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Gagnon P, Dunning J, Bliton P, Charlebois C, Henry N, Gorby P, Mourad F. Dry needling in the management of chronic tension-type headache associated with levator scapulae syndrome: A case report. Clin Case Rep 2024; 12:e8858. [PMID: 38689684 PMCID: PMC11060885 DOI: 10.1002/ccr3.8858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Key Clinical Message The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS. Abstract Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.
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Affiliation(s)
- Peter Gagnon
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physical Therapy of BoulderBoulderColoradoUSA
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Montgomery Osteopractic Physical Therapy & AcupunctureMontgomeryAlabamaUSA
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- William S. Middleton VA HospitalMadisonWisconsinUSA
| | - Casey Charlebois
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Arcadia UniversityGlensidePennsylvaniaUSA
| | - Nathan Henry
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physio RoomColorado SpringsColoradoUSA
| | - Patrick Gorby
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Gorby Osteopractic Physiotherapy, Colorado Springs, COColorado SpringsColoradoUSA
| | - Firas Mourad
- Department of PhysiotherapyLUNEX International University of Health, Exercise and SportsDifferdangeLuxembourg
- Luxembourg Health & Sport Sciences Research Institute ASBLDifferdangeLuxembourg
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Lin LH, Lin TY, Chang KV, Wu WT, Özçakar L. Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2024; 28:231-243. [PMID: 37694895 DOI: 10.1002/ejp.2182] [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: 04/01/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Chronic neck pain (CNP) is a common musculoskeletal disorder. Pain neuroscience education (PNE) is a promising nonpharmacological intervention for CNP, however, its effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of PNE in treating CNP. METHODS Electronic databases from inception to February 2023 were searched for randomized controlled trials (RCTs) on the effects of PNE on CNP. The primary outcome was the change in pain intensity, and the secondary outcome was improvement in kinesiophobia, standardized using Hedges' g. Two authors independently scrutinized eligible articles, extracted data and assessed quality; a random-effects model was employed for data pooling. RESULTS In total, seven RCTs comprising 479 participants were included and demonstrated that PNE significantly reduced pain intensity (Hedges' g = -0.730, 95% CI = -1.340 to -0.119, p = 0.019, I2 = 89.288%). Subgroup analysis revealed that the adult group experienced significant pain reduction after PNE, whereas the adolescent group did not. PNE also reduced kinesiophobia which was evaluated in four of seven RCTs (Hedges' g = -0.444, 95% CI = -0.735 to -0.154, p = 0.003, I2 = 36.822%). The meta-regression analysis indicated that an increased intervention duration contributed to greater pain reduction. No adverse events were reported following PNE or the control treatment. CONCLUSIONS PNE effectively reduced pain intensity and kinesiophobia in patients with CNP. A longer PNE time leads to greater pain reduction and is more effective in adults than in adolescents. Further studies are required to examine the long-term effects on CNP management. SIGNIFICANCE This is the first meta-analysis evaluating the effectiveness of treating chronic neck pain with pain neuroscience education. Pain neuroscience education is successful in reducing pain and decreasing kinesiophobia in the chronic neck pain population. Longer treatment time leads to greater pain reduction.
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Affiliation(s)
- Long-Huei Lin
- Kaohsiung Rukang Physiotherapy Clinic, Kaohsiung, Taiwan
| | - Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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De la Corte-Rodriguez H, Roman-Belmonte JM, Resino-Luis C, Madrid-Gonzalez J, Rodriguez-Merchan EC. The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review. Healthcare (Basel) 2024; 12:242. [PMID: 38255129 PMCID: PMC10815384 DOI: 10.3390/healthcare12020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.
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Affiliation(s)
- Hortensia De la Corte-Rodriguez
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital, 28046 Madrid, Spain;
- IdiPAZ Institute for Health Research, 28046 Madrid, Spain
| | - Juan M. Roman-Belmonte
- Department of Physical Medicine and Rehabilitation, Cruz Roja San José y Santa Adela University Hospital, 28003 Madrid, Spain; (J.M.R.-B.); (C.R.-L.)
- Medical School, Universidad Alfonso X El Sabio (UAX), 28691 Madrid, Spain
| | - Cristina Resino-Luis
- Department of Physical Medicine and Rehabilitation, Cruz Roja San José y Santa Adela University Hospital, 28003 Madrid, Spain; (J.M.R.-B.); (C.R.-L.)
| | - Jorge Madrid-Gonzalez
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital, 28046 Madrid, Spain;
| | - Emerito Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, 28046 Madrid, Spain;
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research—IdiPAZ (La Paz University Hospital—Autonomous University of Madrid), 28046 Madrid, Spain
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Rahman S, Kidwai A, Rakhamimova E, Elias M, Caldwell W, Bergese SD. Clinical Diagnosis and Treatment of Chronic Pain. Diagnostics (Basel) 2023; 13:3689. [PMID: 38132273 PMCID: PMC10743062 DOI: 10.3390/diagnostics13243689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved. Furthermore, it is a tremendous financial strain on the healthcare system, as over USD 100 billion is spent yearly in the United States on healthcare costs related to pain management and opioids. This exceeds the costs of diabetes, heart disease, and cancer-related care combined. Being able to properly diagnose, manage, and treat chronic pain conditions can substantially lower morbidity, mortality, and healthcare costs in the United States. This review will outline the current definitions, biopsychosocial model, subclassifications, somatosensory assessments, imaging, clinical prediction models, and treatment modalities associated with chronic pain.
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Affiliation(s)
| | | | | | | | | | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.R.); (A.K.); (E.R.); (M.E.); (W.C.)
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Araújo Almeida L, Bilterys T, Van Looveren E, Mairesse O, Cagnie B, Meeus M, Moens M, Goubert D, Munneke W, Danneels L, Ickmans K, Rezende Camargo P, Nijs J, Malfliet A, De Baets L. Do Patients with Chronic Spinal Pain and Comorbid Insomnia Have More Features of Central Sensitization? A Case-Control Study. Healthcare (Basel) 2023; 11:3152. [PMID: 38132043 PMCID: PMC10742599 DOI: 10.3390/healthcare11243152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/26/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Chronic spinal pain (CSP) is a major public health problem worldwide, frequently related to sleep problems. Central sensitization (CS) may worsen the clinical picture of CSP patients with insomnia. The aim of this study was to compare self-reported and objectively measured clinical outcomes between insomniac CSP patients with comorbid insomnia with and without symptoms of CS. METHODS A case-control study on baseline self-reported sleep, functioning, and psychological distress through online questionnaires. Objective sleep and physical activity parameters and pressure pain thresholds (PPTs) were assessed through polysomnography, actigraphy, and digital algometry, respectively. Independent sample t-test and Mann-Whitney U tests were used to examine possible differences in the outcome measures between the groups. RESULTS Data from 123 participants were included and revealed no statistically significant group for objective sleep and physical activity parameters. The CS group, however, presented with worse self-reported sleep (quality sleep, insomnia severity, and dysfunctional beliefs about sleep), increased mental and physical fatigue, and higher psychological distress (anxiety and depressive symptoms), and reported lower PPTs. CONCLUSIONS symptoms of CS may influence perceived sleep and affect functional health and well-being perception but do not seem to affect objective sleep and physical activity.
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Affiliation(s)
- Lucas Araújo Almeida
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos 13565-905, SP, Brazil;
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA
| | - Thomas Bilterys
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
- Institute of Advanced Study, University of Warwick, Coventry CV4 7AL, UK
| | - Eveline Van Looveren
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
| | - Olivier Mairesse
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
| | - Mira Meeus
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Maarten Moens
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Neurosurgery and Radiology, University Hospital Brussels, 1090 Brussels, Belgium
- Stimulus Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Center of Neurosciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Dorien Goubert
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
| | - Wouter Munneke
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Sport and Rehabilitation Sciences, University of Liège, 4000 Liege, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Movement & Nutrition for Health & Performance Research Group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos 13565-905, SP, Brazil;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41390 Göterbog, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
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Cortés-Pérez I, Zagalaz-Anula N, Ibancos-Losada MDR, Nieto-Escámez FA, Obrero-Gaitán E, Osuna-Pérez MC. Virtual Reality-Based Therapy Reduces the Disabling Impact of Fibromyalgia Syndrome in Women: Systematic Review with Meta-Analysis of Randomized Controlled Trials. J Pers Med 2021; 11:1167. [PMID: 34834518 PMCID: PMC8621064 DOI: 10.3390/jpm11111167] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Virtual reality-based therapy (VRBT) is a novel therapeutic approach to be used in women with fibromyalgia syndrome (FMS). The aim of our study is to assess the effect of VRBT to reduce the impact of FMS in outcomes such as pain, dynamic balance, aerobic capacity, fatigue, quality of life (QoL), anxiety and depression. METHODS Systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science and CINAHL until April 2021 in accordance with PRISMA guidelines. We included randomized controlled trials (RCTs) that compare VRBT versus others to assess the mentioned outcomes in women with FMS. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI). RESULTS Eleven RCTs involving 535 women with FMS were included. Using the PEDro scale, the mean methodological quality of the included studies was moderate (6.63 ± 0.51). Our findings showed an effect of VRBT on the impact of FMS (SMD -0.62, 95% CI -0.93 to -0.31); pain (SMD -0.45, 95% CI -0.69 to -0.21); dynamic balance (SMD -0.76, 95% CI -1.12 to -0.39); aerobic capacity (SMD 0.32, 95% CI 0.004 to 0.63); fatigue (SMD -0.58, 95% CI -1.02 to -0.14); QoL (SMD 0.55, 95% CI 0.3 to 0.81); anxiety (SMD -0.47, 95% CI -0.91 to -0.03) and depression (SMD -0.46, 95% CI -0.76 to -0.16). CONCLUSIONS VRBT is an effective therapy that reduces the impact of FMS, pain, fatigue, anxiety and depression and increases dynamic balance, aerobic capacity and quality of life in women with FMS. In addition, VRBT in combination with CTBTE showed a large effect in reducing the impact of FMS and fatigue and increasing QoL in these women.
