative treatment of distal radius fracture in elderly patients: a pragmatic randomized controlled trial study protocol. BMC Musculoskelet Disord 2017; 18:401. [PMID: 28923035 PMCID: PMC5604291 DOI: 10.1186/s12891-017-1759-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/11/2017] [Indexed: 11/19/2022] Open
Abstract
Background Distal radius fractures (DRFs) are the second most common fractures, after hip fractures, seen in clinical practice. The high incidence of low-energy trauma DRFs in elderly patients raises questions about the best treatment method in terms of function, pain, and quality of life. Although the majority of these fractures are treated non-operatively with cast immobilization, valid scientific evidence of the optimal cast immobilization is lacking. In addition, several publications, including Cochrane review have outlined the need for more evidence to determine the most appropriate method of cast immobilization. Methods This study is a pragmatic, prospective, randomized, multi-centre trial. The trial is designed to compare two widely used cast positions (volar flexion-ulnar deviation position and functional position) for the non-operative treatment of DRF in patients over 64 years of age. The main hypothesis of the trial is that function position yields corresponding functional outcome, pain relief and quality of life when compared to the volar flexion-ulnar deviation position. The primary outcome measure is Patient Rated Wrist Evaluation (PRWE) score and the secondary outcome measures will be the Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS), 15-dimensional (15D) value and rate of surgical interventions. The results of the trial will be analysed after 1 and 2-years. Discussion This publication presents a prospective, pragmatic, randomized, national multi-centre trial study protocol. It provides details of patient flow, randomization, follow-up and methods of analysis of the material as well as publication plan. Trial registration ClinicalTrials.gov identifier: NCT02894983 22 August 2016. Electronic supplementary material The online version of this article (10.1186/s12891-017-1759-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauri Raittio
- University of Tampere, School of Medicine, 33014, Tampere, Finland.
| | - Antti Launonen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Teemu Hevonkorpi
- University of Tampere, School of Medicine, 33014, Tampere, Finland
| | - Toni Luokkala
- Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Juha Kukkonen
- Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
| | - Aleksi Reito
- Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Bakir Sumrein
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Minna Laitinen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Ville M Mattila
- University of Tampere, School of Medicine, 33014, Tampere, Finland.,Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
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Cluster Analysis of an International Pressure Pain Threshold Database Identifies 4 Meaningful Subgroups of Adults With Mechanical Neck Pain. Clin J Pain 2017; 33:422-428. [DOI: 10.1097/ajp.0000000000000421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Söderlund A, Sterling M. Effect of verbal persuasion on self-efficacy for pain-related diagnostic sensory testing in individuals with chronic neck pain and healthy controls - a randomized, controlled trial. J Pain Res 2016; 9:115-22. [PMID: 27022298 PMCID: PMC4790511 DOI: 10.2147/jpr.s98956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to investigate the differences in cold pain threshold (CTh), pressure pain threshold (PPT), cold pain tolerance (CPTo) tests, and the level of self-efficacy when self-efficacy for diagnostic sensory testing was manipulated by verbal persuasion before a testing situation in persons with neck pain and in healthy controls. A randomized experimental design was used. Twenty-one healthy volunteers and 22 individuals with either traumatic or nontraumatic chronic neck pain were recruited to participate in the study. The intervention consisted of two experimental verbal persuasion conditions: Increase self-efficacy and Decrease self-efficacy. The PPT was measured using a pressure algometer, the CTh was measured using a thermo test system, and CPTo was measured by submerging the participant’s hand in ice water up to the elbow joint. On three occasions, the participants reported their self-efficacy level in performing the sensory tests. In the chronic neck pain group, there were no differences in pain threshold or tolerance. There was a difference in the self-efficacy level after verbal persuasion between the experimental conditions. In the healthy control group, the CThs increased following the condition that aimed to increase self-efficacy. No other differences were observed in the healthy controls. A short verbal persuasion in the form of manipulative instructions seems to have a marginal effect on the individual’s self-efficacy levels in the chronic neck pain group and a slight influence on the results of sensory testing in healthy controls.
