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Dunn M, Rushton AB, Mistry J, Soundy A, Heneghan NR. The biopsychosocial factors associated with development of chronic musculoskeletal pain. An umbrella review and meta-analysis of observational systematic reviews. PLoS One 2024; 19:e0294830. [PMID: 38557647 PMCID: PMC10984407 DOI: 10.1371/journal.pone.0294830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
AIM The aim of this umbrella review was to establish which biopsychosocial factors are associated with development of chronic musculoskeletal pain. METHODS Ovid Medline, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PsycINFO, CINAHL, PEDro, PROSPERO, Google Scholar and grey literature were searched from database inception to 4th April 2023. Systematic reviews of observational prospective longitudinal studies, including populations with <3 months (not chronic) musculoskeletal pain, investigating biopsychosocial factors that contribute to development of chronic (>3 months) musculoskeletal pain. Two reviewers searched the literature, assessed risk of bias (Assessing the Methodological Quality of Systematic Reviews-2), and evaluated quality (Grading of Recommendations, Assessment, Development and Evaluation) to provide an overall statement on the certainty of evidence for each biopsychosocial factor. Data analysis was performed through random effects meta-analysis (including meta-analysis of meta-analyses where possible) and descriptive synthesis. RESULTS 13 systematic reviews were included comprising 185 original research studies (n = 489,644 participants). Thirty-four biopsychosocial factors are associated with development of chronic musculoskeletal pain. Meta-analyses of odds and/or likelihood ratios were possible for 25 biopsychosocial factors. There is moderate certainty evidence that smoking (OR 1.24 [95%CI, 1.14-1.34), fear avoidance (LR+ 2.11 [95%CI, 1.59-2.8]; LR- 0.5 [95%CI, 0.35-0.71]) poorer support networks (OR 1.21 [95%CI, 1.14-1.29]), lower socioeconomic status (OR 2.0 [95%CI, 1.64-2.42]), and high levels of pain (OR 5.61 [95%CI, 3.74-8.43]) are associated with development of chronic musculoskeletal pain (all P<0.001). Remaining factors are of low or very low certainty evidence. CONCLUSIONS AND RELEVANCE There is moderate certainty evidence that smoking, fear avoidance, poorer support networks, lower socioeconomic status, and high levels of pain are associated with development of chronic musculoskeletal pain. High risk of bias was evident in most included reviews; this highlights the need for higher quality systematic reviews.
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Affiliation(s)
- Michael Dunn
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Musculoskeletal Physiotherapy, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
- Institute of Medical and Biomedical Education, Centre for Allied Health, St. George's University of London, London, United Kingdom
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Jai Mistry
- Musculoskeletal Physiotherapy, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Andrew Soundy
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
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Zafereo J, Uhlenbrock B, Watson S, Wang-Price S, Noe C, Jarrett RB, Meltzer KJ, Huang M. Using quantitative sensory testing to predict attrition in an interdisciplinary pain management program: a pilot study. Pain Manag 2022; 12:623-633. [PMID: 35345888 DOI: 10.2217/pmt-2021-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To determine the extent to which quantitative sensory testing (QST) predicted attrition in an interdisciplinary pain program (IPP). Patients & methods: Participants (n = 53) enrolled in an IPP completed pretreatment assessments of QST and the PROMIS-29 quality of life survey. Results & conclusion: Compared with completers, non-completers (24.5%) reported significantly higher pain intensity (7.1, 95% CI [5.8, 8.4] versus 5.4, 95% CI [4.8, 6.1]) and cold hyperalgesia (14.6°C, 95% CI [8.8, 20.4] versus 7.5°C, 95% CI [4.8, 6.1]), with both variables also predicting attrition. This finding highlights a potentially novel and clinically significant use of QST. Higher overall pain intensity and the presence of remote cold hyperalgesia may identify patients at risk for dropping out of an IPP.
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Affiliation(s)
- Jason Zafereo
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Brittany Uhlenbrock
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Seth Watson
- School of Physical Therapy, Texas Woman's University, Dallas, TX 75235, USA
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University, Dallas, TX 75235, USA
| | - Carl Noe
- Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Robin B Jarrett
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Karen J Meltzer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Mu Huang
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Nedić D, Pilija V. Risk factors for developing chronic whiplash disorders. J Back Musculoskelet Rehabil 2022; 35:213-219. [PMID: 34459385 DOI: 10.3233/bmr-210106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Whiplash injury is one of the most common injuries in traffic accidents. Most of the injured recover within three months, however, a significant number have symptoms much longer. OBJECTIVE The aim of this study was to determine the basic epidemiological characteristics of whiplash (gender, age, collision type, the type of participants in an accident, clinical signs) on Bosnia and Herzegovina roads and identify risk factors for chronic symptoms. METHODS The subjects of this retrospective study were traffic accident whiplash patients who were diagnosed, treated and monitored in a single hospital center. The initial examination was performed on the day or the day after the accident and follow-up examinations after four weeks, three months, and six months. RESULTS Out of the 241 patients in this study, 14.1% had symptoms over six months after the trauma. 54.7% of the injured belong to the third and fourth decade and close to 80% were younger than 50 years. In addition to neck pain, the most common symptoms were limited neck mobility (69.7%), muscle spasms (63.5%), palpable pain of neck muscles (56%), headache (43.6%), nausea (23.7%). Statistical analysis showed a positive impact of age, Quebec Task Force (QTF) grade II, and more injury severity and cervical spine degenerative changes on prolonged recovery. CONCLUSIONS The overwhelming majority of the injured belong to the working population. QTF2+ score is a useful indicator for prolonged recovery and chronic symptoms. Age, QTF score and degenerative changes of the cervical spine indicate an increased risk for poor recovery and chronic symptoms.
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Affiliation(s)
- Dalibor Nedić
- Department of Forensic Medicine, University of Banja Luka, Banja Luka, Bosnia and Hercegovina
| | - Vladimir Pilija
- Center of Forensic Medicine, Toxicology and Molecular Genetics, Clinical Center of Vojvodina, Novi Sad, Serbia
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Alalawi A, Mazaheri M, Gallina A, Luque-Suarez A, Sterling M, Falla D. Are Measures of Physical Function of the Neck Region Associated With Poor Prognosis Following a Whiplash Trauma?: A Systematic Review. Clin J Pain 2021; 38:208-221. [PMID: 34954730 DOI: 10.1097/ajp.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to synthesize the current evidence regarding the predictive ability of measures of physical function (PF) of the neck region and perceived PF on prognosis following a whiplash injury. MATERIALS AND METHODS Electronic databases were searched by 2 independent reviewers up to July 2020, including MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science as well as gray literature. Eligible studies were selected by 2 reviewers who then extracted and assessed the quality of evidence. Observational cohort studies were included if they involved participants with acute whiplash-associated disorders (WAD), followed for at least 3 months postinjury, and included objective measures of neck PF or self-reported measures of PF as prognostic factors. Data could not be pooled and therefore were synthesized qualitatively. RESULTS Fourteen studies (13 cohorts) were included in this review. Low to very low quality of evidence indicated that initial higher pain-related disability and higher WAD grade were associated with poor outcome, while there was inconclusive evidence that neck range of motion, joint position error, activity of the superficial neck muscles, muscle strength/endurance, and perceived functional capacity are not predictive of outcome. The predictive ability of more contemporary measures of neck PF such as the smoothness of neck movement, variability of neck motion, and coactivation of neck muscles have not been assessed. DISCUSSION Although initial higher pain-related disability and higher WAD grade are associated with poor outcome, there is little evidence available investigating the role of neck PF on prognosis following a whiplash injury.
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Affiliation(s)
- Ahmed Alalawi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Physical Therapy Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Masood Mazaheri
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, University of Malaga
- Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Herston, QLD, Australia
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Kennedy DL, Ridout D, Lysakova L, Vollert J, Alexander CM, Rice ASC. The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery. BMC Musculoskelet Disord 2021; 22:962. [PMID: 34789204 PMCID: PMC8600705 DOI: 10.1186/s12891-021-04832-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Up to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome. METHODS With ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; "worse" or "no change" and good outcome; "slightly better", "much better" or "completely cured". RESULTS Seventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability (p < 0.001). Symptom severity diminished (p < 0.001), as did pain-related worry (p < 0.001), anxiety (p = 0.02) and insomnia (p < 0.001). Patient-rated surgical outcome was good in 92% of the cohort, poor in 8%. Baseline sensory phenotype category was not associated with surgical outcome however pain-related worry, anxiety and functional interference were significantly associated with outcome (p ≤ 0.05). CONCLUSION In patients undergoing carpal tunnel surgery, pain-related worry, anxiety and pain functional interference are candidate prognostic outcome factors and require further elucidation.
