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Yang J, Rolnick N, Merriwether E, Rao S. Hypoalgesia and Conditioned Pain Modulation in Blood Flow Restriction Resistance Exercise. Int J Sports Med 2024. [PMID: 38588713 DOI: 10.1055/a-2301-9115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
We compared the magnitude of exercise-induced hypoalgesia and conditioned pain modulation between blood-flow restriction (BFR) resistance exercise (RE) and moderate-intensity RE. Twenty-five asymptomatic participants performed unilateral leg press in two visits. For moderate-intensity RE, subjects exercised at 50% 1RM without BFR, whereas BFR RE exercised at 30% 1RM with a cuff inflated to 60% limb occlusion pressure. Exercise-induced hypoalgesia was quantified by pressure pain threshold changes before and after RE. Conditioned pain modulation was tested using cold water as the conditioning stimulus and mechanical pressure as the test stimulus and quantified as pressure pain threshold change. Difference in conditioned pain modulation pre- to post-RE was then calculated. The differences of RE on pain modulations were compared using paired t-tests. Pearson's r was used to examine the correlation between exercise-induced hypoalgesia and changes in conditioned pain modulation. We found greater hypoalgesia with BFR RE compared to moderate-intensity RE (p=0.008). Significant moderate correlations were found between exercise-induced hypoalgesia and changes in conditioned pain modulation (BFR: r=0.63, moderate-intensity: r=0.72). BFR RE has favorable effects on pain modulation in healthy adults and the magnitude of exercise-induced hypoalgesia is positively correlated with conditioned pain modulation activation.
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Affiliation(s)
- Jinghui Yang
- Physical Therapy, New York University Steinhardt School of Culture Education and Human Development, New York, United States
| | - Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, Bronx, United States
| | - Ericka Merriwether
- Physical Therapy, New York University Steinhardt School of Culture Education and Human Development, New York, United States
- Department of Medicine, NYU Grossman School of Medicine, New York, United States
| | - Smita Rao
- Physical Therapy, New York University Steinhardt School of Culture Education and Human Development, New York, United States
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Yang J, O'Keeffe R, Shirazi SY, Mehrdad S, Atashzar SF, Rao S. Muscle activity and hypoalgesia in blood flow restricted versus unrestricted effort-matched resistance exercise in healthy adults. Physiol Rep 2024; 12:e16037. [PMID: 39034596 PMCID: PMC11260880 DOI: 10.14814/phy2.16037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/06/2024] [Accepted: 04/18/2024] [Indexed: 07/23/2024] Open
Abstract
This study assessed muscle activity (root mean square, RMS, and median frequency, MDF) to evaluate the acute response to blood flow restriction (BFR) resistance exercise (RE) and conventional moderate intensity (MI) RE. We also performed exploratory analyses of differences based on sex and exercise-induced hypoalgesia (EIH). Fourteen asymptomatic individuals performed four sets of unilateral leg press with their dominant leg to volitional fatigue under two exercise conditions: BFR RE and MI RE. Dominant side rectus femoris (RF) and vastus lateralis (VL) muscle activity were measured using surface electromyography (sEMG) through exercise. RMS and MDF were calculated and compared between conditions and timepoints using a linear mixed model. Pressure pain thresholds (PPT) were tested before and immediately after exercise and used to quantify EIH. Participants were then divided into EIH responders and nonresponders, and the differences on RMS and MDF were compared between the two groups using Hedges' g. RMS significantly increased over time (RF: p = 0.0039; VL: p = 0.001) but not between conditions (RF: p = 0.4; VL: p = 0.67). MDF decreased over time (RF: p = 0.042; VL: p < 0.001) but not between conditions (RF: p = 0.74; VL: p = 0.77). Consistently lower muscle activation was found in females compared with males (BRF, RF: g = 0.63; VL, g = 0.5. MI, RF: g = 0.72; VL: g = 1.56), with more heterogeneous findings in MDF changes. For BFR, EIH responders showed greater RMS changes (Δ RMS) (RF: g = 0.90; VL: g = 1.21) but similar MDF changes (Δ MDF) (RF: g = 0.45; VL: g = 0.28) compared to nonresponders. For MI, EIH responders demonstrated greater increase on Δ RMS (g = 0.61) and decrease on Δ MDF (g = 0.68) in RF but similar changes in VL (Δ RMS: g = 0.40; Δ MDF: g = 0.39). These results indicate that when exercising to fatigue, no statistically significant difference was observed between BFR RE and conventional MI RE in Δ RMS and Δ MDF. Lower muscle activity was noticed in females. While exercising to volitional fatigue, muscle activity may contribute to EIH.