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Affiliation(s)
- Anne Söderlund
- Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Michele Sterling
- Centre for National Research on Disability and Rehabilitation Medicine (CONROD), Menzies Health Institute Queensland, Griffith University, Parklands, Australia
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Addition of posttraumatic stress and sensory hypersensitivity more accurately estimates disability and pain than fear avoidance measures alone after whiplash injury. Pain 2016; 157:1645-1654. [DOI: 10.1097/j.pain.0000000000000564] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Reliability of 2 Protocols for Assessing Pressure Pain Threshold in Healthy Young Adults. J Manipulative Physiol Ther 2015; 38:282-7. [DOI: 10.1016/j.jmpt.2015.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 01/31/2015] [Accepted: 03/05/2015] [Indexed: 01/01/2023]
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Pallegama RW, Ariyawardana A, Ranasinghe AW, Sitheeque M, Glaros AG, Dissanayake WP, Idirimanna KS, Jayasinghe RD. The Sinhala version of the pain catastrophizing scale: validation and establishment of the factor structure in pain patients and healthy adults. PAIN MEDICINE 2014; 15:1734-42. [PMID: 25105529 DOI: 10.1111/pme.12529] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was conducted to translate the Pain Catastrophizing Scale into and adapt it to the Sinhala language and to examine its psychometric properties and factor structure in pain patients and healthy adults in Sri Lanka. SETTING AND DESIGN A cross-sectional study was conducted, recruiting pain patients from multiple clinics and healthy adults from the community as convenience samples. METHODS Cross-cultural adaptation of the Pain Catastrophizing Scale for Sinhala speakers was carried out using recommended methods. The adaptation's psychometric properties and factor structure were tested in 149 pain patients and 172 healthy adults. Temporal stability was tested in a sample of 104 young adults. Pain intensity of patients was assessed using a visual analog scale, and personality traits of all participants were assessed with the Eysenck Personality Questionnaire. RESULTS Factor analysis revealed that the three-factor structure of the original version of the Pain Catastrophizing Scale was the best fit to the data from participant samples. Cronbach's alpha values of the three components and total scores for patients and healthy adults ranged from 0.72 to 0.87. Pain catastrophizing exhibited moderate positive correlations with neuroticism in patients and healthy adults and with pain intensities in patients. A high intraclass correlation coefficient of agreement (0.81) revealed an acceptable temporal stability in young adults. CONCLUSIONS The results suggest that the Sinhala version of the Pain Catastrophizing Scale retains the original three-factor structure. It is a stable, valid and sufficiently reliable tool to assess pain catastrophizing in Sinhala-speaking individuals in Sri Lanka.
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Affiliation(s)
- Ranjith W Pallegama
- Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Mankovsky-Arnold T, Wideman TH, Larivière C, Sullivan MJL. Measures of spontaneous and movement-evoked pain are associated with disability in patients with whiplash injuries. THE JOURNAL OF PAIN 2014; 15:967-75. [PMID: 24998695 DOI: 10.1016/j.jpain.2014.06.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/28/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022]
Abstract
UNLABELLED This study examined the degree to which measures of spontaneous and movement-evoked pain accounted for shared or unique variance in functional disability associated with whiplash injury. The study also addressed the role of fear of movement as a mediator or moderator of the relation between different indices of pain and functional disability. Measures of spontaneous pain, single-point movement-evoked pain, repetition-induced summation of activity-related pain (RISP), and fear of movement and disability were obtained on a sample of 142 individuals who had sustained whiplash injuries. Participants' pain ratings, provided after lifting a weighted canister, were used as the index of single-point movement-evoked pain. RISP was computed as the increase in pain reported by participants over successive lifts of 18 weighted canisters. Measures of functional disability included physical lift tolerance and self-reported disability. Hierarchical regression analyses revealed that measures of single-point movement-evoked pain and RISP accounted for significant unique variance in self-reported disability, beyond the variance accounted for by the measure of spontaneous pain. Only RISP accounted for significant unique variance in lift tolerance. The results suggest that measures of movement-evoked pain represent a disability-relevant dimension of pain that is not captured by measures of spontaneous pain. The clinical and conceptual implications of the findings are discussed. PERSPECTIVE This study examined the degree to which measures of spontaneous and movement-evoked pain accounted for shared or unique variance in functional disability associated with whiplash injury. The findings suggest that approaches to the clinical evaluation of pain would benefit from the inclusion of measures of movement-evoked pain.