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Affiliation(s)
- Donna L Kennedy
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Chelsea & Westminster Hospital Campus, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK. .,Therapies Department, Imperial College Healthcare NHS Trust, London, UK.
| | - Deborah Ridout
- Population, Policy and Practice Programme, University College London Great Ormond St Institute of Child Health, London, UK
| | - Ladislava Lysakova
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Chelsea & Westminster Hospital Campus, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK.,Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany.,Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.,Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Caroline M Alexander
- Therapies Department, Imperial College Healthcare NHS Trust, London, UK.,MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Chelsea & Westminster Hospital Campus, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK
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Barun B, Barišić I, Krnić A, Benzon B, Vlak T, Aljinović J. Neck Disability Index Is Better in Classification of Recovery after Whiplash Injury in Comparison with Ultrasound Shear Wave Elastography of Trapezius Muscle. Diagnostics (Basel) 2021; 11:diagnostics11112077. [PMID: 34829424 PMCID: PMC8622903 DOI: 10.3390/diagnostics11112077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 12/04/2022] Open
Abstract
A prospective observational study comparing shear wave elastography (SWE) of trapezius muscle with Neck Disability Index (NDI) in a prediction model of health status six months after a whiplash injury. Both SWE values, measured by two radiologists, and NDI scores were obtained at baseline and after physical therapy (PT) (6-month period). Those values were compared with a 3-point Likert scale (no, partial or full recovery). Twenty-two subjects completed the study. A decrease in trapezius stiffness was detected by both radiologists, statistically significant for one (Δ10.1 kPa; p = 0.04) but not for the second radiologist (Δ8.63 kPa; p = 0.07). The measurements showed excellent intra-observer (ICC 0.75–0.94) and inter-observer (ICC 0.78–0.88) reliability. After six months, fully recovered patients showed lower NDI scores than partially recovered patients (Δ22.98; p < 0.001). SWE values did not differ with the recovery status (55.6 ± 9.7 vs. 57 ± 15.8, Δ1.45; p = 0.82). The single most accurate variable in classifying health status six months after whiplash injury was the relative change of NDI, and it showed the highest accuracy (73.9%) and low Akaike information criterion (AIC = 39.2). Overall, the most accurate classification was obtained when combining NDI and SWE after physical therapy with an accuracy of 77.3% and a decrease in AIC (32.8).
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Affiliation(s)
- Blaž Barun
- Institute of Physical and Rehabilitation Medicine with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (T.V.)
| | - Igor Barišić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (I.B.); (A.K.)
| | - Ana Krnić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (I.B.); (A.K.)
| | - Benjamin Benzon
- Departments of Anatomy, Histology and Embryology and Neuroscience, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Tonko Vlak
- Institute of Physical and Rehabilitation Medicine with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (T.V.)
- Department of Physical and Rehabilitation Medicine, School of Medicine, University of Split, 21000 Split, Croatia
| | - Jure Aljinović
- Institute of Physical and Rehabilitation Medicine with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (T.V.)
- Department for Health Studies, University of Split, 21000 Split, Croatia
- Correspondence:
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Eller OC, Glidden N, Knight B, McKearney N, Perry M, Bernier Carney KM, Starkweather A, Young EE, Baumbauer KM. A Role for Global DNA Methylation Level and IL2 Expression in the Transition From Acute to Chronic Low Back Pain. FRONTIERS IN PAIN RESEARCH 2021; 2:744148. [PMID: 35295525 PMCID: PMC8915771 DOI: 10.3389/fpain.2021.744148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The transition from acute low back pain (aLBP) to chronic LBP (cLBP) results from a variety of factors, including epigenetic modifications of DNA. The aim of this study was to (1) compare global DNA (gDNA) methylation and histone acetylation at LBP onset between the aLBP and cLBP participants, (2) compare mRNA expression of genes with known roles in the transduction, maintenance, and/or modulation of pain between the aLBP and cLBP participants, (3) compare somatosensory function and pain ratings in our participants, and (4) determine if the aforementioned measurements were associated.Methods: A total of 220 participants were recruited for this prospective observational study following recent onset of an episode of LBP. We retained 45 individuals whose gDNA was of sufficient quality for analysis. The final sample included 14 participants whose pain resolved within 6 weeks of onset (aLBP),15 participants that reported pain for 6 months (cLBP), and 16 healthy controls. Participants were subjected to quantitative sensory testing (QST), blood was drawn via venipuncture, gDNA isolated, and global DNA methylation and histone acetylation, as well as mRNA expression of 84 candidate genes, were measured.Results: Individuals that develop cLBP display multimodal somatosensory hypersensitivity relative to aLBP participants. cLBP participants also had significantly lower global DNA methylation, which was negatively correlated with interleukin-2 (IL2) mRNA expression.Discussion: cLBP is characterized by somatosensory hypersensitivity, lower global DNA methylation, and higher IL2 expression level compared to those whose pain will resolve quickly (aLBP). These results suggest potential diagnostic and therapeutic relevance for global DNA methylation and IL2 expression in the pathology underlying the transition from acute to chronic LBP.
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Affiliation(s)
- Olivia C. Eller
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Nicole Glidden
- Department of Genetics and Genome Sciences, UConn Health, Farmington, CT, United States
- Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Brittany Knight
- Department of Neuroscience, UConn Health, Farmington, CT, United States
| | - Noelle McKearney
- Department of Genetics and Genome Sciences, UConn Health, Farmington, CT, United States
- Department of Neuroscience, UConn Health, Farmington, CT, United States
| | - Mallory Perry
- Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Katherine M. Bernier Carney
- Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Angela Starkweather
- Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Erin E. Young
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Genetics and Genome Sciences, UConn Health, Farmington, CT, United States
- Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, Storrs, CT, United States
- Department of Neuroscience, UConn Health, Farmington, CT, United States
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, United States
- *Correspondence: Erin E. Young
| | - Kyle M. Baumbauer
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, United States
- Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, Storrs, CT, United States
- Department of Neuroscience, UConn Health, Farmington, CT, United States
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, United States
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Bontinck J, Lenoir D, Cagnie B, Murillo C, Timmers I, Cnockaert E, Bernaers L, Meeus M, Coppieters I. Temporal changes in pain processing after whiplash injury, based on Quantitative Sensory Testing: A systematic review. Eur J Pain 2021; 26:227-245. [PMID: 34464486 DOI: 10.1002/ejp.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE After whiplash injury, some patients develop chronic whiplash-associated disorders. The exact pathophysiology of this chronification is still unclear and more knowledge is needed regarding the different post-injury phases. Therefore, studies were searched that examined temporal changes in pain processing, measured by Quantitative Sensory Testing (QST). DATABASES AND DATA TREATMENT This systematic review searched three electronic databases (Medline, Web of Science and Embase) for articles meeting the eligibility requirements. Risk of bias was assessed according to a modified Newcastle-Ottawa Scale. RESULTS The 12 included studies presented moderate to good methodological quality. These studies showed altered pain processing within the first month after injury and normalization within 3 months in 59%-78% of the patients. After 3 months, recovery stagnates during the following years. Thermal and widespread mechanical hyperalgesia occur already in the acute phase, but only in eventually non-recovered patients. CONCLUSIONS Differences in pain processing between recovering and non-recovering patients can be observed already in the acute phase. Early screening for signs of altered pain processing can identify patients with high risk for chronification. These insights in temporal changes show the importance of rehabilitation in the acute phase. Future research should target to develop a standardized (bed-site) QST protocol and collect normative data which could, in relation with self-reported pain parameters, allow clinicians to identify the risk for chronification. SIGNIFICANCE Altered pain processing is present soon after whiplash injury, but usually recovers within 3 months. Non-recovering patients show little to no improvements in the following years. Differences between recovering and non-recovering patients can be observed by Quantitative Sensory Testing already in the acute phase. Therefore, it is considered a feasible and effective tool that can contribute to the identification of high-risk patients and the prevention of chronification.
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Affiliation(s)
- Jente Bontinck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carlos Murillo
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Inge Timmers
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.,Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Elise Cnockaert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisa Bernaers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Iris Coppieters
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
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9
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Contribution of COMT and BDNF Genotype and Expression to the Risk of Transition From Acute to Chronic Low Back Pain. Clin J Pain 2021; 36:430-439. [PMID: 32079998 PMCID: PMC7211115 DOI: 10.1097/ajp.0000000000000819] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES A number of factors, including heritability and the environment, contribute to risk of transition from acute low back pain to chronic low back pain (CLBP). The aim of this study was to (1) compare somatosensory function and pain ratings at low back pain (LBP) onset between the acute low back pain and CLBP conditions and (2) evaluate associations between BDNF and COMT polymorphisms and expression levels at LBP onset to acute and chronic pain burden and risk for transition to the chronic pain state. METHODS In this longitudinal study, 220 participants were enrolled following recent onset of LBP and data were collected until the LBP resolved or until the end of the study at 6 months. Forty-two participants' pain resolved before 6 weeks from onset and 42 participants continued to have pain at 6 months. Patient-reported pain burden, somatosensory function (quantitative sensory testing), and blood samples were collected at each study visit. RESULTS CLBP is associated with greater pain burden and somatosensory hypersensitivity at the time of LBP onset. COMT rs4680 genotype (GG) was associated with acute cold pain sensitivity and with the risk for transition to CLBP while COMT expression was independently associated with risk for transition. DISCUSSION CLBP was characterized by higher reported pain burden and augmented hypersensitivity at LBP onset. COMT expression and genotype were associated with acute pain burden and likelihood of transition to CLBP.