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Affiliation(s)
- Irene Cortés-Pérez
- Granada Northeast Health District, Andalusian Health Service, Street San Miguel 2, 18500 Guadix, Spain;
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (M.d.R.I.-L.); (M.C.O.-P.)
| | - Noelia Zagalaz-Anula
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (M.d.R.I.-L.); (M.C.O.-P.)
| | - María del Rocío Ibancos-Losada
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (M.d.R.I.-L.); (M.C.O.-P.)
| | - Francisco Antonio Nieto-Escámez
- Department of Psychology, University of Almería, Ctra. Sacramento s/n, 04120 Almería, Spain;
- Center for Neuropsychological Assessment and Rehabilitation (CERNEP), Ctra. Sacramento s/n, 04120 Almeria, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (M.d.R.I.-L.); (M.C.O.-P.)
| | - María Catalina Osuna-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (M.d.R.I.-L.); (M.C.O.-P.)
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Perry T. Treatment of thoracic spine pain and pseudovisceral symptoms with dry needling and manual therapy in a 78-year-old female: A case report. Physiother Theory Pract 2021; 38:3255-3263. [PMID: 34632909 DOI: 10.1080/09593985.2021.1987603] [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: 10/20/2022]
Abstract
DESIGN Case Report. BACKGROUND AND PURPOSE Thoracic spine pain and movement dysfunction is a relatively common problem in the general population but has received little attention in research. Dry needling is frequently utilized by physical therapists and has been shown to reduce pain and improve function in areas, such as the cervical and lumbar spine, shoulder, hip, and knee. However, little research has been performed on the use of dry needling in the thoracic area with only two prior case studies being published. This case report documents the use of dry needling and manual therapy to treat a patient with symptoms of thoracic spine pain with concurrent pseudovisceral symptoms of chest pain and difficulty breathing. CASE DESCRIPTION The patient was a 78-year-old female who was referred to physical therapy with complaints of pain focused in her mid-thoracic spine radiating anteriorly into her chest. The patient underwent medical diagnostic tests prior to her referral to physical therapy to rule out cardiac pathology, pulmonary pathology, and fracture. She was treated with dry needling and manual therapy for a total of four sessions over a two-week period. OUTCOMES Fifteen days after her initial evaluation, the patient reported she was pain-free with a pain score of 0/10 on the VAS. She reported she was no longer taking pain medication or NSAIDS. She was able to return to normal daily activities without restriction and normal sleep pattern. Her score on the Oswestry disability index at intake was 42% impairment and 2% impairment after 4 treatments. At follow-up 6 weeks and 12 weeks after her discharge from physical therapy, the patient reported she continued to be pain-free.
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Affiliation(s)
- Todd Perry
- Perry Physical Therapy, PLLC, Trillium Wellness Center, Potsdam, NY, USA.,Department of Physical Therapy, Clarkson University, Potsdam, NY, USA
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Xie Y, Thomas L, Barbero M, Falla D, Johnston V, Coombes BK. Heightened pain facilitation rather than impaired pain inhibition distinguishes those with moderate/severe disability in work-related neck pain. Pain 2021; 162:2225-2236. [PMID: 33534358 DOI: 10.1097/j.pain.0000000000002213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/20/2021] [Indexed: 01/16/2023]
Abstract
ABSTRACT To better understand the mechanisms underpinning work-related neck pain, this cross-sectional and single-blinded study compared somatosensory profiles among sonographers with varied neck disability levels. Based on K-mean cluster analysis of scores on the neck disability index (NDI), participants were classified into no (NDI ≤ 8%, n = 31, reference group), mild (NDI = 10%-20%, n = 43), or moderate/severe (NDI ≥ 22%, n = 18) disability groups. Data were collected on bodily pain distribution and severity and psychological measures including depression, anxiety, pain-catastrophizing, and fear-avoidance beliefs using validated scales. Participants attended 1 session of quantitative sensory testing performed according to a standardized protocol, including local and remote thermal and mechanical pain thresholds, temporal summation of pain (TSP), conditioned pain modulation, and an exercise-induced analgesia paradigm. Compared with participants with no and mild disability, those with moderate/severe disability showed more widespread pain, cold and mechanical hyperalgesia at a remote nonpainful site, and significantly higher TSP. Participants with mild disability demonstrated significantly higher TSP than those with no disability. These group differences were attenuated after adjusting for depression or anxiety, indicating these psychological factors may mediate the somatosensory changes associated with neck disability. Group differences were not found for conditioned pain modulation or exercise-induced analgesia. These findings suggest that heightened pain facilitation, rather than impaired pain inhibition may underpin nociplastic pain in participants with moderate/severe disability, and it may be associated with depression and anxiety. Clinicians should be aware that individuals with work-related neck pain presenting with moderate/severe disability display distinct somatosensory features and tailor management strategies accordingly.
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Affiliation(s)
- Yanfei Xie
- School of Health and Rehabilitation Science, The University of Queensland, QLD, Australia
| | - Lucy Thomas
- School of Health and Rehabilitation Science, The University of Queensland, QLD, Australia
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
| | - 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, United Kingdom
| | - Venerina Johnston
- School of Health and Rehabilitation Science, The University of Queensland, QLD, Australia
- RECOVER Injury Research Centre, The University of Queensland, QLD, Australia
| | - Brooke K Coombes
- School of Allied Health Sciences, Griffith University, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
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9
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Paris-Alemany A, Belaustegui-Ferrández I, López-Ruiz M, Gadea-Mateos L, La Touche R, Suso-Martí L. Cognitive, emotional, and somatosensory behavior in professional dancers with acute and chronic pain. PM R 2021; 14:987-995. [PMID: 34252270 DOI: 10.1002/pmrj.12672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dance has been linked in a complex manner to pain and the physical and psychological peculiarities of this discipline could influence pain perception and chronicity of pain. OBJECTIVE To determine the differences in cognitive, emotional, and somatosensory symptoms between dancers with acute versus chronic pain. DESIGN A cross-sectional study of professional dancers with pain. SETTING Higher conservatory of dance. PARTICIPANTS Thirty-four professional dancers experiencing pain were included. The cohort was divided into two subgroups: those with acute pain (<3 months duration) and those with chronic pain (>3 months duration). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain intensity (as measured by the visual analogue scale or VAS), pressure pain threshold (PPT), Pain Catastrophizing Scale (PCS), pain-related fear of movement (Tampa Scale of Kinesiophobia [TSK-11]), fear avoidance beliefs (Fear-Avoidance Beliefs Questionnaire [FABQ]), self-efficacy (Chronic Pain Self-Efficacy Scale [CPSS]). and chronic pain severity (Chronic Pain Graded Scale [CPGS]). RESULTS Dancers with chronic pain reported higher levels of pain intensity in daily activities (p < .01; t = 3.42; d = 1.17) and during exercise/dance (p = .02; t = 2.82; d = 0.82), as well as lower PPT in lumbar (p = .03; t = 3.22; d = 1.1) and tibialis regions (p = .01; t = 2.51; d = 0.86). Dancers with acute pain experienced worse psychological symptoms indicated by the fear of harm subscale of TSK-11 (p = .04; t = -2.08; d = 0.72), physical activity subscale of FABQ (p = .03; t = -2.27; d = 0.78), and pain management subscale of CPSS (p = .01; t = -2.76; d = 0.94) and lower scores for CPGS scale (p = .01; t = 2.99; d = 0.7 to 1.26). CONCLUSIONS The results showed differences in pain intensity and PPT revealing higher values in dancers with chronic pain. It is possible that the physical and psychological characteristics of dancers, as well as the sociocultural aspects of this discipline, could influence the way in which this population interprets pain.