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Affiliation(s)
| | - Timothy H Wideman
- School of Occupational and Physical Therapy, McGill University, Montreal, Quebec, Canada
| | - Christian Larivière
- Robert-Sauvé Occupational Health and Safety Research Institute (IRSST), Montreal, Quebec, Canada
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Clinical pressure pain threshold testing in neck pain: comparing protocols, responsiveness, and association with psychological variables. Phys Ther 2014; 94:827-37. [PMID: 24557645 PMCID: PMC4040424 DOI: 10.2522/ptj.20130369] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Quantitative sensory testing, including pressure pain threshold (PPT), is seeing increased use in clinical practice. In order to facilitate clinical utility, knowledge of the properties of the tool and interpretation of results are required. OBJECTIVES This observational study used a clinical sample of people with mechanical neck pain to determine: (1) the influence of number of testing repetitions on measurement properties, (2) reliability and minimum clinically important difference, and (3) associations between PPT and key psychological constructs. DESIGN This study was observational with both cross-sectional and prospective elements. METHODS Experienced clinicians measured PPT in patients with mechanical neck pain following a standardized protocol. Subcohorts also provided repeated measures and completed scales of key psychological constructs. RESULTS The total sample was 206 participants, but not all participants provided data for all analyses. Interrater and 1-week test-retest reliability were excellent (intraclass correlation coefficients [2,1]=.75-.95). Potentially important differences in reliability and PPT scores were found when using only 1 or 2 repeated measures compared with all 3. The PPT over a distal location (tibialis anterior muscle) was not adequately responsive in this sample, but the local site (upper trapezius muscle) was responsive and may be useful as part of a protocol to evaluate clinical change. Sensitivity values (range=0.08-0.50) and specificity values (range=0.82-0.97) for a range of change scores are presented. Depression, catastrophizing, and kinesiophobia were able to explain small but statistically significant variance in local PPT (3.9%-5.9%), but only catastrophizing and kinesiophobia explained significant variance in the distal PPT (3.6% and 2.9%, respectively). LIMITATIONS Limitations of the study include multiple raters, unknown recruitment rates, and unknown measurement properties at sites other than those tested here. CONCLUSIONS The results suggest that PPT is adequately reliable and that 3 measurements should be taken to maximize measurement properties. The variance explained by the psychological variables was small but significant for 3 constructs related to catastrophizing, depression, and fear of movement. Clinical implications for application and interpretation of PPT are discussed.
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Angst F, Gantenbein AR, Lehmann S, Gysi-Klaus F, Aeschlimann A, Michel BA, Hegemann F. Multidimensional associative factors for improvement in pain, function, and working capacity after rehabilitation of whiplash associated disorder: a prognostic, prospective outcome study. BMC Musculoskelet Disord 2014; 15:130. [PMID: 24739588 PMCID: PMC3996256 DOI: 10.1186/1471-2474-15-130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 02/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Whiplash associated disorders (WAD) have dramatic consequences for individual and public health. Risk factors for better and worse outcomes are important to optimize management. This study aimed to determine short- and mid-term associative co-factors of neck pain relief, improved physical functioning, and improved working capacity (dependent variables) in patients suffering from whiplash associated disorder who participated in a standardized, inpatient pain management program. METHODS Naturalistic, observational, prospective cohort study. Outcome was measured by standardized assessment instruments. Co-factors covered sociodemographics, comorbidities, social participation, affective health, and coping abilities. Stepwise, multivariate linear regression analysis was performed at discharge and at the 6-month follow-up. RESULTS All regression models explained high proportions of variance (53.3% - 72.1%). The corresponding baseline level was significantly associated with a change in every dependent variable (explained variances: 11.4%-56.7%). Pain relief significantly depended on improved function and vice-versa (3.4%-14.8%). Improved ability to decrease pain was associated with pain relief at discharge (9.6%). Functional improvement was associated with decreased catastrophizing (19.4%) at discharge and decreased depression (20.5%) at the 6 month follow-up. CONCLUSIONS Pain relief, improved physical function and working capacity were associated with each other. Improved coping (catastrophizing and ability to decrease pain) and reduced depression may act as important predictors for pain relief and improved function. These findings offer toe-holds for optimized therapy of chronic WAD.
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Affiliation(s)
- Felix Angst
- Rehabilitation Clinic “RehaClinic”, Bad Zurzach, Switzerland
| | | | - Susanne Lehmann
- Rehabilitation Clinic “RehaClinic”, Bad Zurzach, Switzerland
| | | | | | - Beat A Michel
- Department of Rheumatology, Physical Medicine and Rehabilitation, University Hospital of Zurich, Zurich, Switzerland
| | - Frank Hegemann
- Rehabilitation Clinic “RehaClinic”, Bad Zurzach, Switzerland
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Is pressure pain sensitivity over the cervical musculature associated with neck disability in individuals with migraine? J Bodyw Mov Ther 2014; 19:67-71. [PMID: 25603745 DOI: 10.1016/j.jbmt.2014.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/31/2014] [Accepted: 02/19/2014] [Indexed: 11/23/2022]
Abstract
The objective was to determine if disability due to neck pain is correlated with pressure pain sensitivity in the cervical muscles in patients with migraine. Thirty-two volunteers with migraine completed the Neck Disability Index (NDI). Pressure pain thresholds (PPT) over the sternocleidomastoid, upper trapezius and suboccipital muscles were also assessed. Data were analyzed using the Spearman correlation coefficient (rs) and linear regression models (α < 0.05). Moderate negative correlations between NDI and PPT were obtained for the sternocleidomastoid (rs = -0.42; p = 0.001), upper trapezius (rs = -0.33; p = 0.001) and suboccipital muscles (rs = -0.41; p = 0.001). The linear regression revealed no association between NDI and PPT of sternocleidomastoid (β = 0.01; R(2) = 0.17), upper trapezius (β = 0.01; R(2) = 0.11) and suboccipital muscles (β = 0.02; R(2) = 0.17). NDI scores and PPT of the cervical muscles correlated moderately and was inversely proportional in patients with migraine, but the association was not linear, so both outcomes should be considered in the assessment of this population.