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10
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Paredes AC, Pinto JM, Almeida A, Pinto PR. Predictive value of quantitative sensory testing for acute and chronic postsurgical pain after total joint arthroplasty: a systematic review. Pain 2021; 163:e385-e400. [PMID: 34224493 DOI: 10.1097/j.pain.0000000000002385] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Quantitative sensory testing (QST) can be useful to identify high-risk patients for the development of chronic postsurgical pain. This systematic review aims to assess if presurgical sensory sensitivity measured using QST is associated with acute and chronic postsurgical pain after total joint arthroplasty. A systematic search was performed in September 2020 in PubMed, EMBASE, Web of Science, and Scopus, using terms related to total joint arthroplasty and QST. Prospective studies were included if they reported an association between presurgical QST and postsurgical pain in adults with osteoarthritis undergoing primary unilateral total joint arthroplasty. From 2994 identified studies, 18 met the inclusion criteria (1869 patients). Total knee arthroplasty was the most common surgery (16 studies), and pressure pain threshold was the most common test (11 studies), followed by dynamic measures (9 studies). Postsurgical pain was assessed at acute (5 studies), subacute (2 studies), and chronic (13 studies) time points. Risk of bias was assessed using the Quality in Prognosis Studies tool and evaluated as low to moderate in most domains. Fourteen studies reported at least one statistically significant association between QST and pain (acute: 4 studies, subacute: 1 study, and chronic: 9 studies). Pressure pain threshold was associated with postsurgical pain in 6 studies (of 11, 55%), heat pain threshold in 2 studies (of 6, 33%), conditioned pain modulation in 1 study (of 6, 17%), and temporal summation of pain in 5 studies (of 8, 63%). The predictive role of presurgical QST for postarthroplasty pain remains unclear, mainly because of heterogeneous methodologies and inconsistent results.
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Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Masterclass: A pragmatic approach to pain sensitivity in people with musculoskeletal disorders and implications for clinical management for musculoskeletal clinicians. Musculoskelet Sci Pract 2021; 51:102221. [PMID: 32972875 DOI: 10.1016/j.msksp.2020.102221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Research on musculoskeletal disorders indicates that pain sensitivity can be an important consideration for musculoskeletal clinicians in the holistic view of a patient presentation. However, diversity in research findings in this field can make this a difficult concept for clinicians to navigate. Limited integration of the concept of pain sensitivity into clinical practice for musculoskeletal clinicians has been noted. PURPOSE The purpose of this masterclass is to provide a framework for the consideration of pain sensitivity as a contributing factor in the presentation of people with musculoskeletal pain. It provides pragmatic synthesis of the literature related to pain sensitivity through a lens of how this information can inform clinical practice for musculoskeletal clinicians. Guidance is provided in a 'how to' format for integration of this knowledge into the clinical encounter to facilitate personalised care. IMPLICATIONS The relationship of pain sensitivity with pain and disability is not clear or linear. The real importance of pain sensitivity in a clinical presentation may be: (1) the potential for pain sensitivity to modify the effect of common treatments utilised by musculoskeletal clinicians, or (2) the effect of pain sensitivity on the prognosis/course of a disorder. Screening tools and subjective features have been highlighted to indicate when physical assessment of pain sensitivity should be prioritised in the physical examination. A pragmatic blueprint for specific assessment related to pain sensitivity has been outlined. A framework for integrating assessment findings into clinical reasoning to formulate management plans for the pain sensitive patient is provided.
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Alalawi A, Luque-Suarez A, Fernandez-Sanchez M, Gallina A, Evans D, Falla D. Do measures of physical function enhance the prediction of persistent pain and disability following a whiplash injury? Protocol for a prospective observational study in Spain. BMJ Open 2020; 10:e035736. [PMID: 33033010 PMCID: PMC7542919 DOI: 10.1136/bmjopen-2019-035736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Not all factors that predict persistent pain and disability following whiplash injury are known. In particular, few physical factors, such as changes in movement and muscle behaviour, have been investigated. The aim of this study is to identify predictive factors that are associated with the development of persistent pain and disability following a whiplash injury by combining contemporary measures of physical function together with established psychological and pain-related predictive factors. METHODS AND ANALYSIS A prospective observational study will recruit 150 consecutive eligible patients experiencing whiplash-related symptoms, admitted to a private physiotherapy clinic in Spain within 15 days of their whiplash injury. Poor outcome will be measured using the Neck Disability Index (NDI), defined as an NDI score of 30% or greater at 6 months post injury. Candidate predictors, including demographic characteristics, injury characteristics, pain characteristics, self-reported psychosocial factors and physical factors, will be collected at baseline (within 15 days of inception). Regression analyses will be performed to identify factors that are associated with persistent neck pain and disability over the study period. ETHICS AND DISSEMINATION The project has been approved by the Ethics Committee of the province of Malaga, Spain (#30052019). The results of this study will be published in peer-reviewed journals.
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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, UK
| | | | - Manuel Fernandez-Sanchez
- Facultad de Ciencias de la Educacion Enfermeria y Fisioterapia, Universidad De Almeria, Almeria, Spain
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - David Evans
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Othman R, Jayakaran P, Swain N, Dassanayake S, Tumilty S, Mani R. Relationships Between Psychological, Sleep, and Physical Activity Measures and Somatosensory Function in People With Peripheral Joint Pain: A Systematic Review and Meta-Analysis. Pain Pract 2020; 21:226-261. [PMID: 32696604 DOI: 10.1111/papr.12943] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/21/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Alteration in somatosensory function has been linked to pain experience in individuals with joint pain. In this systematic review we aimed to establish the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function that were assessed via quantitative sensory testing (QST) among individuals with joint pain. METHODS A comprehensive literature search was conducted in 6 electronic databases from their inception to July 2019. 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 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 Seventeen studies related to joint pain were included. Pain catastrophizing, depression, anxiety, and physical activity level have been shown to have a significant (small to fair) association with several QST measures. Pressure pain threshold (PPT) is the only measure that was found to be consistently correlated with all the domains. The overall quality of evidence for all factors ranged from very low to moderate. Subgroup analysis revealed a stronger association for depression and pain catastrophizing and PPT and temporal pain summation in individuals with shoulder pain. CONCLUSION Psychological factors and physical activity levels are associated with somatosensory function in people with joint pain. These factors need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with joint pain.
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Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Suranga Dassanayake
- 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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Middlebrook N, Heneghan NR, Evans DW, Rushton A, Falla D. Reliability of temporal summation, thermal and pressure pain thresholds in a healthy cohort and musculoskeletal trauma population. PLoS One 2020; 15:e0233521. [PMID: 32469913 PMCID: PMC7259760 DOI: 10.1371/journal.pone.0233521] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/06/2020] [Indexed: 01/09/2023] Open
Abstract
Traumatic injuries affect approximately 978 million people worldwide with 56.2 million requiring inpatient care. Quantitative sensory testing (QST) can be useful in predicting outcome following trauma, however the reliability of multiple QST including temporal summation (TS), heat and cold pain thresholds (HPT, CPT) and pressure pain thresholds (PPT) is unknown. We assessed intra (between day) and inter-rater (within day) reliability of QST in asymptomatic participants (n = 21), and inter-rater (within day) reliability in participants presenting with acute musculoskeletal trauma (n = 25). Intra-class correlations with 95% confidence intervals (ICC 3,2), standard error of measurement (SEM) and Bland Altman Plots for limits of agreement were calculated. For asymptomatic participants, reliability was good to excellent for HPT (ICC range 0.76–0.95), moderate to good for PPT (ICC range 0.52–0.93), with one site rated poor (ICC 0.41), and poor to excellent for TS scores (ICC range 0.20–0.91). For musculoskeletal trauma participants reliability was good to excellent for HPT and PPT (ICC range 0.76–0.86), and moderate to good reliability for TS (ICC range 0.69–0.91). SEM for HPT for both sets of participants was ~1°C and an average of 7N for asymptomatic participants and less than 8N for acute musculoskeletal trauma participants for PPT. This study demonstrates moderate to excellent intra and inter-rater reliability for HPT and PPT in asymptomatic participants and good to excellent inter-rater reliability for acute musculoskeletal trauma participants, with TS showing more variability for both sets of participants. This study provides foundations for future work evaluating the sensory function over time following acute musculoskeletal trauma.