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Affiliation(s)
- Alba Paris-Alemany
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
| | - Ignacio Belaustegui-Ferrández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - María López-Ruiz
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
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10
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Sillevis R, Trincado G, Shamus E. The immediate effect of a single session of pain neuroscience education on pain and the autonomic nervous system in subjects with persistent pain, a pilot study. PeerJ 2021; 9:e11543. [PMID: 34131526 PMCID: PMC8174152 DOI: 10.7717/peerj.11543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The autonomic nervous system is a system that operates at the subconscious level and has been associated with neurobehavioral aspects of pain. Overall, persistent pain has a stimulating effect on the sympathetic nervous system. A promising emerging nonpharmacological treatment to manage persistent pain is neuroscience-based pain education. The overarching goal of neuroscience-based pain education is to change cognitions about pain and the pain experience through education. The aim was to determine the immediate and short-term impact of a neuroscience-based pain education video on the autonomic nervous system and pain in a subgroup of individuals with persistent pain. METHODS A convenience sample of 26 subjects were recruited for this study. Each subject indicated their pain level at the time of testing using a Visual Analogue Scale. Automated pupillometry was utilized to measure pupil diameter. After two minutes of accommodation to the goggles, the pupil was measured continuously for 60 s. Following this a 5-minute video presentation "Understanding Pain" was watched, followed by a continuous pupil measurement for 60 s. Three minutes after this measure, the final pupil diameter measurement was taken for 60 s. After completing the final pupil measure, the subject was asked to fill out a second Visual Analogue Scale and a Global Rate of Change. OUTCOMES Each subject completed a Global Rating of Change Scale and the mean score was 1.14 (SD = 1.61 and a SEM = 0.), supporting the hypothesis of an overall self-perceived benefit from the intervention. There was a statistically significant difference in pain following the video, P < 0.01. A significant correlation was observed between the self-perceived decrease in pain level and the Global Rating of Change score, p = 0.02. There was no statistically significant difference in the mean pupil diameter following the video with p = 0.76 for the right eye and p = 0.250 for the left eye. DISCUSSION This pilot study demonstrated that a 5-minute neuroscience-based pain education video reduced perceived pain in a small sample of subjects with persistent pain. Watching the neuroscience-based pain education video did not seem to result in an immediate generalized autonomic nervous system response. However, it resulted in a different reaction on each eye. This unequal response might be the result of the hemispheric lateralization of the ANS. This study supports the fact that the pain experience is determined by the balance between conscious cognitive processes and subconscious processes based on previous psychological experiences.
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Affiliation(s)
- Rob Sillevis
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
| | - Gabriel Trincado
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
| | - Eric Shamus
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
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11
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Xu C, Fu Z, Wang X. Effect of Transversus abdominis muscle training on pressure-pain threshold in patients with chronic low Back pain. BMC Sports Sci Med Rehabil 2021; 13:35. [PMID: 33794983 PMCID: PMC8017650 DOI: 10.1186/s13102-021-00262-8] [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] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/23/2021] [Indexed: 12/29/2022]
Abstract
Background Therapeutic training is the most commonly used treatment methods for chronic low back pain (CLBP), and the use of a pressure biofeedback unit for transversus abdominis muscle (TrA) training is one of the core muscle training methods. The study aim of this research is to explore the effects of different intensities (sham training, low-intensity and high-intensity) of TrA muscle training on people with CLBP in pressure-pain threshold (PPT). Methods A total of 45 patients with CLBP were recruited, of whom 44 were included in the analysis. Fifteen, 14, and 15 were included in the sham training group, the low-intensity group, and the high-intensity group, respectively. A pressure biofeedback unit was used in performing a one-time TrA training intervention involving 30 times of 180 mmHg TrA contraction training at high intensity for 10 min and 15 times of 100 mmHg TrA contraction training at low intensity for 5 min. The sham training group completed comfort exercises and did not undergo training. The evaluation indicators were as follows: PPT, short-form McGill pain questionnaire, and body surface pain radiation. Results High-intensity training could activate more waist core muscles than low-intensity training. Significant changes on PPT (units: kgf) were observed in the following four muscles immediately after high-intensity training: iliopsoas [0.69 (0.13–1.25) 95% CI, p = 0.020]; quadratus lumborum [0.84 (0.23–1.45) 95% CI, p = 0.012]; erector spinae [0.66 (0.18–1.15) 95% CI, p = 0.011]; transversus abdominis [0.70 (0.26–1.14) 95% CI, p = 0.004], and in three muscles after low-intensity training: quadratus lumborum [0.61 (0.17–1.05) 95% CI, p = 0.009]; transversus abdominis [0.14 (from − 0.15 to 0.43) 95% CI, p = 0.022]; piriformis [0.55 (0.13–0.98) 95% CI, p = 0.014]. The change in body surface pain radiation immediately after exercise was [− 10.87 (from − 17.51 to − 4.22) 95% CI, p = 0.003] for high-intensity training and [− 5.21 (from − 9.40 to − 1.03) 95% CI, p = 0.019] for low-intensity training. Conclusions TrA training could increase the PPT of the waist core muscles and reduce the radiation range of waist pain. The benefits of high-intensity training are higher than those of low-intensity training. Trial registration ChiCTR-TRC-13003701. Registered 18 October 2013. Code of ethical approval: 2018069.
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Affiliation(s)
- Changming Xu
- Department of Rehabilitation, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Zhiwei Fu
- Department of Bone and Joint Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China. .,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospitai, Shanghai, China.
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12
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Efficacy of Manual Therapy on Facilitatory Nociception and Endogenous Pain Modulation in Older Adults with Knee Osteoarthritis: A Case Series. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11041895] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: manual therapy (MT) has been shown to have positive effects in patients with osteoarthritis (OA)-related pain, and its use in clinical settings is recommended. However, the mechanisms of action for how these positive effects occur are not yet well understood. The aim of the present study was to investigate the influence of MT treatment on facilitatory nociception and endogenous pain modulation in patients with knee OA related pain. Methods: Twenty-eight patients with knee OA were included in this study. Pain intensity using the numerical pain rating scale (NPRS), temporal summation (TS), conditioned pain modulation (CPM), and local (knee) and distant (elbow) hyperalgesia through the pressure pain threshold (PPT), were assessed to evaluate the pain modulatory system. Patients underwent four sessions of MT treatments within 3 weeks and were evaluated at the baseline, after the first session and after the fourth session. Results: the MT treatment reduced knee pain after the first session (p = 0.03) and after the fourth session (p = 0.04). TS decreased significantly after the fourth session of MT (p = 0.02), while a significant increase in the CPM assessment was detected after the fourth session (p = 0.05). No significant changes in the PPT over the knee and elbow were found in the follow-ups. Conclusions: The results from our study suggest that MT might be an effective and safe method for improving pain and for decreasing temporal summation.
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13
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Therapeutic Exercise and Pain Neurophysiology Education in Female Patients with Fibromyalgia Syndrome: A Feasibility Study. J Clin Med 2020; 9:jcm9113564. [PMID: 33167469 PMCID: PMC7694507 DOI: 10.3390/jcm9113564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background: We compared the effects of therapeutic exercise (TE) combined with pain neurophysiology education (PNE) to those of TE in isolation on pain intensity, general fibromyalgia impact, mechanical pain sensitivity, pain catastrophizing, psychological distress and quality of life in women with fibromyalgia syndrome (FMS). Methods: A feasibility study with a 3 month follow-up was designed. Thirty-two patients with FMS were randomly assigned to PNE + TE group (n = 16) or to TE group (n = 16). Both groups received 30 sessions of TE (3 per week), and the PNE + TE group received eight face-to-face educational sessions. The measuring instruments used were the visual analogue scale, a standard pressure algometer, the Revised Fibromyalgia Impact Questionnaire, the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale and the Health Assessment Questionnaire. Results: The PNE + TE group showed a statistically significant decrease on pain intensity compared to TE group at short term (p = 0.015). No between-groups differences were found for mechanical pain sensitivity, general fibromyalgia impact, pain catastrophizing, psychological distress or quality of life (p > 0.05). Conclusions: The combination of PNE and TE was more effective than TE for reducing pain intensity in the short-term. No differences were found for psychological distress, pain catastrophizing and quality of life after the intervention or at 3 months of follow-up.