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The course of serum inflammatory biomarkers following whiplash injury and their relationship to sensory and muscle measures: a longitudinal cohort study. PLoS One 2013; 8:e77903. [PMID: 24147095 PMCID: PMC3798600 DOI: 10.1371/journal.pone.0077903] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/13/2013] [Indexed: 01/23/2023] Open
Abstract
Tissue damage or pathological alterations are not detectable in the majority of people with whiplash associated disorders (WAD). Widespread hyperalgisa, morphological muscle changes and psychological distress are common features of WAD. However little is known about the presence of inflammation and its association with symptom persistence or the clinical presentation of WAD. This study aimed to prospectively investigate changes in serum inflammatory biomarker levels from the acute (<3 weeks) to chronic (>3 months) stages of whiplash injury. It also aimed to determine relationships between biomarker levels and hyperalgesia, fatty muscle infiltrates of the cervical extensors identified on MRI and psychological factors. 40 volunteers with acute WAD and 18 healthy controls participated. Participants with WAD were classified at 3 months as recovered/mild disability or having moderate/severe disability using the Neck Disability Index. At baseline both WAD groups showed elevated serum levels of CRP but by 3 months levels remained elevated only in the moderate/severe group. The recovered/mild disability WAD group had higher levels of TNF-α at both time points than both the moderate/severe WAD group and healthy controls. There were no differences found in serum IL-1β. Moderate relationships were found between hyperalgesia and CRP at both time points and between hyperalgesia and IL-1β 3 months post injury. There was a moderate negative correlation between TNF-α and amount of fatty muscle infiltrate and pain intensity at 3 months. Only a weak relationship was found between CRP and pain catastrophising and no relationship between biomarker levels and posttraumatic stress symptoms. The results of the study indicate that inflammatory biomarkers may play a role in outcomes following whiplash injury as well as being associated with hyperalgesia and fatty muscle infiltrate in the cervical extensors.
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Gender differences in neck/shoulder muscular patterns in response to repetitive motion induced fatigue. J Electromyogr Kinesiol 2013; 23:1183-9. [DOI: 10.1016/j.jelekin.2013.06.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 04/13/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022] Open
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Cheung J, Kajaks T, MacDermid JC. The relationship between neck pain and physical activity. Open Orthop J 2013; 7:521-9. [PMID: 24133553 PMCID: PMC3795407 DOI: 10.2174/1874325001307010521] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 11/22/2022] Open
Abstract
Neck pain is a significant societal burden due to its high prevalence and healthcare costs. While physical activity can help to manage other forms of chronic musculoskeletal pain, little data exists on the relationship between physical activity and neck pain. The purpose of this study was to compare physical activity levels between individuals with neck pain and healthy controls, and then to relate disability, fear of movement, and pain sensitivity measures to physical activity levels in each of the two participant groups. 21 participants were recruited for each of the two participant groups (n = 42). Data collection included the use of the Neck Disability Index, the Tampa Scale for Kinesiophobia, electrocutaneous (Neurometer® CPT) and pressure stimulation (JTech algometer) for quantitative sensory testing, and 5 days of subjective (Rapid Assessment of Physical Activity) and objective (BioTrainer II) measurements of physical activity. Analysis of Variance and Pearson's Correlation were used to determine if differences and relationships exist between dependent variables both within and between groups. The results show that individuals with mild neck pain and healthy controls do not differ in subjectively and objectively measured physical activity. While participants with neck pain reported higher neck disability and fear of movement, these factors did not significantly relate to physical activity levels. Perceived activity level was related to pain threshold and tolerance at local neck muscles sites (C2 paraspinal muscle and upper trapezius muscle), whereas measured activity was related to generalized pain sensitivity, as measured at the tibialis anterior muscle site.