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Affiliation(s)
- Nicola Middlebrook
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- NIHR Surgical Reconstruction & Microbiology Research Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - David W. Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- NIHR Surgical Reconstruction & Microbiology Research Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- NIHR Surgical Reconstruction & Microbiology Research Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
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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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Alalawi A, Gallina A, Sterling M, Falla D. Are physical factors associated with poor prognosis following a whiplash trauma?: a protocol for a systematic review and data synthesis. BMJ Open 2019; 9:e033298. [PMID: 31748312 PMCID: PMC6887082 DOI: 10.1136/bmjopen-2019-033298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Mitigating the transition from acute to chronic whiplash-associated disorders (WAD) is fundamental, and this could be achieved through early identification of individuals at risk. Several physical factors such as angular velocity, smoothness of neck movement and coactivation of neck flexors and extensors, have been observed in patients with WAD, but their predictive ability after a whiplash injury have not been considered in previous reviews. Therefore, the aim of the current protocol is to outline the protocol for a systematic review that synthesises the current evidence of which physical factors can predict ongoing pain and disability following a whiplash trauma. METHODS AND ANALYSIS Two independent reviewers will search for studies in several electronic databases including MEDLINE, Embase, CINAHL, PsycINFO, Scopus and Web of Science as well as grey literature. Observational cohort studies will be considered if they involve participants with acute WAD followed for at least 3 months post-injury. Studies will be required to assess the prognostic ability of one or more physical factors that directly involve a body function and/or structure and can be measured objectively. Further, patient-reported outcomes of physical function will be considered. The primary outcome for this review is Neck Disability Index, while all other validated measures will be considered as secondary outcomes. Risk of bias across individual studies will be assessed using the Quality In Prognostic Studies tool along with the Grades of Recommendation, Assessment, Development and Evaluation method to assess the quality of evidence. A meta-analysis will be conducted depending on homogeneity and the number of available studies. If appropriate, data will be pooled and presented as odds ratios, otherwise, a qualitative synthesis will be conducted. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. The result from this review will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42019122559.
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Affiliation(s)
- Ahmed Alalawi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Physical Therapy Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Queensland, Australia
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Abstract
Cold intolerance after nerve injury can be severe and has been associated with high levels of pain and disability. This article provides an overview of the assessment and nonoperative management of cold-induced symptoms after peripheral nerve injury. A comprehensive evaluation should include both objective measures such as skin temperatures and subjective tools to assess the patient's perspective and impact of the symptoms. Management of the patient with cold intolerance remains challenging and should include adaptive strategies, warming interventions, and desensitization conditioning programs to minimize cold-induced pain and hyperresponses.
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Georgopoulos V, Akin-Akinyosoye K, Zhang W, McWilliams DF, Hendrick P, Walsh DA. Quantitative sensory testing and predicting outcomes for musculoskeletal pain, disability, and negative affect: a systematic review and meta-analysis. Pain 2019; 160:1920-1932. [PMID: 31045746 PMCID: PMC6701980 DOI: 10.1097/j.pain.0000000000001590] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hypersensitivity due to central pain mechanisms can influence recovery and lead to worse clinical outcomes, but the ability of quantitative sensory testing (QST), an index of sensitisation, to predict outcomes in chronic musculoskeletal disorders remains unclear. We systematically reviewed the evidence for ability of QST to predict pain, disability, and negative affect using searches of CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, and PubMed databases up to April 2018. Title screening, data extraction, and methodological quality assessments were performed independently by 2 reviewers. Associations were reported between baseline QST and outcomes using adjusted (β) and unadjusted (r) correlations. Of the 37 eligible studies (n = 3860 participants), 32 were prospective cohort studies and 5 randomised controlled trials. Pain was an outcome in 30 studies, disability in 11, and negative affect in 3. Meta-analysis revealed that baseline QST predicted musculoskeletal pain (mean r = 0.31, 95% confidence interval [CI]: 0.23-0.38, n = 1057 participants) and disability (mean r = 0.30, 95% CI: 0.19-0.40, n = 290 participants). Baseline modalities quantifying central mechanisms such as temporal summation and conditioned pain modulation were associated with follow-up pain (temporal summation: mean r = 0.37, 95% CI: 0.17-0.54; conditioned pain modulation: mean r = 0.36, 95% CI: 0.20-0.50), whereas baseline mechanical threshold modalities were predictive of follow-up disability (mean r = 0.25, 95% CI: 0.03-0.45). Quantitative sensory testing indices of pain hypersensitivity might help develop targeted interventions aiming to improve outcomes across a range of musculoskeletal conditions.
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Affiliation(s)
- Vasileios Georgopoulos
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - Kehinde Akin-Akinyosoye
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - Weiya Zhang
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - Daniel F. McWilliams
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - Paul Hendrick
- Department of Physiotherapy, Faculty of Medicine and Health
Sciences, University of Nottingham
| | - David A. Walsh
- Department of Academic Rheumatology, Faculty of Medicine and Health
Sciences, University of Nottingham
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Othman R, Jayakaran P, Tumilty S, Swain N, Mani R. Predictive relationship between psychological, social, physical activity, and sleep measures and somatosensory function in individuals with musculoskeletal pain: a systematic review and meta-analysis protocol. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1648715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Wright A, Benson HAE, Moss P. Development of a topical menthol stimulus to evaluate cold hyperalgesia. Musculoskelet Sci Pract 2019; 41:55-63. [PMID: 31010570 DOI: 10.1016/j.msksp.2019.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Cold hyperalgesia is an indicator of widespread pain sensitivity and is associated with poor clinical outcomes. Menthol activates TRPM8, a cold-sensing receptor channel. This research evaluated topical menthol as a potential stimulus to be used in the clinical evaluation of cold hyperalgesia. METHODS Participants were 59 pain free volunteers (17 male: 42 female). A blinded, repeated measures design was used. Participants received applications of menthol at different concentrations in a liquid (study 1) or gel (study 2) formulation with a 24-h interval between each application. Each menthol concentration was applied for 15 min and participants were asked to rate the sensation produced using a series of visual analogue scales and by selecting words from a descriptor list derived from the McGill pain questionnaire (MPQ). The menthol was applied to a site on the volar forearm. Participants also had their cold pain thresholds (CPT) evaluated at the same site using a contact thermode. RESULTS There were significant concentration-dependent effects for intensity of cold, unpleasantness and pain VAS: cold F(2,62) = 8.67, p < 0.001; unpleasantness χ2(2) = 14.14, p < 0.001; χ2(2) = 11.74, p = 0.003, with moderate effect sizes for unpleasantness and pain. There were also significant concentration dependent effects for descriptor indices, pain rating index (PRI) F(2,62) = 26.33, p < 0.001; number of words chosen (NWC) F(2,62) = 19.62, p < 0.001, with large effect sizes for 10-20% and 10-30% comparisons. Significant correlations were seen between measures of unpleasantness, pain, PRI, NWC and CPT dependent on menthol concentration. CONCLUSION Topical menthol has potential as a stimulus to evaluate cold hyperalgesia.
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Affiliation(s)
- Anthony Wright
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Heather A E Benson
- School of Pharmacy and Biomedical Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Penny Moss
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
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Middlebrook N, Rushton AB, Heneghan NR, Falla D. Measures of central sensitisation and their measurement properties in the adult musculoskeletal trauma population: a protocol for a systematic review and data synthesis. BMJ Open 2019; 9:e023204. [PMID: 30904837 PMCID: PMC6475353 DOI: 10.1136/bmjopen-2018-023204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pain following musculoskeletal trauma is common with poor outcomes and disability well documented. Pain is complex in nature and can include the four primary mechanisms of pain: nociceptive, neuropathic, inflammatory and central sensitisation (CS). CS can be measured in multiple ways; however, no systematic review has evaluated the measurement properties of such measures in the musculoskeletal trauma population. This systematic review aims to evaluate the measurement properties of current measures of CS in this population. METHODS/ANALYSIS This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Google Scholar as well as key journals and grey literature will be searched in two stages to (1) identify what measures are being used to assess CS in this population and (2) evaluate the measurement properties of the identified measures. Two independent reviewers will conduct the search, extract the data, assess risk of bias for included studies and assess overall quality. The Consensus-based Standards for the selection of Health Measurement Instruments Risk of Bias Checklist and a modified Grading of Recommendations, Assessment, Development and Evaluation guidelines will be used. Meta-analysis will be conducted if deemed appropriate. Alternatively, a narrative synthesis will be conducted and summarised per measurement property per outcome measure. ETHICS AND DISSEMINATION This review will aid clinicians in using the most appropriate tool for assessing central sensitisation in this population and is the first step towards a more standardised approach in pain assessment. The results of this study will be submitted to a peer reviewed journal and presented at conferences. PROSPERO REGISTRATIONNUMBER CRD42018091531.