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14
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Arribas-Romano A, Fernández-Carnero J, Molina-Rueda F, Angulo-Diaz-Parreño S, Navarro-Santana MJ. Efficacy of Physical Therapy on Nociceptive Pain Processing Alterations in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:2502-2517. [PMID: 32100027 DOI: 10.1093/pm/pnz366] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Chronic musculoskeletal pain is a major health, social, and economic problem. Most of the subjects who suffer from chronic musculoskeletal pain present processes of central sensitization. Temporal summation and conditioned pain modulation are the two most commonly used clinical measures of this. The objective of this review is to evaluate the effects of physical therapy on temporal summation (TS) and conditioned pain modulation (CPM) in patients with chronic musculoskeletal pain. METHODS This is a systematic review and meta-analysis. We searched the MEDLINE, EMBASE, CINAHL, EBSCO, PubMed, PEDro, Cochrane Collaboration Trials Register, Cochrane Database of Systematic Reviews, and SCOPUS databases. Different mesh terms and key words were combined for the search strategy, with the aim of encompassing all studies that have used any type of physical therapy treatment in patients with chronic musculoskeletal pain and have measured both TS and CPM. RESULTS Eighteen studies remained for qualitative analysis and 16 for quantitative analysis. Statistically significant differences with a 95% confidence interval (CI) were obtained for TS (-0.21, 95% CI = -0.39 to -0.03, Z = 2.50, P = 0.02, N = 721) and CPM (0.34, 95% CI = 0.12 to 0.56, Z = 2.99, P = 0.003, N = 680) in favor of physical therapy as compared with control. Manual therapy produces a slight improvement in TS, and physical therapy modalities in general improve CPM. No significant differences between the subgroups of the meta-analysis were found. The methodological quality of the studies was high. CONCLUSIONS Physical therapy produces a slight improvement in central sensitization (CS)-related variables, with TS decreased and CPM increased when compared with a control group in patients with CMP. Only significant differences in TS were identified in the manual therapy subgroup.
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Affiliation(s)
- Alberto Arribas-Romano
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Physiotherapy and Pain Research Center. General Foundation of the University of Alcalá, Madrid, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Grupo Multidisciplinar de Investigación & Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, Madrid, Spain
| | - Francisco Molina-Rueda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
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15
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The moderating effects of pain catastrophizing on the relationship between illness perceptions and self-reported signs of central sensitization in patients with persistent pain. Int J Rehabil Res 2020; 43:347-354. [PMID: 32909989 DOI: 10.1097/mrr.0000000000000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two factors related to the continuation of persistent pain are pain catastrophizing and illness perceptions. Pain neuroscience education is known to positively influence both in patients with persistent pain. As the integration of pain neuroscience education in monodisciplinary physiotherapy treatments is effective, integration in transdisciplinary cognitive-behavioral treatments seems recommendable. When doing so, the moderating effect of pain catastrophizing and perceptions on treatment results have to be examined, as these provide valuable information under which conditions treatment works. A bottom-up retrospective observational study evaluated the changes in clinical outcomes, and relationships between clinical outcomes and cognitive and emotional factors in patients with persistent pain. Multiple regression analysis, PROCESS macro, explored the moderating effects of pain catastrophizing on the relationship between illness perceptions and self-reported symptoms of central sensitization. In total, 78 patients were included in the study. A correlation between pretreatment scores and change scores in illness perceptions and self-reported symptoms of central sensitization following treatment were found (resp. R-sq 0.407, F(10,99) = 0.638, P = 0.000; R-sq 0.361, F(5, 54) = 0.609, P = 0.000; and R-sq 0.314, F(4,55) = 0.560, P = 0.00), however, moderation of pain catastrophizing scores on these correlations was not found. Even though an association between changes in pain catastrophizing and illness perceptions in patients with persistent pain was found, the direction or strength between the changes in illness perceptions and changes in self-reported symptoms of central sensitization was not influenced by pretreatment scores of pain catastrophizing.
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16
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Sturman S, Killingback C. Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia? J Bodyw Mov Ther 2020; 24:141-153. [PMID: 32825980 DOI: 10.1016/j.jbmt.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current clinical guidelines do not support the use of manual therapy (MT) interventions for Fibromyalgia (FM) patients, despite evidence of positive biochemical, mechanical and psychological effects, and the popularity of hands-on treatments amongst patients. An optimal dose for MT has not been established; this may explain the discrepancies found within the published literature. The aim of this systematic review was to determine whether there is a dose response relationship for MT leading to improvements in core domains of FM symptomology; Pain, Mood, Sleep, Global Measure of Impact (Functional Status & Quality of Life). METHODS We searched six databases from 1990 to January 2018; studies were evaluated using the PEDro scale. Within-group (ESd) and between-group (ESg) Effect Sizes were calculated. RESULTS We identified and screened 4012 articles, 12 articles were critically appraised. Overall, there is moderate evidence that MT has positive effects on the four clinical outcomes investigated. However, there was no consistent dose response relationship observed across all studies. CONCLUSIONS A dose of approximately 45 min MT, three to five times per week, for three to five weeks, totalling 11 h 15 min, should be considered a baseline generic protocol for treatment delivery and research trials. Further research is necessary to confirm domain specific, or patient specific optimal doses. Moderator variables such as treatment time, frequency, duration; and MT type also need to be explored to ensure optimal delivery of MT in future research and clinical care provision.
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Affiliation(s)
- Sarah Sturman
- Dorset Pain Management Service, Dorset Healthcare University NHS Foundation Trust, Poole, BH2 2NT, UK.
| | - Clare Killingback
- Faculty of Health Sciences, Department for Sport, Health and Exercise Science, University of Hull, Don 207, HU6 7RX, UK
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17
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Khodadad B, Letafatkar A, Hadadnezhad M, Shojaedin S. Comparing the Effectiveness of Cognitive Functional Treatment and Lumbar Stabilization Treatment on Pain and Movement Control in Patients With Low Back Pain. Sports Health 2019; 12:289-295. [PMID: 31841078 DOI: 10.1177/1941738119886854] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The treatment of chronic low back pain (LBP) should target both behavioral variables and physical performance factors. HYPOTHESIS Cognitive functional treatment (CFT) and lumbar stabilization treatment (LST) will result in positive changes in pain and lumbar movement control (LMC) in patients with LBP. STUDY DESIGN Pretest-posttest intervention. LEVEL OF EVIDENCE Level 3. METHODS After screening, 52 participants (mean age, 44.3 ± 2.46 years) with chronic LBP were allocated into CFT (n = 17), LST (n = 17), or control (n = 18) groups. Pain and LMC were evaluated before and after 8 weeks of intervention with visual analog scale (VAS) and Luomajoki LMC battery tests, respectively. RESULTS Compared with baseline, pain and LMC were reduced and improved significantly in both groups after 8 weeks. However, the changes in both variables were not significantly different between groups. Percent change for pain between pretest and posttest values in the LST group was a decrease of 45% (P = 0.003), compared with a decrease of 40% (P = 0.003) in the CFT group. Change in LMC in the LST group was a decrease of 100% (P = 0.026), compared with a decrease of 200% (P = 0.018) in the CFT group. There as no change for both variables in the control group. CONCLUSION Both CFT and LST groups improved LMC scores and reduced pain intensity. However, there was no difference between the 2 experimental groups on pain and LMC test results. CLINICAL RELEVANCE In this study, intended to construct an intervention for people with chronic LBP, the primary aims were to help individuals "make sense of their pain," develop effective pain control strategies via body relaxation and extinction of safety behaviors, and adopt healthy lifestyle behaviors to affect cognitive factors known to affect pain sensitivity and disability. These primary aims were achieved through an emphasis on factors such as development of positive beliefs, reduced fear, increased awareness, enhanced understanding and control of pain, adaptive coping, enhanced self-efficacy, confidence, and improved mood through the class-based intervention.
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Affiliation(s)
- Behrouz Khodadad
- Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Republic of Iran
| | - Amir Letafatkar
- Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Republic of Iran
| | - Malihe Hadadnezhad
- Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Republic of Iran
| | - Sadredin Shojaedin
- Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Republic of Iran
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Larson CM, Wilcox GL, Fairbanks CA. Defining and Managing Pain in Stroke and Traumatic Brain Injury Research. Comp Med 2019; 69:510-519. [PMID: 31896392 PMCID: PMC6935700 DOI: 10.30802/aalas-cm-19-000099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 01/01/2023]
Abstract
Neurologic conditions such as stroke and traumatic brain injury are challenging conditions to study in humans. Animal models are necessary to uncover disease processes and develop novel therapies. When attempting to model these or other neurologic diseases, the accompanying anesthesia and analgesia create variables that are not part of the onset of the clinical disease in the human population but are critical components of the postinjury care both in humans and animals. To maximize model validity, researchers must consider whether the disease process or a novel therapy is being studied. Damage to the neurons of the brain or the spinal cord is not painful at the neural tissue itself, but alterations to nociceptive signaling along the pain pathway can induce chronic pain. In addition, trauma or surgery leading to the event is associated with damage to peripheral tissue. Inflammation is inextricably associated with tissue injury. Inflammation is known to evoke nociception in the periphery and drive long-term changes to neurons in the CNS. Analgesics and anesthetics alter these responses yet are required as part of humane animal care. Careful planning for effective drug administration consistent with the standard of care for humans and equivalent animal care is required.
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Affiliation(s)
- Christina M Larson
- Departments of Comparative and Molecular Biosciences, University of Minnesota College of Veterinary Medicine, St Paul, Minnesota;,
| | - George L Wilcox
- Departments of Neuroscience, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Carolyn A Fairbanks
- Departments of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota
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Palsson TS, Gibson W, Darlow B, Bunzli S, Lehman G, Rabey M, Moloney N, Vaegter HB, Bagg MK, Travers M. Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. Phys Ther 2019; 99:1511-1519. [PMID: 31355883 DOI: 10.1093/ptj/pzz108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/18/2018] [Accepted: 03/10/2019] [Indexed: 02/09/2023]
Abstract
The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where SIJ is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, when the SIJ might be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the SIJ(s)-a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this Perspective article argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models with contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.