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Affiliation(s)
- Janice Cheung
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Tara Kajaks
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Joy C. MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Mechanical pain sensitivity and the severity of chronic neck pain and disability are not modulated across the menstrual cycle. THE JOURNAL OF PAIN 2013; 14:1450-9. [PMID: 24021578 DOI: 10.1016/j.jpain.2013.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/28/2013] [Accepted: 07/07/2013] [Indexed: 11/23/2022]
Abstract
UNLABELLED Despite the high prevalence of neck pain among women, menstrual effects on regional pain outcomes have not been investigated in this clinical population. This study evaluated menstrual effects on mechanical pain sensitivity (pressure pain threshold [PPT]), neck pain intensity (numeric pain rating scale [NPRS]), and neck-related disability (Neck Disability Index [NDI]) in 22 normally menstruating (NM) and 17 hormonal contraceptive users with chronic neck pain. Sex hormones, PPT, and NDI were measured during the early follicular (F1), late follicular (F2), and luteal (L) menstrual phases. Daily NPRS scores were recorded in an online symptom diary and averaged within each phase. Estradiol and progesterone increased only for NM women in F2 and L, respectively. Phase effects on PPT (η(2) = .003), NDI (η(2) = .003), and NPRS (η(2) = .016) for NM women were small and did not differ from those for the hormonal contraceptive users (P ≥ .386). Averaged across the menstrual cycle, PPT scores explained 29% of the variance in NPRS scores for NM women but were not associated with NDI scores in either group. Results indicate that the magnitude of menstrual effects on mechanical pain sensitivity and the severity of neck pain and disability do not exceed thresholds of clinically detectable change in women with chronic neck pain. PERSPECTIVE Fluctuations in evoked and clinical pain outcomes across the menstrual cycle do not appear to be of sufficient magnitude to impact clinical decision making for women with chronic neck pain.
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Walton DM, MacDermid JC. A brief 5-item version of the Neck Disability Index shows good psychometric properties. Health Qual Life Outcomes 2013; 11:108. [PMID: 23816395 PMCID: PMC3718697 DOI: 10.1186/1477-7525-11-108] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this secondary analysis of clinical databases of people with neck pain was to use a mixed unique conceptual and statistical approach to develop a brief version of the Neck Disability Index (NDI). METHODS An a priori framework of neck-related function based on the International Classification of Functioning, Disability and Health was used to identify items from the original 10-item NDI that do not conceptually fit. Remaining items were subject to Rasch analysis to identify items that did not statistically fit with axioms of quantitative measurement. Finally, approaches drawn from classical test theory were used to compare stability, responsiveness and concurrent validity of the original NDI, the new brief NDI and the linearly-transformed brief NDI. RESULTS Conceptual analysis identified 3 items that did not fit with the construct of self-reported ability to perform activity: pain intensity, headache, and sleeping. These items were removed, and responses to the remaining 7 items drawn from an assembled database of 316 physiotherapy patients with neck pain were subject to Rasch analysis. Two items were removed due to either considerable differential item functioning (reading) or statistical redundancy (lifting). The remaining items were considered the NDI-5. Test-retest reliability, responsiveness, sensitivity to change, and concurrent validity were all comparable across the original NDI, NDI-5 and linearly-transformed NDI-5. Sensitivity to change over a 1-month period of physiotherapy was the notable exception, where the linearly-transformed NDI-5 showed superiority over the other two forms. CONCLUSIONS A shortened version of the NDI, the NDI-5, has been constructed that is conceptually and statistically sound. Implications for research and clinical practice are discussed. Comparison with the NDI-8 is provided that suggests overall similar function across the forms, although the latter may be more sensitive to change.
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Affiliation(s)
- David M Walton
- School of Physical Therapy, Western University, 1201 Western Rd, London, Ontario, Canada.
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Hübscher M, Moloney N, Leaver A, Rebbeck T, McAuley JH, Refshauge KM. Relationship between quantitative sensory testing and pain or disability in people with spinal pain-a systematic review and meta-analysis. Pain 2013; 154:1497-1504. [PMID: 23711482 DOI: 10.1016/j.pain.2013.05.031] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 11/28/2022]
Abstract
Sensitization of the nervous system can present as pain hypersensitivity that may contribute to clinical pain. In spinal pain, however, the relationship between sensory hypersensitivity and clinical pain remains unclear. This systematic review examined the relationship between pain sensitivity measured via quantitative sensory testing (QST) and self-reported pain or pain-related disability in people with spinal pain. Electronic databases and reference lists were searched. Correlation coefficients for the relationship between QST and pain intensity or disability were pooled using random effects models. Subgroup analyses and mixed effects meta-regression were used to assess whether the strength of the relationship was moderated by variables related to the QST method or pain condition. One hundred and forty-five effect sizes from 40 studies were included in the meta-analysis. Pooled estimates for the correlation between pain threshold and pain intensity were -0.15 (95% confidence interval [CI]: -0.18 to -0.11) and for disability -0.16 (95% CI: -0.22 to -0.10). Subgroup analyses and meta-regression did not provide evidence that these relationships were moderated by the QST testing site (primary pain/remote), pain condition (back/neck pain), pain type (acute/chronic), or type of pain induction stimulus (eg, mechanical/thermal). Fair correlations were found for the relationship between pain intensity and thermal temporal summation (0.26, 95% CI: 0.09 to 0.42) or pain tolerance (-0.30, 95% CI: -0.45 to -0.13), but only a few studies were available. Our study indicates either that pain threshold is a poor marker of central sensitization or that sensitization does not play a major role in patients' reporting of pain and disability. Future research prospects are discussed.