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Affiliation(s)
- Nicola Middlebrook
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Wang J, Chen K, Jin X, Li X, An P, Yang N, Chen Y, Fang Y, Mu Y. Prognostic factors for cesarean section outcome of pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr Obes 2019; 12:913-929. [PMID: 31296993 PMCID: PMC6596347 DOI: 10.2147/dmso.s188293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/15/2019] [Indexed: 11/28/2022] Open
Abstract
Objective: To evaluate the prognostic factors for cesarean section outcome of pregnant women with diabetes mellitus. Methods: MEDLINE, EMBASE, Cochrane Library, CBM, CNKI and Wanfang database were searched. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies. For pooled data with factors of perioperative outcome, the RevMan software was used for data translation and meta-analysis. The result is shown intuitively with the bubble diagram of evidence mapping by Excel 2016. Results: We included 12 randomized controlled trials (RCTs) in the meta-analysis. Twelve RCTs with 1,390 patients were included in the systematic review. The results show that the perioperative blood glucose management regimens, preoperative fasting and water deprivation, anesthesia regimens, postoperative fluid regimens, postoperative analgesia regimens, postoperative wound care regimens, psychological interventions, different dosing regimens for antibiotics, and obesity may affect the cesarean section outcome of diabetic mothers and newborns. The evidence for all the outcomes was low quality. Conclusion: Many prognostic factors have shown significant association with postoperative outcomes of cesarean section. More clinical research evidence with high-quality is needed.
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Affiliation(s)
- Jinjing Wang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing100853, People’s Republic of China
- Department of Endocrinology, Fifth Medical Center of PLA General Hospital, Beijing100071, People’s Republic of China
| | - Kang Chen
- Department of Endocrinology, Chinese PLA General Hospital, Beijing100853, People’s Republic of China
| | - Xinye Jin
- Department of Endocrinology, Chinese PLA General Hospital, Beijing100853, People’s Republic of China
| | - Xueqiong Li
- Department of Gerontology, First Affiliated Hospital of Kunming Medical University, Kunming650031, People’s Republic of China
| | - Ping An
- Department of Endocrinology, Chinese PLA General Hospital, Beijing100853, People’s Republic of China
| | - Nan Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People’s Republic of China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People’s Republic of China
| | - Yi Fang
- Department of Endocrinology, Fifth Medical Center of PLA General Hospital, Beijing100071, People’s Republic of China
- Yi Fang Department of Endocrinology, Fifth Medical Center of PLA General Hospital, Chinese PLA 307 Hospital, No. 8, East Street, Fengtai District, Beijing100071, People’s Republic of ChinaTel +86 136 4122 3053 Email
| | - Yiming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing100853, People’s Republic of China
- Correspondence: Yiming MuDepartment of Endocrinology, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing100853, People’s Republic of ChinaTel +86 189 1096 8729Email
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Associations Between Musculoskeletal Pain Experience and Pressure and Cold Pain Sensitivity. Clin J Pain 2019; 35:56-64. [DOI: 10.1097/ajp.0000000000000650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Moloney N, Beales D, Azoory R, Hübscher M, Waller R, Gibbons R, Rebbeck T. Are measures of pain sensitivity associated with pain and disability at 12-month follow up in chronic neck pain? Musculoskeletal Care 2018; 16:415-424. [PMID: 29901261 DOI: 10.1002/msc.1247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Pain sensitivity and psychosocial issues are prognostic of poor outcome in acute neck disorders. However, knowledge of associations between pain sensitivity and ongoing pain and disability in chronic neck pain are lacking. We aimed to investigate associations of pain sensitivity with pain and disability at the 12-month follow-up in people with chronic neck pain. METHODS The predictor variables were: clinical and quantitative sensory testing (cold, pressure); neural tissue sensitivity; neuropathic symptoms; comorbidities; sleep; psychological distress; pain catastrophizing; pain intensity (for the model explaining disability at 12 months only); and disability (for the model explaining pain at 12 months only). Data were analysed using uni- and multivariate regression models to assess associations with pain and disability at the 12-month follow-up (n = 64 at baseline, n = 51 at follow-up). RESULTS Univariable associations between all predictor variables and pain and disability were evident (r > 0.3; p < 0.05), except for cold and pressure pain thresholds and cold sensitivity. For disability at the 12-month follow-up, 24.0% of the variance was explained by psychological distress and comorbidities. For pain at 12 months, 39.8% of the variance was explained primarily by baseline disability. CONCLUSIONS Neither clinical nor quantitative measures of pain sensitivity were meaningfully associated with long-term patient-reported outcomes in people with chronic neck pain, limiting their clinical application in evaluating prognosis.
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Affiliation(s)
- Niamh Moloney
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- THRIVE Physiotherapy, Guernsey, Channel Islands
| | - Darren Beales
- Curtin University, School of Physiotherapy and Exercise Science, Perth, WA, Australia
| | - Roxanne Azoory
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | | | - Robert Waller
- Curtin University, School of Physiotherapy and Exercise Science, Perth, WA, Australia
| | - Rebekah Gibbons
- Curtin University, School of Physiotherapy and Exercise Science, Perth, WA, Australia
| | - Trudy Rebbeck
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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Ris I, Barbero M, Falla D, Larsen MH, Kraft MN, Søgaard K, Juul-Kristensen B. Pain extent is more strongly associated with disability, psychological factors, and neck muscle function in people with non-traumatic versus traumatic chronic neck pain: a cross sectional study. Eur J Phys Rehabil Med 2018; 55:71-78. [PMID: 30156084 DOI: 10.23736/s1973-9087.18.04977-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neck pain is presented with a variety of symptoms. Pain drawings are used in the clinical assessment of people with neck pain. Pain extent based upon pain drawings can be associated with different factors. However, the relation between pain extent and function limitations in people with neck pain is unknown. AIM The aim of this study was to explore the associations between pain extent extracted from pain drawings, and self-reported neck pain related disability, quality of life, depression, self-reported neck function, cervical muscle function, and range of motion in a chronic neck pain population and possible differences depending on the onset of pain being traumatic or not. DESIGN Observational cross-sectional study. SETTING Primary and secondary healthcare. POPULATION People with chronic neck pain (N.=200) of traumatic (N.=120) or non-traumatic (N.=80) origin. METHODS Outcome measures: Pain extent, Short Form 36 Health Survey Physical and Mental Component Summary (SF36-PCS/MCS), TAMPA Scale of Kinesiophobia (TSK), Beck Depression Inventory-II (BDI-II), Neck Disability Index (NDI), Craniocervical Flexion Test (CCFT), Cervical Extension Test (CE), and Cervical Range of Motion (ROM). Correlations were calculated using Spearman or Pearson correlation coefficients. Correlation between pain extent and outcomes were calculated for all participants collectively and then separately for those with a traumatic versus non-traumatic neck pain. RESULTS Overall, significant positive correlations were observed between pain extent and NDI (r=0.33; P<0.001), BDI-II (r=0.29; P<0.001), CCFT (r=-0.24; P=0.001) and CE (r=-0.19; P=0.006). No difference was observed in pain extent between patients with traumatic (mean: 7.6±6.7%) and non-traumatic onset (7.4±6.8%). Pain extent correlated moderately with NDI, BDI-II, TSK, CCFT and CE in those with non-traumatic onset, but weakly with NDI, BDI-II, CCFT and CE in those with trauma-induced chronic neck pain. CONCLUSIONS Pain extent is correlated with patient-reported neck function, depression and muscle test performance in people with chronic neck pain. These correlations were strongest in those with non-traumatic neck pain. CLINICAL REHABILITATION IMPACT Patients presenting with larger pain areas show poorer psychological and physical function. Pain drawings can therefore indicate a need for addressing these functions in management of a person with chronic neck pain.
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Affiliation(s)
- Inge Ris
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark - .,Metropolitan University College, Copenhagen, Denmark -
| | - Marco Barbero
- 2rLab Rehabilitation Research Laboratory, Department of Business, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland
| | - Deborah Falla
- Center of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Mads H Larsen
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin N Kraft
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Research Unit for Physical Activity and Health in Working Life, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen University College, Bergen, Norway
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Cold Pain Threshold Identifies a Subgroup of Individuals With Knee Osteoarthritis That Present With Multimodality Hyperalgesia and Elevated Pain Levels. Clin J Pain 2018; 33:793-803. [PMID: 27898461 PMCID: PMC5638431 DOI: 10.1097/ajp.0000000000000458] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Cold hyperalgesia has been established as an important marker of pain severity in a number of conditions. This study aimed to establish the extent to which patients with knee osteoarthritis (OA) demonstrate widespread cold, heat, and pressure hyperalgesia. OA participants with widespread cold hyperalgesia were compared with the remaining OA cohort to determine whether they could be distinguished in terms of hyperalgesia, pain report, pain quality, and physical function. METHODS A total of 80 participants with knee OA and 40 matched healthy, pain-free controls participated. OA participants completed a washout of their usual medication. Quantitative sensory testing was completed at 3 sites using standard methods. Cold pain threshold (CPT) and heat pain thresholds (HPT) were tested using a Peltier thermode and pressure pain thresholds (PPT) using a digital algometer. All participants completed the short-form health survey questionnaire and OA participants completed the PainDETECT, Western Ontario and McMaster Universities Osteoarthritis Index of the Knee (WOMAC), and pain quality assessment scale questionnaires. RESULTS OA participants demonstrated widespread cold hyperalgesia (P<0.0001), had lower PPT at the index knee (P<0.0001) compared with controls and reported decreased physical health on the SF-36 (P=0.01). The OA subcohort with high global CPT (≥12.25°C) exhibited multimodality sensitization compared with the remaining OA cohort (PPT P<0.0001; CPT P<0.0001; HPT P=0.021 index knee). This group also reported increased pain, decreased function, and more features of neuropathic pain. DISCUSSION This study identified a specific subgroup of patients with knee OA who exhibited widespread, multimodality hyperalgesia, more pain, more features of neuropathic pain, and greater functional impairment. Identification of patients with this pain phenotype may permit more targeted and effective pain management.