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Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | - Niamh Moloney
- Thrive Physiotherapy; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Henrik B Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; and New College Village, University of New South Wales
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame; and School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Hamasaki T, Pelletier R, Bourbonnais D, Harris P, Choinière M. Pain-related psychological issues in hand therapy. J Hand Ther 2019; 31:215-226. [PMID: 29449064 DOI: 10.1016/j.jht.2017.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/16/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Literature review. INTRODUCTION Pain is a subjective experience that results from the modulation of nociception conveyed to the brain via the nervous system. Perception of pain takes place when potential or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced by one's cognitions and emotions based on her/his pain-related experiences, which are processed in the forebrain and limbic areas of the brain. Unarguably, patients' psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, disability, and treatment outcomes. Therefore, hand therapists should address the patient pain experience using a biopsychosocial approach. However, in hand therapy, a biomedical perspective predominates in pain management by focusing solely on tissue healing. PURPOSE OF THE STUDY This review aims to raise awareness among hand therapists of the impact of pain-related psychological factors. METHODS AND RESULTS This literature review allowed to describe (1) how the neurophysiological mechanisms of pain can be influenced by various psychological factors, (2) several evidence-based interventions that can be integrated into hand therapy to address these psychological issues, and (3) some approaches of psychotherapy for patients with maladaptive pain experiences. DISCUSSION AND CONCLUSION Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. Numerous psychological factors including patients' beliefs, cognitions, and emotions alter their pain experience and may impact on their outcomes. Decoding the biopsychosocial components of the patients' pain is thus essential for hand therapists.
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Affiliation(s)
- Tokiko Hamasaki
- Research Center of the CHUM, Montreal, Québec, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Hand Center, CHUM, Montreal, Québec, Canada
| | - René Pelletier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Daniel Bourbonnais
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada
| | - Patrick Harris
- Hand Center, CHUM, Montreal, Québec, Canada; Department of Surgery, Plastic Surgery Service, CHUM, Montreal, Québec, Canada; Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Manon Choinière
- Research Center of the CHUM, Montreal, Québec, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
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21
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Palsson TS, Travers MJ, Rafn T, Ingemann-Molden S, Caneiro JP, Christensen SW. The use of posture-correcting shirts for managing musculoskeletal pain is not supported by current evidence - a scoping review of the literature. Scand J Pain 2019; 19:659-670. [PMID: 31075089 DOI: 10.1515/sjpain-2019-0005] [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] [Received: 12/20/2018] [Accepted: 03/13/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The concept of bad posture being a dominant driver of pain is commonly held belief in the society. This may explain the significant attention supportive clothing such as posture-correcting shirts has recently gained in Scandinavia and the USA. The aim of this scoping review was to present an overview and synthesis of the available evidence for the use of posture-correcting shirts aimed at reducing pain or postural discomfort and optimising function/posture. METHODS A systematic search was conducted for literature investigating the effect of posture-correcting shirts on musculoskeletal pain or function. PubMed, Embase, CINAHL, PEDro and the Cochrane Library were searched for relevant literature. Results of the searches were evaluated by two independent reviewers in three separate steps based on title, abstract and full text. For data synthesis, the population, intervention, comparator and outcome were extracted. The quality of the literature was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the risk of bias was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) assessment tool or the RoB 2.0 tool for individually randomized, parallel group trials. The overall confidence in the literature was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 136 articles were identified and six of these were included in the review. These studies were heterogeneous with regards to aims, outcomes and methods, presenting contrasting results. The overall findings were that posture-correcting shirts change posture and subjectively have a positive effect on discomfort, energy levels and productivity. The quality of the included literature was poor to fair with only one study being of good quality. The risk of bias was serious or critical for the included studies. Overall, this resulted in very low confidence in available evidence. An important limitation of all studies was that they were conducted in pain-free individuals. CONCLUSIONS The contrasting findings and the low quality of current literature, questions the intended effect of posture-correcting shirts and whether the changes it creates are in fact useful for clinical practice. Moreover, the findings are contrasted by the available evidence regarding posture and pain with a particular focus on whether this management strategy may have a detrimental effect on people living with musculoskeletal pain. A major limitation to the existing literature on the effect of posture-correcting shirts is that no studies have investigated their effect in clinical populations. IMPLICATIONS Based on the available literature and the major limitation of no studies investigating clinical populations, there is no good quality evidence to support recommendation of posture-correcting shirts as a management strategy for musculoskeletal pain. Promotion of this product may reinforce the inaccurate and unhelpful message that poor posture leads to pain. The efficacy of such garments should be tested in clinical populations and not only in pain-free individuals, to assess whether there is any meaningful benefit of this management approach. Until then, the use of posture-correcting shirts for musculoskeletal pain is not supported by current evidence.
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Affiliation(s)
- Thorvaldur Skuli Palsson
- Associate Professor, Department of Health Science and Technology, SMI® Aalborg University, Frederik Bajers Vej 7A-205, Aalborg, Denmark, Phone: +4530220937
| | - Mervyn J Travers
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Trine Rafn
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Stian Ingemann-Molden
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - J P Caneiro
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Body Logic Physiotherapy Clinic, Perth, Australia
| | - Steffan Wittrup Christensen
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark.,Department of Health Science and Technology, SMI® Aalborg University, Aalborg, Denmark
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22
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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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23
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Nieto-García J, Suso-Martí L, La Touche R, Grande-Alonso M. Somatosensory and Motor Differences between Physically Active Patients with Chronic Low Back Pain and Asymptomatic Individuals. ACTA ACUST UNITED AC 2019; 55:medicina55090524. [PMID: 31450752 PMCID: PMC6780835 DOI: 10.3390/medicina55090524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
Background and Objectives: Chronic low back pain (CLBP) is the most common occupational disorder due to its associated disability and high risk of recurrence and chronicity. However, the mechanisms underlying physical and psychological variables in patients with CLBP remain unclear. The main objective of this study was to assess whether there were differences between physically active patients with nonspecific CLBP compared with asymptomatic individuals in sensorimotor and psychological variables. Materials and Methods: This was an observational cross-sectional design with a nonprobabilistic sample. The sample was divided into two groups: individuals with nonspecific CLBP (n = 30) and asymptomatic individuals as a control (n = 30). The psychological variables assessed were low back disability, fear of movement, pain catastrophizing, and self-efficacy. The sensorimotor variables assessed were two-point discrimination, pressure pain threshold, lumbopelvic stability, lumbar flexion active range of motion, and isometric leg and back strength. Results: Statistically significant differences between the groups in terms of catastrophizing levels (p = 0.026) and fear of movement (p = 0.001) were found, but no statistically significant differences between groups were found in self-efficacy (p > 0.05). No statistically significant differences between the groups in any of the sensorimotor variables were found (p > 0.05). Conclusion: No sensorimotor differences were found between patients with asymptomatic and chronic low back pain, but differences were found in the psychological variables of catastrophizing and fear of movement.
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Affiliation(s)
- Juan Nieto-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Department of Physiotherapy, Universidad CEU Cardenal Herrera, CEU Universities, 46115 Valencia, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain.
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain.
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), 28023 Madrid, Spain.
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), 28046 Madrid, Spain.
| | - Mónica Grande-Alonso
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
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24
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Grande-Alonso M, Suso-Martí L, Cuenca-Martínez F, Pardo-Montero J, Gil-Martínez A, La Touche R. Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial. PAIN MEDICINE 2019; 20:2571-2587. [DOI: 10.1093/pm/pnz093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Objective
To compare the effectiveness of a biobehavioral approach with and without orthopedic manual physical therapy on the intensity and frequency of pain in patients diagnosed with nonspecific chronic low back pain.
Methods
A single-blind randomized controlled trial. Fifty patients were randomly allocated into two groups: one group received biobehavioral therapy with orthopedic manual physical therapy, and the other group received only biobehavioral therapy. Both groups completed a total of eight sessions, with a frequency of two sessions per week. The somatosensory, physical, and psychological variables were recorded at baseline and during the first and third month after initiation of treatment.
Results
In both groups, the treatment was effective, presenting significant differences for all the variables in the time factor. There were no significant differences between groups in intensity or frequency of pain, with a large effect size (>0.80), but there were intragroup differences for both intervention groups at one- and three-month follow-up. There were also no significant differences between groups in the secondary variables during the same follow-up period.
Conclusions
The results of this study suggest that orthopedic manual physical therapy does not increase the effects of a treatment based on biobehavioral therapy in the short or medium term, but these results should be interpreted with caution.