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Affiliation(s)
- Markus Hübscher
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia Neuroscience Research Australia and The University of New South Wales, Sydney, New South Wales, Australia
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Stone AM, Vicenzino B, Lim EC, Sterling M. Measures of central hyperexcitability in chronic whiplash associated disorder – A systematic review and meta-analysis. ACTA ACUST UNITED AC 2013; 18:111-7. [DOI: 10.1016/j.math.2012.07.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
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Kasch H, Kongsted A, Qerama E, Bach FW, Bendix T, Jensen TS. A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study. BMJ Open 2013; 3:bmjopen-2012-002050. [PMID: 23370009 PMCID: PMC3563124 DOI: 10.1136/bmjopen-2012-002050] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. DESIGN The design was an observational prospective study of risk factors embedded in a randomised controlled study. SETTING Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres. PARTICIPANTS During a 2-year inclusion period, acute consecutive whiplash-injured (age 18-70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I-III, symptoms within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability. RESULTS The risk score and number of sick-listing days were related (Kruskal-Wallis, p<0.0001). In stratum 1, less than 4%, but in stratum 7, 68% were work-disabled after 1 year. Early work assessment (p<0.0001), impact of the event questionnaire (p<0.0006), psychophysical pain measures being McGill pain questionnaire parameters (p<0.0001), pressure pain algometry (p<0.0001) and palpation (p<0.0001) showed a significant relationship with risk stratification. ANALYSIS Findings confirm previous studies reporting intense neck pain/headache and distress as predictors for work disability after whiplash. Neck-mobility was a strong predictor in this study; however, it was a more inconsistent predictor in other studies. CONCLUSIONS Application of the risk assessment score and use of the risk strata system may be beneficial in future studies and may be considered as a valuable tool to assess return-to-work following injuries; however, further studies are needed.
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Affiliation(s)
- Helge Kasch
- Department of Neurology, The Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Alice Kongsted
- Department of Research, Spine Center of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Erisela Qerama
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Flemming W Bach
- Department of Neurology, Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark
| | - Tom Bendix
- Department of Rheumatology, Copenhagen Spine Center, Glostrup Hospital, Glostrup, Denmark
| | - Troels Staehelin Jensen
- Department of Neurology, The Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
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Abstract
Pain catastrophizing has been described for more than half a century which adversely affects the pain coping behavior and overall prognosis in susceptible individuals when challenged by painful conditions. It is a distinct phenomenon which is characterized by feelings of helplessness, active rumination and excessive magnification of cognitions and feelings toward the painful situation. Susceptible subjects may have certain demographic or psychological predisposition. Various models of pain catastrophizing have been proposed which include attention-bias, schema-activation, communal-coping and appraisal models. Nevertheless, consensus is still lacking as to the true nature and mechanisms for pain catastrophizing. Recent advances in population genomics and noninvasive neuroimaging have helped elucidate the known determinants and neurophysiological correlates behind this potentially disabling behavior.