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Sewell J, Dixon C, Morris R, Stuart S. Anatomical distribution of musculoskeletal disorders following a road traffic collision in litigants presenting to physiotherapists within a private-clinic in North-East England. Physiother Theory Pract 2018; 35:873-883. [PMID: 29659312 DOI: 10.1080/09593985.2018.1459986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Introduction: Musculoskeletal disorders (MSDs) are common following a road traffic collision (RTC) in England. Establishing the anatomical distribution of MSDs following RTC that present to physiotherapists may improve understanding and clinical practice. This study examined anatomical distribution of MSDs that present to physiotherapists within a litigant population following a RTC in England. Methods: A retrospective review of physiotherapy records was conducted at a private practice in North-East England. Data were collected from 2105 patients between January 2014 and December 2015. The primary outcome was anatomical regions with MSDs. Descriptive data is reported. Results: Overall, 90% of patients presented with a neck/upper back disorder, while 52% presented with a lower back disorder. Of the assessed patients, 46% presented with one MSD, 45% presented with two MSDs while 9% presented with ≥3 MSDs. Further analysis showed that those who presented to physiotherapy later and were not motor vehicle occupants (MVOs) were more likely to have upper-limb, lower-limb, or lumbar MSDs. Younger patients, who presented sooner and were non-MVO were more likely to have multiple regions affected by MSDs. Conclusions: This study presents epidemiological evidence that MSDs following a RTC occur primarily in the neck/upper back or lower back regions, and that multiple MSDs are common.
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Affiliation(s)
| | - Cheryl Dixon
- a On Medical Ltd ., Newcastle upon Tyne , England, UK
| | - Rosie Morris
- a On Medical Ltd ., Newcastle upon Tyne , England, UK.,b Institute of Neuroscience/Newcastle University Institute of Ageing , Newcastle University , Newcastle upon Tyne , England, UK
| | - Samuel Stuart
- a On Medical Ltd ., Newcastle upon Tyne , England, UK.,b Institute of Neuroscience/Newcastle University Institute of Ageing , Newcastle University , Newcastle upon Tyne , England, UK
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Moss P, Benson HAE, Will R, Wright A. Fourteen days of etoricoxib 60 mg improves pain, hyperalgesia and physical function in individuals with knee osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage 2017; 25:1781-1791. [PMID: 28778815 DOI: 10.1016/j.joca.2017.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Mounting evidence points to the heterogeneity of osteoarthritis (OA) pain, increasing the need for more comprehensive assessment of the efficacy of standard interventions. This study investigated whether 14 days of the selective Cox-2 inhibitor etoricoxib (60 mg/day) would modify self-report of pain intensity and quality, and physical measures of hyperalgesia and function in individuals with knee OA. DESIGN This double-blind placebo-controlled trial included 80 community-recruited volunteers with painful knee OA (≥3/10 VAS), randomly allocated to Active or Placebo groups. Self-report measures of pain, stiffness, function Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and pain quality (PainDETECT, Pain Quality Assessment Scale [PQAS]) and physical measures of locomotion and local (knee) and widespread (elbow) hyperalgesia were assessed at Days 0, 4 and 14. Repeated Measures ANOVA analysed group differences. RESULTS Significant group × time interaction effects were found for all measures of pain (all p < 0.001), with WOMAC pain sub-score improving by 30.7% by Day 14 and index knee mechanical hyperalgesia improving by 32.6%, whilst Placebo group values worsened. Both self-report and physical tests of function improved (p < 0.001-p = 0.006): WOMAC-function by 28.4%, sit-to-stand and walk time by 13%, pain during locomotion tasks by 12.4-32.6%. Pain quality also significantly improved for the Active and declined for the Placebo group (p < 0.001): PainDETECT score reduced by 23.6% and PQAS paroxsysmal and surface sub-scores by 36.9% and 29.4%. There were also significant improvements in local cold hyperalgesia and widespread mechanical hyperalgesia (10-13.8%). CONCLUSION Just 14 days of etoricoxib significantly improves pain intensity and quality, function and local and widespread hyperalgesia, measured by both self-report and physical tests.
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Affiliation(s)
- P Moss
- School of Physiotherapy and Exercise Science, Curtin University, Australia.
| | - H A E Benson
- School of Pharmacy, CHIRI Bioscience, Curtin University, Australia.
| | - R Will
- School of Medicine and Pharmacology, University of Western Australia, Australia.
| | - A Wright
- School of Physiotherapy and Exercise Science, Curtin University, Australia.
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Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.
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Lindbäck Y, Tropp H, Enthoven P, Gerdle B, Abbott A, Öberg B. Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2581-2588. [PMID: 28168345 DOI: 10.1007/s00586-017-4979-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis. METHODS This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression. RESULTS Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs. CONCLUSIONS Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.
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Affiliation(s)
- Yvonne Lindbäck
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| | - Hans Tropp
- Department of Spinal Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Paul Enthoven
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Allan Abbott
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
- Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - Birgitta Öberg
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
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Sarrami P, Armstrong E, Naylor JM, Harris IA. Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors. J Orthop Traumatol 2016; 18:9-16. [PMID: 27738773 PMCID: PMC5311004 DOI: 10.1007/s10195-016-0431-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 09/23/2016] [Indexed: 01/08/2023] Open
Abstract
Background Whiplash injuries are among the leading injuries related to car crashes and it is important to determine the prognostic factors that predict the outcome of patients with these injuries. This meta-review aims to identify factors that are associated with outcome after acute whiplash injury. Materials and methods A systematic search for all systematic reviews on outcome prediction of acute whiplash injury was conducted across several electronic databases. The search was limited to publications in English, and there were no geographical or time of publication restrictions. Quality appraisal was conducted with A Measurement Tool to Assess Systematic Reviews. Results The initial search yielded 207 abstracts; of these, 195 were subsequently excluded by topic or method. Twelve systematic reviews with moderate quality were subsequently included in the analysis. Post-injury pain and disability, whiplash grades, cold hyperalgesia, post-injury anxiety, catastrophizing, compensation and legal factors, and early healthcare use were associated with continuation of pain and disability in patients with whiplash injury. Post-injury magnetic resonance imaging or radiographic findings, motor dysfunctions, or factors related to the collision were not associated with continuation of pain and disability in patients with whiplash injury. Evidence on demographic and three psychological factors and prior pain was conflicting, and there is a shortage of evidence related to the significance of genetic factors. Conclusions This meta-review suggests an association between initial pain and anxiety and the outcome of acute whiplash injury, and less evidence for an association with physical factors. Level of evidence Level 1. Electronic supplementary material The online version of this article (doi:10.1007/s10195-016-0431-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pooria Sarrami
- Institute of Trauma and Injury Management, New South Wales Agency for Clinical Innovation, Level 4, Sage Building, 67 Albert Avenue, Chatwswood, Sydney, NSW, 2067, Australia.
- South Western Sydney Clinical School, UNSW, Sydney, Australia.
| | | | - Justine M Naylor
- South Western Sydney Clinical School, UNSW, Sydney, Australia
- South Western Sydney Local Health District, Liverpool Hospital, Liverpool, Australia
| | - Ian A Harris
- South Western Sydney Clinical School, UNSW, Sydney, Australia
- South Western Sydney Local Health District, Liverpool Hospital, Liverpool, Australia
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Abstract
Synopsis Recovery from a whiplash injury is varied and complex. Some individuals recover quickly and fully, while others experience ongoing pain and disability. Three distinct patterns of predicted recovery (trajectories) have been identified using disability and psychological outcome measures. These trajectories are not linear, and show that recovery, if it is going to occur, tends to happen within the first 3 months of the injury, with little improvement after this period. Identification of factors associated with poor recovery is accumulating, and since 2000 there have been at least 10 published systematic reviews on prognostic factors for whiplash-associated disorder. Poor recovery has been consistently reported to be associated with high initial neck pain intensity and neck-related disability, posttraumatic stress symptoms, pain catastrophizing, and, to a lesser extent, low self-efficacy and cold hyperalgesia. Evidence regarding factors, including compensation status, psychological factors, structural pathology, and preinjury health status, remains equivocal. Given the huge number of predictive factors and various interpretations of recovery, adapting these data for use in clinical practice is difficult. Tools such as clinical prediction rules (CPRs), by statistically quantifying relevant data, may help to predict the probability of diagnosis, prognosis, or response to treatment. Numerous CPRs have been derived for individuals with whiplash; however, to date, only 3 prognostic CPRs have undergone external validation, and none have yet undergone impact analysis, a necessary step in providing information about the rules' ability to improve clinically relevant outcomes. J Orthop Sports Phys Ther 2016;46(10):851-861. Epub 3 Sep 2016. doi:10.2519/jospt.2016.6918.