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Affiliation(s)
- Jinghui Yang
- Department of Physical TherapyNew York UniversityNew YorkNew YorkUSA
| | - Rory O'Keeffe
- Department of Electrical and Computer EngineeringNew York University (NYU)New YorkNew YorkUSA
| | - Seyed Yahya Shirazi
- Department of Electrical and Computer EngineeringNew York University (NYU)New YorkNew YorkUSA
| | - Sarmad Mehrdad
- Department of Electrical and Computer EngineeringNew York University (NYU)New YorkNew YorkUSA
| | - S. Farokh Atashzar
- Department of Electrical and Computer EngineeringNew York University (NYU)New YorkNew YorkUSA
| | - Smita Rao
- Department of Physical TherapyNew York UniversityNew YorkNew YorkUSA
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Boussi-Gross R, Catalogna M, Lang E, Shamai Z, Ablin JN, Aloush V, Doenyas-Barak K, Lorberboym M, Lev-Wiesel R, Efrati S. Hyperbaric oxygen therapy vs. pharmacological intervention in adults with fibromyalgia related to childhood sexual abuse: prospective, randomized clinical trial. Sci Rep 2024; 14:11599. [PMID: 38773296 PMCID: PMC11109175 DOI: 10.1038/s41598-024-62161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterized by disruptions in pain processing within the central nervous system. It exhibits a high prevalence among patients with a history of traumatic experiences, notably childhood sexual abuse (CSA). This study compared the efficacy of hyperbaric oxygen therapy (HBOT) to the current pharmacological standard of care for individuals suffering from CSA-related FMS. Forty-eight participants diagnosed with FMS and a history of CSA were randomly assigned to either the HBOT group (60 sessions of 100% oxygen at 2 ATA for 90 min, with air breaks every 5 min) or the medication (MED) group (FDA-approved medications, Pregabalin and Duloxetine). The primary endpoint was the Fibromyalgia impact questionnaire (FIQ) score, while secondary endpoints encompassed emotional status and daily functioning questionnaires, as well as pain thresholds and conditioned pain modulation tests. Brain activity was evaluated through single photon emission computed tomography (SPECT). Results revealed a significant group-by-time interaction for the FIQ score favoring HBOT over MED (p < 0.001), with a large effect size (Cohen's d = - 1.27). Similar findings were observed in emotional symptoms and functional measures. SPECT imaging demonstrated an increase in activity in pre-frontal and temporal brain areas, which correlated with symptoms improvement. In conclusion, HBOT exhibited superior benefits over medications in terms of physical, functional, and emotional improvements among FMS patients with a history of CSA. This associated with increased activity in pre-frontal and temporal brain areas, highlighting the neuroplasticity effect of HBOT.