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Affiliation(s)
- Lawrence Leung
- Department of Family Medicine, Centre of Neurosciences Study, Centre of Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
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Johansen TI, Samani A, Antle DM, Côté JN, Madeleine P. Gender effects on the coordination of subdivisions of the trapezius muscle during a repetitive box-folding task. Eur J Appl Physiol 2012; 113:175-82. [DOI: 10.1007/s00421-012-2425-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 05/08/2012] [Indexed: 01/14/2023]
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Wang J, Jian F, Chen J, Ye NS, Huang YH, Wang S, Huang RH, Pei J, Liu P, Zhang L, Zhao ZH, Chen QM, Lai WL, Lin YF. Cognitive behavioral therapy for orthodontic pain control: a randomized trial. J Dent Res 2012; 91:580-5. [PMID: 22492277 DOI: 10.1177/0022034512444446] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to evaluate the efficacy of cognitive behavioral therapy intervention for patients who experienced pain during orthodontic treatment. The baseline characteristics were assessed via questionnaires and oral examinations. Four hundred and fifty eligible individuals were recruited and randomized by computer-generated block randomization into three groups: cognitive behavioral therapy intervention (n = 150), ibuprofen intervention (n = 150), and no intervention (control; n = 150). Primary outcomes were the change from baseline in pain intensity measured with 100-mm Visual Analog Scale (VAS) scores at 1, 2, 3, 7, 14, and 30 days after initial archwire placement. Outcomes assessment was blinded and followed the intention-to-treat principle. One hundred forty-three (95.30%), 145 (96.70%), and 141 (94.00%) individuals in the cognitive behavioral therapy, the ibuprofen, and the control groups, respectively, completed the one-month follow-up evaluations. Those in the cognitive behavioral therapy group showed a greater decrease in mean VAS scores than did those in the control group over the previous five time-points (p < 0.001). Cognitive behavioral therapy was shown to be effective in pain control during the initial stage of orthodontic treatment. The study registration number was ChiCTR-TRC-00000556.
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Affiliation(s)
- J Wang
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, P.R. China
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Ramiro-González MD, Cano-de-la-Cuerda R, De-la-Llave-Rincón AI, Miangolarra-Page JC, Zarzoso-Sánchez R, Fernández-de-Las-Peñas C. Deep tissue hypersensitivity to pressure pain in individuals with unilateral acute inversion ankle sprain. PAIN MEDICINE 2012; 13:361-7. [PMID: 22221311 DOI: 10.1111/j.1526-4637.2011.01302.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The objective of this study was to investigate whether pressure hypersensitivity over deep tissues is a feature of acute inversion ankle sprain. DESIGN This is a cross-sectional study. SETTING No study has previously investigated peripheral and central sensitization mechanisms in a clinical acute pain model such as inversion ankle sprain. PATIENTS Twenty individuals with unilateral inversion ankle sprain (10 women/10 men, age: 31 ± 7 years) and 19 comparable healthy controls (11 women/8 men, age: 30 ± 6 years) participated in this study. OUTCOMES Pressure pain thresholds (PPTs) over anterior talofibular, calcaneofibular, and deltoid ligaments; the lateral and medial malleolus; the tibialis anterior muscle; second metacarpal; and median, radial, and ulnar nerves were bilaterally assessed. RESULTS The analysis of variance (ANOVA) revealed that PPT levels over the affected anterior talofibular (P = 0.048) and calcaneofibular (P = 0.002) ligaments, and over the affected lateral malleolus (P < 0.001) were lower compared with the non-affected side within patients and both sides in controls. The patients also showed bilateral lower PPT levels over the deltoid ligament than controls (P < 0.05). No significant differences for PPT over the medial malleolus; the second metacarpal; the tibialis anterior muscle; and the median, ulnar, radial nerves were found. Significant negative correlations between intensity of ongoing pain and PPT over the anterior talofibular and deltoid ligaments were found: the higher the pain intensity, the lower the PPT. CONCLUSIONS This study showed the presence of localized pressure pain hypersensitivity over ankle ligaments in patients with unilateral acute inversion ankle sprain, confirming the presence of localized peripheral sensitization.
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Affiliation(s)
- María D Ramiro-González
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Potential processes involved in the initiation and maintenance of whiplash-associated disorders: discussion paper 3. Spine (Phila Pa 1976) 2011; 36:S322-9. [PMID: 22101752 DOI: 10.1097/brs.0b013e318238853f] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Nonsystematic review and discussion of the etiological processes involved in whiplash-associated disorders (WAD). OBJECTIVE To summarize the research and identify priorities for future research. SUMMARY OF BACKGROUND DATA Although there is convergent evidence of a peripheral lesion in some individuals after whiplash injury, in the majority of injured people, a lesion cannot be established with current imaging technology. Therefore, it is important to consider processes that underlie the initiation and maintenance of whiplash pain as this may allow for the development and testing of interventions to target these processes and improve outcomes. METHODS A nonsystematic review was performed to summarize current knowledge regarding potential etiological processes involved in the initiation and maintenance of WAD and to identify future research priorities. RESULTS There are several etiological processes potentially involved in the initiation and maintenance of WAD. These include augmented nociceptive processing, stress system responses, and psychosocial and sociocultural factors. Recent findings also indicate that morphological changes in the neck muscles of injured people show some association with poor recovery, but the mechanisms underlying these changes are not clear. Preliminary evidence indicates associations between these processes. Future research priorities include the following: more sophisticated investigation and analysis of interactions between the various processes; whether the modification of these processes is achievable and if modification can improve health outcomes; and to clarify factors involved in the initiation of whiplash pain versus those involved in symptom maintenance. CONCLUSION Research to date indicates that there are several physiological and psychological etiological processes that may underlie the initiation and maintenance of whiplash-related pain and disability. Further research is required to determine relationships and interactions between these factors and to determine whether their modification is possible and will improve outcomes after injury.