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Waller R, Smith AJ, O’Sullivan PB, Slater H, Sterling M, Alexandra McVeigh J, Straker LM. Pressure and cold pain threshold reference values in a large, young adult, pain-free population. Scand J Pain 2016; 13:114-122. [DOI: 10.1016/j.sjpain.2016.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 01/10/2023]
Abstract
Abstract
Background and aims
Currently there is a lack of large population studies that have investigated pain sensitivity distributions in healthy pain free people. The aims of this study were: (1) to provide sex-specific reference values of pressure and cold pain thresholds in young pain-free adults; (2) to examine the association of potential correlates of pain sensitivity with pain threshold values.
Methods
This study investigated sex specific pressure and cold pain threshold estimates for young pain free adults aged 21–24 years. A cross-sectional design was utilised using participants (n =617) from the Western Australian Pregnancy Cohort (Raine) Study at the 22-year follow-up. The association of site, sex, height, weight, smoking, health related quality oflife, psychological measures and activity with pain threshold values was examined. Pressure pain threshold (lumbar spine, tibialis anterior, neck and dorsal wrist) and cold pain threshold (dorsal wrist) were assessed using standardised quantitative sensory testing protocols.
Results
Reference values for pressure pain threshold (four body sites) stratified by sex and site, and cold pain threshold (dorsal wrist) stratified by sex are provided. Statistically significant, independent correlates of increased pressure pain sensitivity measures were site (neck, dorsal wrist), sex (female), higher waist-hip ratio and poorer mental health. Statistically significant, independent correlates of increased cold pain sensitivity measures were, sex (female), poorer mental health and smoking.
Conclusions
These data provide the most comprehensive and robust sex specific reference values for pressure pain threshold specific to four body sites and cold pain threshold at the dorsal wrist for young adults aged 21–24 years. Establishing normative values in this young age group is important given that the transition from adolescence to adulthood is a critical temporal period during which trajectories for persistent pain can be established.
Implications
These data will provide an important research resource to enable more accurate profiling and interpretation of pain sensitivity in clinical pain disorders in young adults. The robust and comprehensive data can assist interpretation of future clinical pain studies and provide further insight into the complex associations of pain sensitivity that can be used in future research.
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Affiliation(s)
- Robert Waller
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Anne Julia Smith
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Peter Bruce O’Sullivan
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury , Menzies Health Institute , Griffith University , QLD , 4222 , Australia
| | - Joanne Alexandra McVeigh
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
| | - Leon Melville Straker
- School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia 6845 , Australia
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O'Leary H, Smart KM, Moloney NA, Doody CM. Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: A Systematic Review. Pain Pract 2016; 17:249-266. [DOI: 10.1111/papr.12484] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Helen O'Leary
- School of Public Health, Physiotherapy and Sports Science; University College Dublin; Dublin Ireland
| | - Keith M. Smart
- Physiotherapy Department; St. Vincent's University Hospital; Dublin Ireland
| | - Niamh A. Moloney
- Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
| | - Catherine M. Doody
- School of Public Health, Physiotherapy and Sports Science; University College Dublin; Dublin Ireland
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Moloney N, Wrigley P, Hush J. Somatosensory assessment in chronic pain: progress and potential. Pain Manag 2016; 6:125-8. [DOI: 10.2217/pmt.15.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Niamh Moloney
- Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, NSW 2113, Australia
| | - Paul Wrigley
- Sydney Medical School – Northern, University of Sydney, Sydney, NSW 2006, Australia
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Julia Hush
- Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, NSW 2113, Australia
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Sterling M, Head J, Cabot PJ, Farrell M. Serum C-reactive protein levels predict regional brain responses to noxious cold stimulation of the hand in chronic whiplash associated disorders. Scand J Pain 2016; 11:19-26. [PMID: 28850464 DOI: 10.1016/j.sjpain.2015.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/25/2015] [Accepted: 11/01/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Whiplash Associated Disorders (WAD) are a costly health burden. The condition is characterised by sensory disturbances such as widespread hyperalgesia likely indicative of central hyperexcitability. Recently elevated levels of pro-inflammatory biomarkers have also found in acute and chronic WAD. The aim of this cross-sectional study was to investigate the relationship between inflammatory biomarkers and pain processing in people with persistent whiplash associated disorders (WAD). METHODS Twenty one participants with chronic whiplash (>3 months) were recruited. Venous blood samples were collected and assays performed for C-reactive protein (CRP) and TNF-α. Blood oxygen level-dependent (BOLD) contrast images of the brain were acquired with a Siemens 1.5T MRI scanner during repeated 24s stimulus blocks of innocuous or painful stimuli (thumbnail pressure and cold stimulation of dorsum of hand) separated by 36s inter-stimulus intervals. Stimulus intensities used during scanning were at the level of participants' thresholds for moderate pain. Parameter estimates representing BOLD signal increases during painful events from each participant were tested for associations with inflammatory biomarkers. RESULTS Clinically relevant levels of CRP and TNF-α were found in 33% and 38% of participants. Levels of CRP showed a positive correlation with levels of cold pain activation in brain regions including the anterior insula, posterior parietal cortex, caudate and thalamus (pcorrected<0.05). Levels of TNF-α were not related to activation levels during either noxious pressure or cold. Pressure pain activations also did not show a relationship with CRP levels. CONCLUSIONS Shared variance between inflammation and increased levels of regional pain-related activation in people with persistent whiplash symptoms is apparent for cold, but not pressure stimuli. IMPLICATIONS The results highlight cold pain processing as an important aspect of whiplash chronicity, although the implications of this modality-specific effect are not readily apparent.
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Affiliation(s)
- Michele Sterling
- Centre of National Research on Disability and Rehabilitation Medicine (CONROD), CRE in Road Traffic Injury, Menzies Health Institute Queensland, Griffith University, Parklands, Australia.
| | - Jessica Head
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Peter J Cabot
- The School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, St Lucia, Australia
| | - Michael Farrell
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia
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Quantitative and Qualitative Responses to Topical Cold in Healthy Caucasians Show Variance between Individuals but High Test-Retest Reliability. PLoS One 2016; 11:e0151972. [PMID: 27007696 PMCID: PMC4805254 DOI: 10.1371/journal.pone.0151972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 03/07/2016] [Indexed: 01/21/2023] Open
Abstract
Increased sensitivity to cold may be a predictor of persistent pain, but cold pain threshold is often viewed as unreliable. This study aimed to determine the within-subject reliability and between-subject variance of cold response, measured comprehensively as cold pain threshold plus pain intensity and sensation quality at threshold. A test-retest design was used over three sessions, one day apart. Response to cold was assessed at four sites (thenar eminence, volar forearm, tibialis anterior, plantar foot). Cold pain threshold was measured using a Medoc thermode and standard method of limits. Intensity of pain at threshold was rated using a 10cm visual analogue scale. Quality of sensation at threshold was quantified with indices calculated from subjects' selection of descriptors from a standard McGill Pain Questionnaire. Within-subject reliability for each measure was calculated with intra-class correlation coefficients and between-subject variance was evaluated as group coefficient of variation percentage (CV%). Gender and site comparisons were also made. Forty-five healthy adults participated: 20 male, 25 female; mean age 29 (range 18–56) years. All measures at all four test sites showed high within-subject reliability: cold pain thresholds r = 0.92–0.95; pain rating r = 0.93–0.97; McGill pain quality indices r = 0.87–0.85. In contrast, all measures showed wide between-subject variance (CV% between 51.4% and 92.5%). Upper limb sites were consistently more sensitive than lower limb sites, but equally reliable. Females showed elevated cold pain thresholds, although similar pain intensity and quality to males. Females were also more reliable and showed lower variance for all measures. Thus, although there was clear population variation, response to cold for healthy individuals was found to be highly reliable, whether measured as pain threshold, pain intensity or sensation quality. A comprehensive approach to cold response testing therefore may add validity and improve acceptance of this potentially important pain measure.