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Affiliation(s)
- Mónica Grande-Alonso
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, España
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Alfonso Gil-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, España
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, España
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España
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25
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Hwang UJ, Kwon OY, Jung SH, Ahn SH, Kim HA. Predictors of pain intensity and Oswestry Disability Index in prolonged standing service workers with nonspecific chronic low back pain subclassified as active extension pattern. Musculoskelet Sci Pract 2019; 40:58-64. [PMID: 30710825 DOI: 10.1016/j.msksp.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/14/2018] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Because patients with nonspecific chronic low back pain (NSCLBP) are heterogeneous, subgrouping patients with NSCLBP might clarify the research findings. NSCLBP in the direction of extension movement, namely active extension pattern (AEP), is common during prolonged standing. OBJECTIVE Predictors of pain intensity and dysfunction were determined in prolonged standing service workers (PSSWs) with NSCLBP subclassified as AEP in the motor impairment subgroup. METHODS Variables were measured using questionnaires including a visual analog scale (VAS), the Oswestry Disability Index (ODI), Borg Rating of Perceived Exertion (RPE) Scale, and Korean Occupational Stress Scale (KOSS). Postural assessment was performed by measuring pelvic anterior tilting angle (PATA). The smart KEMA measurement system was used to evaluate hip flexion, hip extension (HE), and knee flexion range of motion (ROM), as well as hip extensor strength, hip abductor strength (HArS), hip external rotator strength (HERrS), hip internal rotator strength, knee extensor strength, and knee flexor strength, and lumbopelvic stability (LS) in 78 PSSWs with NSCLBP subclassified as AEP. RESULTS In prediction models, HArS, LS, PATA, KOSS and HE ROM accounted for 40.1% of the variance in the VAS (p < 0.05); predictors of dysfunction included the HERrS and age, which accounted for 11.9% of the variance in the ODI (p < 0.05) in multiple regression models when using a stepwise selection procedure. CONCLUSIONS The present results indicate that HArS and HERrS, LS, PATA, KOSS, HE ROM and age should be considered for evaluating and predicting NSCLBP subclassified as AEP in PSSWs, and when designing interventions.
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Affiliation(s)
- Ui-Jae Hwang
- 234 Maeji-ri, Heungeop-Myeon, Wonju, Kangwon-Do, 220-710, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea.
| | - Oh-Yun Kwon
- 234 Maeji-ri, Heungeop-Myeon, Wonju, Kangwon-Do, 220-710, Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, South Korea.
| | - Sung-Hoon Jung
- 234 Maeji-ri, Heungeop-Myeon, Wonju, Kangwon-Do, 220-710, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea.
| | - Sun-Hee Ahn
- 234 Maeji-ri, Heungeop-Myeon, Wonju, Kangwon-Do, 220-710, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea.
| | - Hyun-A Kim
- 234 Maeji-ri, Heungeop-Myeon, Wonju, Kangwon-Do, 220-710, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea.
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26
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Brund RBK, Rasmussen S, Kersting UG, Arendt-Nielsen L, Palsson TS. Prediction of running-induced Achilles tendinopathy with pain sensitivity - a 1-year prospective study. Scand J Pain 2019; 19:139-146. [PMID: 30407913 DOI: 10.1515/sjpain-2018-0084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Indexed: 02/01/2023]
Abstract
Background and aims Achilles tendinopathy is common among runners, but the etiology remains unclear. High mechanical pain sensitivity may be a predictor of increased risk of developing Achilles tendinopathy in this group. The purpose of this study was to investigate whether local pain sensitivity could predict the development of Achilles tendinopathy in recreational male runners. The overall hypothesis was that high pain sensitivity would be related to a higher risk of developing Achilles tendinopathy among recreational male runners. Methods Ninety-nine recreational male runners were recruited and followed prospectively for 1 year. At baseline and after 500 km of running the pressure pain threshold (PPT) was assessed at the infraspinatus and at the Achilles tendon (AT-PPT). Based on the AT-PPT at baseline, a median split was used to divide the runners into two groups. The high pain sensitivity groups was defined as runners displaying a pain pressure threshold below 441 kPa on the Achilles tendon, while the low pain sensitivity group was defined as runners displaying a pain pressure threshold above 441 kPa on the Achilles tendon, respectively. Subsequently, the cumulative risk difference between the two groups was assessed by using the pseudo-observation method. Results High pain sensitivity runners sustained 5%-point (95% CI: -0.18 to 0.08) more Achilles tendinopathy episodes during the first 1,500 km. No significant group differences in risk were found at 100, 250, 500, 1,000 and 1,500 km of running. Conclusions No significant association was found between mechanical pain sensitivity in the Achilles tendon and the risk of developing Achilles tendinopathy. However, the risk difference indicated a association between a high mechanical pain sensitivity and an increased risk of developing Achilles tendinopathy. It is plausible that changes in pain sensitivity were masked by unmeasured covariates, such as the differences in progression/regression of training volume and running speed between the two groups. This study was limited in size, which limited the possibility to account for covariates, such as differences in progression/regression of running speed between runners. With the limitations in mind, future studies should control the training volume, speed and running shoes in the design or account for it in the analysis. Implications Pain sensitivity of the Achilles tendon seems not to be related to an increased risk of developing Achilles pain in relation to running.
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Affiliation(s)
- René B K Brund
- Sport Sciences, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Orthopaedic Surgery Research Unit, Science and Innovation Center, Aalborg University Hospital, Aalborg, Denmark
| | - Uwe G Kersting
- Sport Sciences, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Thorvaldur Skuli Palsson
- SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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27
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Malfliet A, Kregel J, Meeus M, Danneels L, Cagnie B, Roussel N, Nijs J. Patients With Chronic Spinal Pain Benefit From Pain Neuroscience Education Regardless the Self-Reported Signs of Central Sensitization: Secondary Analysis of a Randomized Controlled Multicenter Trial. PM R 2018; 10:1330-1343.e1. [DOI: 10.1016/j.pmrj.2018.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 10/16/2022]
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28
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Pires D, Costa D, Martins ID, Cruz EB. Tailoring pain neuroscience education and exercise programme for people with fibromyalgia who also have cognitive deficits: a case series. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1429492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Diogo Pires
- Department of Physiotherapy, Instituto Politecnico de Castelo Branco, Escola Superior de Saude Dr Lopes Dias, Castelo Branco, Portugal
| | - Daniela Costa
- Department of Physiotherapy, Hospital Amato Lusitano, Castelo Branco, Portugal
| | | | - Eduardo B. Cruz
- Departement of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
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29
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Pourahmadi MR, Mohsenifar H, Dariush M, Aftabi A, Amiri A. Effectiveness of mobilization with movement (Mulligan concept techniques) on low back pain: a systematic review. Clin Rehabil 2018; 32:1289-1298. [DOI: 10.1177/0269215518778321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: To evaluate evidence on the effectiveness of Mulligan techniques on low back pain. Data sources: PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google Scholar, and Cochrane Library were searched from inception to 31 March 2018 for randomized clinical trials reporting outcomes of pain or disability in adult patients (⩾18 years) with low back pain. Review methods: Two authors screened the results and extracted data for use in this review. The risk of bias was evaluated using the Cochrane criteria. Basic information and treatment protocols were also extracted. In addition, the level of evidence of each study and strength of conclusion for pain and disability were determined. Results: A total of 20 studies with 693 patients were included. Nine trials focused on sustained natural apophyseal glide, three on spinal mobilization with limb movement and seven on bent leg raise. The results showed that Mulligan techniques can decrease pain and disability and increase range of motion in patients with low back pain; however, the strength of conclusion for pain and disability was moderate. Furthermore, inconclusive results were observed for the effectiveness of Mulligan techniques on movement speed. In this review, eight studies were categorized as low risk of bias, while 12 studies had high risk of bias. Level of evidence analysis revealed that 17 studies were classified as level of evidence B, while three studies were classified as level of evidence A2. Conclusion: Current evidence is insufficient in supporting the benefits of Mulligan techniques on pain, disability, and range of motion in low back pain patients.