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Jull GA, Söderlund A, Stemper BD, Kenardy J, Gross AR, Côté P, Treleaven J, Bogduk N, Sterling M, Curatolo M. Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity: discussion paper 5. Spine (Phila Pa 1976) 2011; 36:S335-42. [PMID: 22101753 DOI: 10.1097/brs.0b013e3182388449] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders. OBJECTIVE To identify a research agenda toward improving outcomes for acute whiplash-injured individuals to lessen the incidence of transition to chronicity. SUMMARY OF BACKGROUND DATA International figures are concordant, estimating that 50% of individuals recover from pain and disability within 3 to 6 months of a whiplash injury. The remainder report continuing symptoms up to 1 to 2 years or longer postinjury. As no management approach to date has improved recovery rates, new clinical/research directions are required for early management of whiplash-injured patients. METHODS A group of multidisciplinary researchers critically debated evidence and current research concerning whiplash from biological, psychological, and social perspectives toward informing future research directions for management of acute whiplash. RESULTS It was recognized that effective treatments for acute whiplash are constrained by a limited understanding of causes of whiplash-associated disorders. Acute whiplash presentations are heterogeneous leading to the proposal that a research priority was development of a triage system based on modifiable prognostic indicators and clinical features to better inform individualized early management decisions. Other priorities identified included researching effective early pain management for individuals presenting with moderate to high levels of pain; development of best education/information for acute whiplash; testing the efficacy of stratified and individualized rehabilitation, researching modes of delivery considering psychosocial modulators of pain and disability; and the timing, nature, and mode of delivery of cognitive-behavioral therapies. Directions were highlighted for future biomechanical research into injury prevention. CONCLUSION The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. Several directions have been proposed for future research, which reflect the potential multifaceted dimensions of an acute whiplash disorder.
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Affiliation(s)
- Gwendolen A Jull
- CCRE Spinal Pain, Injury, and Health, Division of Physiotherapy, The University of Queensland, Australia.
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Catastrophizing and perceived injustice: risk factors for the transition to chronicity after whiplash injury. Spine (Phila Pa 1976) 2011; 36:S244-9. [PMID: 22020619 DOI: 10.1097/brs.0b013e3182387fed] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after whiplash injury. OBJECTIVE This article focuses on two psychological variables that have been shown to impact on recovery trajectories after whiplash injury; namely pain catastrophizing and perceived injustice. SUMMARY OF BACKGROUND DATA Research has shown that psychological variables play a role in determining the trajectory of recovery after whiplash injury. METHODS This article will focus on two psychological variables that have been shown to impact on recovery trajectories after whiplash injury; namely pain catastrophizing and perceived injustice. The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after whiplash injury. RESULTS Several investigations have shown that measures of catastrophizing and perceived injustice prospectively predict problematic trajectories of recovery after whiplash injury. Basic research points to the potential roles of expectancies, attention, coping and endogenous opioid dysregulation as possible avenues through which catastrophizing might heighten the probability of the persistence of pain after whiplash injury. Although research has yet to systematically address the mechanisms by which perceived injustice might contribute to prolonged disability in individuals with whiplash injuries, there are grounds for suggesting the potential contributions of catastrophizing, pain behavior and anger. CONCLUSION A challenge for future research will be the development and evaluation of risk factor-targeted interventions aimed at reducing catastrophizing and perceived injustice to improve recovery trajectories after whiplash injury.
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Sterling M. Whiplash-associated disorder: musculoskeletal pain and related clinical findings. J Man Manip Ther 2011; 19:194-200. [PMID: 23115472 PMCID: PMC3201650 DOI: 10.1179/106698111x13129729551949] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The aim of this paper was to review the physical and psychological processes associated with whiplash-associated disorders. There is now much scientific data available to indicate the presence of disturbed nociceptive processing, stress system responses, muscle and motor changes as well as psychological factors in both acute and chronic whiplash-associated disorders. Some of these factors seem to be associated with the transition from acute to chronic pain and have demonstrated prognostic capacity. Further investigation is required to determine if these processes can be modified and if modification will lead to improved outcomes for this condition. The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. The understanding of processes underlying this condition is improving and this lays the foundation for the development of more effective management approaches.
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Affiliation(s)
- Michele Sterling
- Centre for National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Australia
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