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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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Moss P, Knight E, Wright A. Subjects with Knee Osteoarthritis Exhibit Widespread Hyperalgesia to Pressure and Cold. PLoS One 2016; 11:e0147526. [PMID: 26809009 PMCID: PMC4726459 DOI: 10.1371/journal.pone.0147526] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/05/2016] [Indexed: 12/22/2022] Open
Abstract
Hyperalgesia to mechanical and thermal stimuli are characteristics of a range of disorders such as tennis elbow, whiplash and fibromyalgia. This study evaluated the presence of local and widespread mechanical and thermal hyperalgesia in individuals with knee osteoarthritis, compared to healthy control subjects. Twenty-three subjects with knee osteoarthritis and 23 healthy controls, matched for age, gender and body mass index, were recruited for the study. Volunteers with any additional chronic pain conditions were excluded. Pain thresholds to pressure, cold and heat were tested at the knee, ipsilateral heel and ipsilateral elbow, in randomized order, using standardised methodology. Significant between-groups differences for pressure pain and cold pain thresholds were found with osteoarthritic subjects demonstrating significantly increased sensitivity to both pressure (p = .018) and cold (p = .003) stimuli, compared with controls. A similar pattern of results extended to the pain-free ipsilateral ankle and elbow indicating widespread pressure and cold hyperalgesia. No significant differences were found between groups for heat pain threshold, although correlations showed that subjects with greater sensitivity to pressure pain were also likely to be more sensitive to both cold pain and heat pain. This study found widespread elevated pain thresholds in subjects with painful knee osteoarthritis, suggesting that altered nociceptive system processing may play a role in ongoing arthritic pain for some patients.
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Affiliation(s)
- Penny Moss
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
- * E-mail:
| | - Emma Knight
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
| | - Anthony Wright
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
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Clinical Ratings of Pain Sensitivity Correlate With Quantitative Measures in People With Chronic Neck Pain and Healthy Controls: Cross-Sectional Study. Phys Ther 2015; 95:1536-46. [PMID: 26023218 DOI: 10.2522/ptj.20140352] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 05/21/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Correlations between clinical and quantitative measures of pain sensitivity are poor, making it difficult for clinicians to detect people with pain sensitivity. Clinical detection of pain sensitivity is important because these people have a different prognosis and may require different treatment. OBJECTIVE The purpose of this study was to investigate the relationship between clinical and quantitative measures of pain sensitivity across individuals with and without neck pain. METHODS This cross-sectional study included 40 participants with chronic neck pain and 40 age- and sex-matched controls. Participants underwent quantitative sensory testing of cold pain thresholds (CPTs) and pressure pain thresholds (PPTs). Clinical tests for pain sensitivity were the ice pain test and the pressure pain test. All tests were undertaken at standardized local (neck and upper trapezius muscles) and remote (wrist and tibialis anterior muscles) sites. Median and interquartile range (IQR) were calculated for neck pain and control groups, and parametric and nonparametric tests were used to compare groups. Correlation coefficients were calculated between quantitative and clinical measures. RESULTS There were significant differences for clinical and quantitative measures of cold and pressure sensitivity between the neck pain and control groups (eg, CPT neck pain group: median=22.31°C, IQR=18.58°C; control group: median=5.0°C, IQR=0.74°C). Moderate-to-good correlations were found between the clinical ice pain test and CPT at all sites (.46 to .68) except at the wrist (.29 to .40). Fair correlations were found for the clinical pressure pain test and PPT (-.26 to -.45). Psychological variables contributing to quantitative measures of pain sensitivity included catastrophization, sleep quality, and female sex. LIMITATIONS Clinical pressure pain tests were not quantitatively standardized in this study. CONCLUSIONS The ice pain test may be useful as a clinical correlate of CPT at all sites except the wrist, whereas the pressure pain test is less convincing as a clinical correlate of PPT.
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Magin MN, Auer C. [Expert evidence in whiplash injury: interdisciplinary orthopaedic and biomechanical approach]. Unfallchirurg 2015; 117:263-73. [PMID: 24504496 DOI: 10.1007/s00113-013-2544-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Considering the controversially discussed issue of whiplash injury a pragmatic approach based on our own experience in the area of forensic expert opinion is presented. Findings of accident analysis and biomechanics are correlated with the individual situation after the accident (initial clinical appearance), the course of the ailment and the indispensable physical examination. The latter leads to determination of the individual vulnerability (not increased/increased) which is important for the evaluation of the physical condition and estimation of the physical stress limit. These limits vary widely between individuals and must be considered carefully when relating dose and effect of accident severity to a possible physical injury. Determination of the accident severity is especially important when there are no objective signs of injury and the existence of a minor whiplash injury (Quebec Task Force degree 1 or 2) is in question.
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Affiliation(s)
- M N Magin
- Spezialpraxis für Orthopädie und Unfallchirurgie, Bahnhofsweg 10, 82008, Unterhaching/München, Deutschland,
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Abnormal quantitative sensory testing is associated with persistent pain one year after TKA. Clin Orthop Relat Res 2015; 473:246-54. [PMID: 25293497 PMCID: PMC4390964 DOI: 10.1007/s11999-014-3990-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/29/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Up to 15% of patients report at least moderate persistent pain after TKA. Such pain may be associated with the presence of widespread hyperalgesia and neuropathic-type pain. QUESTIONS/PURPOSES We asked if there was a difference among patients who report moderate to severe pain or no pain at least 12 months after TKA regarding (1) pressure pain threshold, (2) thermal (cold/heat) pain and detection thresholds, and (3) self-reported neuropathic pain. PATIENTS AND METHOD Fifty-three volunteers were recruited from patients reporting no pain or moderate to severe pain, according to the Knee Society Score©. Differences between the moderate-to-severe and no-pain groups regarding pressure pain, heat and cold thresholds, and self-reported neuropathic-type pain were analyzed using independent t-tests. RESULTS Patients in the moderate-to-severe pain group exhibited reduced pressure pain threshold in the knee with the TKA (p=0.025) and at the elbow (p=0.002). This group also showed greater pain sensitivity to cold at the knee (p=0.008) and elbow (p=0.010), and increased heat pain sensitivity at the elbow (p=0.032). Cold and heat detection thresholds were impaired in this group at the elbow (cold, p=0.034; heat, p=0.010), although only heat detection was impaired at the knee (p=0.009). The moderate-to-severe pain group also reported more neuropathic-type pain (p=0.001). CONCLUSION Persistent pain after TKA was associated with widespread pressure, cold hyperalgesia, and greater neuropathic-type pain. LEVEL OF EVIDENCE Level III, prognostic study.
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Rushton A, Wright C, Kontakiotis N, Mystrakis A, Frydas D, Heneghan N. Discriminative validity of sensory evaluation in a whiplash-associated disorder II population. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.10.460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Alison Rushton
- Senior lecturer in physiotherapy, academic lead for physiotherapy and programme leader for the MSc Exercise and Sports Medicine (Football) programme at the School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | | | | | | | - Nicola Heneghan
- Physiotherapy lecturer and programme leader for the MSc Advanced Manipulative Physiotherapy programme at the School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
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Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). J Physiother 2014; 60:5-12. [PMID: 24856935 DOI: 10.1016/j.jphys.2013.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 01/27/2023] Open
Affiliation(s)
- Michele Sterling
- Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland and Griffith University, Australia
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Steinmetz A, Jull GA. Sensory and Sensorimotor Features in Violinists and Violists With Neck Pain. Arch Phys Med Rehabil 2013; 94:2523-2528. [DOI: 10.1016/j.apmr.2013.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 03/14/2013] [Accepted: 04/25/2013] [Indexed: 11/30/2022]
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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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Huguet A, Hayden JA, Stinson J, McGrath PJ, Chambers CT, Tougas ME, Wozney L. Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework. Syst Rev 2013; 2:71. [PMID: 24007720 PMCID: PMC3930077 DOI: 10.1186/2046-4053-2-71] [Citation(s) in RCA: 315] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prognosis research aims to identify factors associated with the course of health conditions. It is often challenging to judge the overall quality of research evidence in systematic reviews about prognosis due to the nature of the primary studies. Standards aimed at improving the quality of primary studies on the prognosis of health conditions have been created, but these standards are often not adequately followed causing confusion about how to judge the evidence. METHODS This article presents a proposed adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE), which was developed to rate the quality of evidence in intervention research, to judge the quality of prognostic evidence. RESULTS We propose modifications to the GRADE framework for use in prognosis research along with illustrative examples from an ongoing systematic review in the pediatric pain literature. We propose six factors that can decrease the quality of evidence (phase of investigation, study limitations, inconsistency, indirectness, imprecision, publication bias) and two factors that can increase it (moderate or large effect size, exposure-response gradient). CONCLUSIONS We describe criteria for evaluating the potential impact of each of these factors on the quality of evidence when conducting a review including a narrative synthesis or a meta-analysis. These recommendations require further investigation and testing.
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Affiliation(s)
- Anna Huguet
- Centre for Pediatric Pain Research, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, Nova Scotia B3K 6R8, Canada.
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Sterling M. Challenges to decrease the burden of spinal pain. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.832869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pedler A, Sterling M. Patients with chronic whiplash can be subgrouped on the basis of symptoms of sensory hypersensitivity and posttraumatic stress. Pain 2013; 154:1640-1648. [DOI: 10.1016/j.pain.2013.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/01/2013] [Accepted: 05/01/2013] [Indexed: 12/28/2022]
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Management of acute whiplash: A randomized controlled trial of multidisciplinary stratified treatments. Pain 2013; 154:1798-1806. [DOI: 10.1016/j.pain.2013.05.041] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/27/2013] [Accepted: 05/22/2013] [Indexed: 12/26/2022]
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