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Affiliation(s)
- Mohammad Reza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Holakoo Mohsenifar
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhdeh Dariush
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amirreza Aftabi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Amiri
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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30
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Roussel NA. Gaining insight into the complexity of pain in patients with haemophilia: State-of-the-art review on pain processing. Haemophilia 2018; 24 Suppl 6:3-8. [DOI: 10.1111/hae.13509] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Affiliation(s)
- N. A. Roussel
- Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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31
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Pelletier R, Bourbonnais D, Higgins J. Nociception, pain, neuroplasticity and the practice of Osteopathic Manipulative Medicine. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Adnan R, Van Oosterwijck J, Cagnie B, Dhondt E, Schouppe S, Van Akeleyen J, Logghe T, Danneels L. Determining Predictive Outcome Factors for a Multimodal Treatment Program in Low Back Pain Patients: A Retrospective Cohort Study. J Manipulative Physiol Ther 2017; 40:659-667. [DOI: 10.1016/j.jmpt.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/26/2017] [Indexed: 11/27/2022]
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Rao RV, Balthillaya G, Prabhu A, Kamath A. Immediate effects of Maitland mobilization versus Mulligan Mobilization with Movement in Osteoarthritis knee- A Randomized Crossover trial. J Bodyw Mov Ther 2017; 22:572-579. [PMID: 30100279 DOI: 10.1016/j.jbmt.2017.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/30/2017] [Accepted: 09/06/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Maitland Mobilization or Mulligan Mobilization with Movement (MWM) approaches have been widely used clinically for pain relief and improving mobility in Osteoarthritis knee. However the experimental evidence supporting the usage of these mobilization techniques as sole interventions in management of Osteoarthritis knee is insufficient. OBJECTIVE To determine from Maitland Mobilization and Mulligan MWM, which mobilization technique will be more effective in reducing pain and improving mobility and function in OA knee immediately after the intervention. STUDY DESIGN Randomized Crossover trial. MATERIALS AND METHODS 30 subjects with osteoarthritis knee were recruited and 15 each were randomly allocated to two intervention sequences-one sequence was where Maitland was given first followed by Mulligan and the other was where Mulligan was given first followed by Maitland with a washout period of 48 h in between the two interventions. Numeric Pain Rating Scale (NPRS), Timed Up and Go (TUG) test and Pain free Squat Angle were the outcome measures measured before and immediately after both interventions. RESULTS Using Repeated Measures ANOVA for analysis of outcomes between and within interventions, no significant differences were seen between Maitland Mobilization and Mulligan MWM, for NPRS, TUG and Pain free Squat Angle (p = 0.18, p = 0.27,p = 0.17) respectively whereas within the interventions both Maitland and Mulligan all outcome measures showed significant changes (p < 0.001). CONCLUSION Thus it can be seen that Maitland mobilization and Mulligan MWM, both are equally effective in osteoarthritis knee in reducing pain and improving functional mobility and pain free squat angle immediately post treatment.
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Affiliation(s)
- Ramya V Rao
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal 576104, Udupi District, Karnataka, India.
| | - Ganesh Balthillaya
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal 576104, Udupi District, Karnataka, India.
| | - Anupama Prabhu
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal 576104, Udupi District, Karnataka, India.
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal 576104, Udupi District, Karnataka, India.
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Baert IAC, Lluch E, Van Glabbeek F, Nuyts R, Rufai S, Tuynman J, Struyf F, Meeus M. Short stem total hip arthroplasty: Potential explanations for persistent post-surgical thigh pain. Med Hypotheses 2017; 107:45-50. [PMID: 28915961 DOI: 10.1016/j.mehy.2017.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022]
Abstract
Short stem uncemented femoral implants were developed with the aim of preserving proximal bone stock for future revisions, improving biomechanical reconstruction, aiding insertion through smaller incisions and potentially decreasing or limiting the incidence of thigh pain. Despite all the advantages of short stem designs, it remains unclear whether they are able to limit post-surgical thigh pain. In patients with short stem hip arthroplasty and persistent thigh pain, it is of the utmost importance to understand the potential etiologies of this chronic pain for selecting the appropriate treatment strategy. Therefore, this manuscript explores the hypothetical etiologies of persistent thigh pain in short stem total hip arthroplasty, including both peripheral factors (structural or biomechanical causes) and central factors (involvement of the central nervous system). First, intrinsic causes (e.g. aseptic femoral loosening and prosthetic joint infection) and extrinsic sources (e.g. muscle pathology or spinal pathology) of persistent thigh pain related to hip arthroplasty are explained. In addition, other specific peripheral causes for thigh pain related to the short stem prosthetic reconstruction (e.g. stem malalignment and micro-motion) are unraveled. Second, the etiology of persistent thigh pain after short stem hip arthroplasty is interpreted in a broader concept than the biomechanical approach where peripheral structural injury is believed to be the sole driver of persistent thigh pain. Over the past decades evidence has emerged of the involvement of sensitization of central nervous system nociceptive pathways (i.e. central sensitization) in several chronic pain disorders. In this manuscript it is explained that there might be a relevant role for altered central nociceptive processing in patients with persistent pain after joint arthroplasty or revision surgery. Recognition of a potential role for centrally-mediated changes in pain processing in total hip replacement surgery has important implications for treatment. Comprehensive treatment addressing peripheral factors as well as neurophysiological changes occurring in the nervous system may help to improve outcomes in patients with short stem hip arthroplasty and chronic thigh pain. Working within a biopsychosocial approach in orthopaedic surgery, specifically in relation to total hip arthroplasty, could be very important and may lead to more satisfaction. Further research is warranted.
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Affiliation(s)
- Isabel A C Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Pain in Motion Research Group, Belgium(1).
| | - Enrique Lluch
- Pain in Motion Research Group, Belgium(1); Departments of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Francis Van Glabbeek
- Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Rudy Nuyts
- Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Salim Rufai
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joanna Tuynman
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Pain in Motion Research Group, Belgium(1); Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Müller-Schwefe G, Morlion B, Ahlbeck K, Alon E, Coaccioli S, Coluzzi F, Huygen F, Jaksch W, Kalso E, Kocot-Kępska M, Kress HG, Mangas AC, Margarit Ferri C, Mavrocordatos P, Nicolaou A, Hernández CP, Pergolizzi J, Schäfer M, Sichère P. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin 2017; 33:1199-1210. [PMID: 28277866 DOI: 10.1080/03007995.2017.1298521] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed. DIAGNOSIS Diagnosis should begin with a focused medical history and physical examination, to exclude serious spinal pathology that may require evaluation by an appropriate specialist. Most patients have non-specific CLBP, which cannot be attributed to a particular cause. It is important to try and establish whether a neuropathic component is present, by combining the findings of physical and neurological examinations with the patient's history. This may prove difficult, however, even when using screening instruments. Multimodal management: The multifactorial nature of CLBP indicates that the most logical treatment approach is multimodal: i.e. integrated multidisciplinary therapy with co-ordinated somatic and psychotherapeutic elements. As both nociceptive and neuropathic components may be present, combining analgesic agents with different mechanisms of action is a rational treatment modality. Individually tailored combination therapy can improve analgesia whilst reducing the doses of constituent agents, thereby lessening the incidence of side effects. CONCLUSIONS This paper outlines the development of CLBP and the underlying mechanisms involved, as well as providing information on diagnosis and the use of a wide range of pharmaceutical agents in managing the condition (including NSAIDs, COX-2 inhibitors, tricyclic antidepressants, opioids and anticonvulsants), supplemented by appropriate non-pharmacological measures such as exercise programs, manual therapies, behavioral therapies, interventional pain management and traction. Surgery may be appropriate in carefully selected patients.
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Affiliation(s)
| | | | | | - Eli Alon
- d Universitätsspital Zurich , Zurich , Switzerland
| | | | - Flaminia Coluzzi
- f Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Frank Huygen
- g University Hospital , Rotterdam , The Netherlands
| | | | - Eija Kalso
- i Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine , University of Helsinki, and Helsinki University Hospital , Finland
| | - Magdalena Kocot-Kępska
- j Department of Pain Research and Treatment , Collegium Medicum Jagiellonian University , Kraków , Poland
| | - Hans-Georg Kress
- k Department of Special Anaesthesia and Pain Therapy , Medizinische Universität/AKH Wien , Vienna , Austria
| | | | | | | | | | | | | | - Michael Schäfer
- r Department of Anaesthesiology and Intensive Care Medicine , Charité University Berlin, Campus Virchow Klinikum , Berlin , Germany
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Ortego G, Villafañe JH, Doménech-García V, Berjano P, Bertozzi L, Herrero P. Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis. J Psychosom Res 2016; 90:70-81. [PMID: 27772562 DOI: 10.1016/j.jpsychores.2016.09.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/28/2016] [Accepted: 09/08/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To systematically review and analyze the research evidence linking stress or anxiety to chronic nonspecific neck-arm pain (NSNAP) in adults. SUBJECTS AND METHODS Data were obtained from Pubmed, Scopus, PsycInfo, Web of Science, Physiotherapy Evidence Database (PEDro) and The Cochrane library database from their inception to July 2015. Two authors independently conducted the searches, extracted data, and completed methodological quality assessments. The methodological quality of the cohort and case-control studies was evaluated using the Newcastle-Ottawa scale, whilst the quality of the Randomized Controlled Trial (RCT) was evaluated using the PEDro scale. RESULTS Twenty-eight studies involving 39,166 participants met the inclusion criteria. Four studies, including 5 pair-wise comparisons, were included in the meta-analysis: Three were cohort studies and 1 was a cross-sectional study. The meta-analysis outcome demonstrated a relationship between chronic NSNAP and psychological stress. The estimate odds ratio for all studies combined was 2.33 (95% CI, 1.04-5.18; p=0.039). A high heterogeneity of the findings appeared (Q=28.94, I2=86% p=0.00). CONCLUSION This study shows that there is a strong relationship between stress and chronic NSNAP. Despite this finding, we cannot support that stress is a risk factor for chronic NSNAP due to the low quality of the results according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). It was not possible to make a quantitative analysis comparing the relationship between anxiety and chronic NSNAP. However, according to the qualitative analysis there is a strong relationship between anxiety and chronic NSNAP.
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Affiliation(s)
- Gorka Ortego
- iPhysio Research Group, Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830, Villanueva de Gállego Zaragoza, Spain.
| | | | - Victor Doménech-García
- iPhysio Research Group, Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830, Villanueva de Gállego Zaragoza, Spain
| | | | | | - Pablo Herrero
- iPhysio Research Group, Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830, Villanueva de Gállego Zaragoza, Spain
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Wijma AJ, van Wilgen CP, Meeus M, Nijs J. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education. Physiother Theory Pract 2016; 32:368-84. [DOI: 10.1080/09593985.2016.1194651] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks TR, Cleland JA. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord 2016; 17:64. [PMID: 26852024 PMCID: PMC4744384 DOI: 10.1186/s12891-016-0912-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/29/2016] [Indexed: 01/03/2023] Open
Abstract
Background Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH. Methods One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable. Results The 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001). Conclusions Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months. Trial registration NCT01580280 April 16, 2012.
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Affiliation(s)
- James R Dunning
- Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA. .,Nova Southeastern University, Ft. Lauderdale, FL, USA. .,AAMT Fellowship in Orthopaedic Manual Physical Therapy, Columbia, SC, USA.
| | - Raymond Butts
- Research Physical Therapy Specialists, Columbia, SC, USA.
| | | | | | - Cesar Fernandez-de-Las Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - Marshall Hagins
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA.
| | | | | | | | | | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA.
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Baert IAC, Lluch E, Mulder T, Nijs J, Noten S, Meeus M. Does pre-surgical central modulation of pain influence outcome after total knee replacement? A systematic review. Osteoarthritis Cartilage 2016; 24:213-23. [PMID: 26382109 DOI: 10.1016/j.joca.2015.09.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 08/21/2015] [Accepted: 09/01/2015] [Indexed: 02/06/2023]
Abstract
The aim of this study is to systematically review whether the presence of altered central pain modulation pre-surgical influences outcome after total knee replacement (TKR) in patients with knee osteoarthritis (OA), and if so which indices of central pain modulation predict poor outcome after TKR. To identify relevant articles, PubMed and Web of Science were searched. The search strategy was a combination of key words related to "Knee Osteoarthritis and Total Knee Replacement", "Central Pain Modulation" and "Post-Surgical Outcome Measures". Articles fulfilling the inclusion criteria were screened for methodological quality and results were analyzed and summarized. Sixteen prospective cohort studies were included. Strong evidence is available that presence of catastrophic thinking and poor coping strategies predict more pain after TKR and that there is no association between fear of movement and post-surgical pain or function. Evidence on other psychosocial influences is limited or conflicting. Literature on the influence of other signs of altered central pain modulation on post-surgical outcome is scarce. It is plausible that pre-surgical signs of altered central pain modulation, such as joint pain at rest or widespread pain sensitization, predict more post-surgical pain. Surgeons should be attentive for patients with signs of altered central pain modulation before surgery as they might be at risk for unfavorable outcome. A broader therapeutic approach aiming to desensitize the central nervous system can be adapted in these patients. Further research is however needed to identify the influence of central pain modulation pre-surgical in predicting outcome after TKR.
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Affiliation(s)
- I A C Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Pain in Motion Research Group (Belgium, Netherlands, Spain, UK).
| | - E Lluch
- Pain in Motion Research Group (Belgium, Netherlands, Spain, UK); Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain.
| | - T Mulder
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
| | - J Nijs
- Pain in Motion Research Group (Belgium, Netherlands, Spain, UK); Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - S Noten
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Pain in Motion Research Group (Belgium, Netherlands, Spain, UK).
| | - M Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Pain in Motion Research Group (Belgium, Netherlands, Spain, UK); Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
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Hidalgo B, Pitance L, Hall T, Detrembleur C, Nielens H. Short-Term Effects of Mulligan Mobilization With Movement on Pain, Disability, and Kinematic Spinal Movements in Patients With Nonspecific Low Back Pain: A Randomized Placebo-Controlled Trial. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dunning J, Mourad F, Giovannico G, Maselli F, Perreault T, Fernández-de-las-Peñas C. Changes in Shoulder Pain and Disability After Thrust Manipulation in Subjects Presenting With Second and Third Rib Syndrome. J Manipulative Physiol Ther 2015; 38:382-94. [DOI: 10.1016/j.jmpt.2015.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 03/26/2015] [Accepted: 04/30/2015] [Indexed: 11/24/2022]
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The role of central sensitization in shoulder pain: A systematic literature review. Semin Arthritis Rheum 2015; 44:710-6. [DOI: 10.1016/j.semarthrit.2014.11.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/29/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
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Efstathiou MA, Stefanakis M, Savva C, Giakas G. Effectiveness of neural mobilization in patients with spinal radiculopathy: A critical review. J Bodyw Mov Ther 2015; 19:205-12. [DOI: 10.1016/j.jbmt.2014.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/08/2014] [Accepted: 08/10/2014] [Indexed: 02/08/2023]
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Lluch Girbés E, Meeus M, Baert I, Nijs J. Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis. ACTA ACUST UNITED AC 2015; 20:349-52. [DOI: 10.1016/j.math.2014.07.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/20/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022]
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The clinical utility of pain classification in non-specific arm pain. ACTA ACUST UNITED AC 2015; 20:157-65. [DOI: 10.1016/j.math.2014.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 08/04/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
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Barbosa AWC, Silva AM, Silva AF, Martins FLM, Almeida Barbosa MCS. Immediate improvements in activation amplitude levels of the deep abdominal muscle following a sacroiliac joint manipulation during rapid upper limb movement. J Bodyw Mov Ther 2014; 18:626-32. [DOI: 10.1016/j.jbmt.2014.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/06/2014] [Accepted: 05/26/2014] [Indexed: 11/16/2022]
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Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with ‘unexplained’ chronic pain: an update. Expert Opin Pharmacother 2014; 15:1671-83. [DOI: 10.1517/14656566.2014.925446] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Management of a patient with chronic low back pain and multiple health conditions using a pain mechanisms-based classification approach. J Orthop Sports Phys Ther 2014; 44:403-C2. [PMID: 24766360 DOI: 10.2519/jospt.2014.4861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Pain can lead to a significant reduction in quality of life. A pain mechanisms-based classification scheme has been outlined to improve management of patients with pain, but studies describing its use are limited. Evidence for physical therapy interventions in those with chronic pain and multiple health conditions is also lacking. This case report describes management of a patient with chronic pain and multiple health conditions. CASE DESCRIPTION A 29-year-old man presented with a 3-year history of low back pain and 11-month history of lower extremity paresthesia. Current health conditions included left-sided hemiparesis secondary to a stroke, pancreatic kidney transplant, left-sided blindness, and osteoporosis secondary to hyperparathyroidism. Inability to walk to school and sit through class, and pain-related sleep disruption were the primary activity and participation restrictions. Outcome measures included the numeric pain rating scale, global rating of change, Oswestry Disability Index, and pain medication usage. A score of 12 on the Leeds assessment of neuropathic symptoms and signs (LANSS) pain scale indicated the presence of neuropathic pain, but other pain mechanisms were also hypothesized to be present. Treatment was designed to improve patient goals considering these pain mechanisms. OUTCOMES The patient was seen for 20 visits over 6 months. Ten months after the initial evaluation, the patient's Oswestry Disability Index scores improved by more than 50% and the patient achieved all initially stated goals without pain medication. DISCUSSION A pain mechanisms-based approach assisted in the management of a patient with chronic pain and multiple health conditions. Using this approach may enhance clinical decision making when managing individuals with chronic pain. LEVEL OF EVIDENCE Therapy, level 4.
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Lluch E, Torres R, Nijs J, Van Oosterwijck J. Evidence for central sensitization in patients with osteoarthritis pain: A systematic literature review. Eur J Pain 2014; 18:1367-75. [DOI: 10.1002/j.1532-2149.2014.499.x] [Citation(s) in RCA: 229] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 01/23/2023]
Affiliation(s)
- E. Lluch
- Department of Physical Therapy; University of Valencia; Spain
- Pain in Motion Research Group; Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Rehabilitation; Vrije Universiteit Brussel; Belgium
| | - R. Torres
- Department of Physical Therapy; University of Valencia; Spain
| | - J. Nijs
- Pain in Motion Research Group; Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Rehabilitation; Vrije Universiteit Brussel; Belgium
- Department of Physical Medicine and Physiotherapy; University Hospital Brussels; Belgium
| | - J. Van Oosterwijck
- Pain in Motion Research Group; Departments of Human Physiology and Physiotherapy; Faculty of Physical Education and Rehabilitation; Vrije Universiteit Brussel; Belgium
- Rehabilitation Sciences and Physiotherapy; Ghent University; Belgium
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