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Affiliation(s)
- Rahav Boussi-Gross
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Merav Catalogna
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Erez Lang
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zipora Shamai
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Jacob N Ablin
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Valerie Aloush
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Keren Doenyas-Barak
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Lorberboym
- Nuclear Medicine Institute, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Rachel Lev-Wiesel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- The Emili Sagol CAT Research Center, Graduate School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
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Wilson AT, Pinette J, Lyons K, Hanney WJ. Exercise induced hypoalgesia during different intensities of a dynamic resistance exercise: A randomized controlled trial. PLoS One 2024; 19:e0299481. [PMID: 38625975 PMCID: PMC11020855 DOI: 10.1371/journal.pone.0299481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/09/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Exercise produces an immediate lessening of pain sensitivity (Exercise-Induced Hypoalgesia (EIH)) in healthy individuals at local and distant sites, possibly through a shared mechanism with conditioned pain modulation (CPM). Dynamic resistance exercise is a recommended type of exercise to reduce pain, yet limited research has examined the effects of intensity on EIH during this type of exercise. Therefore, the primary purpose of this study is to compare changes in PPT at a local and distant site during a leg extension exercise at a high intensity, a low intensity, or a quiet rest condition. A secondary purpose is to examine if CPM changes after each intervention. The final purpose is to examine if baseline pain sensitivity measures are correlated with response to each intervention. METHODS In a randomized controlled trial of 60 healthy participants, participants completed baseline pain sensitivity testing (heat pain threshold, temporal summation, a cold pressor test as measure of CPM) and were randomly assigned to complete a knee extension exercise at: 1) high intensity (75% of a 1 Repetition Maximum (RM), 2) low intensity (30% 1RM), or 3) Quiet Rest. PPT was measured between each set at a local (quadriceps) and distant (trapezius) site during the intervention. CPM was then repeated after the intervention. To test the first purpose of the study, a three-way ANOVA examined for time x site x intervention interaction effects. To examine for changes in CPM by group, a mixed-model ANOVA was performed. Finally, a Pearson Correlation examined the association between baseline pain sensitivity and response to each intervention. RESULTS Time x site x intervention interaction effects were not significant (F(5.3, 150.97) = 0.87, p = 0.51, partial eta2 = 0.03). CPM did not significantly change after the interventions (time x intervention F(1,38) = 0.81, p = 0.37, partial eta2 = 0.02. EIH effects at the quadriceps displayed a significant, positive moderate association with baseline HPT applied over the trapezius (r = 0.61, p<0.01) and TS (r = 0.46, p = 0.04). DISCUSSION In healthy participants, PPT and CPM did not significantly differ after a leg extension exercise performed at a high intensity, low intensity, or quiet rest condition. It is possible pre-intervention CPM testing with a noxious stimuli may have impaired inhibitory effects frequently observed during exercise but future research would need to examine this hypothesis.
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Affiliation(s)
- Abigail T. Wilson
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
- Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States of America
| | - John Pinette
- Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States of America
| | - Kaitlyn Lyons
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
- Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States of America
| | - William J. Hanney
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
- Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States of America
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Hoegh M, Bannister K. Pain Science in Practice (Part 6): How Does Descending Modulation of Pain Work?. J Orthop Sports Phys Ther 2024; 54:1-4. [PMID: 38288567 DOI: 10.2519/jospt.2024.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
SYNOPSIS To understand the neuroscience of pain relief, one must know about the descending pain modulatory system. Neuronal pathways that originate in the brainstem and project to the spinal cord to modulate spinal neuronal activity provide a well-documented perspective on the mechanisms of analgesia that underpin pharmacological and nonpharmacological treatment options for people with musculoskeletal pain. Peripheral stimuli or signals from the cortex and subcortical regions of the brain can trigger the descending pain modulatory system (DPMS). The system helps explain how counter-stimulation techniques (eg, acupuncture and manual therapy), the patients' expectations and beliefs, and social or contextual factors could influence how people experience pain. J Orthop Sports Phys Ther 2024;54(2):1-4. doi:10.2519/jospt.2024.12112.
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Affiliation(s)
- Morten Hoegh
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsty Bannister
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
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Hendriks E, Coppieters I, Voogt L, Cools W, Ickmans K. Exercise-Induced Hypoalgesia in Patients with Chronic Whiplash-Associated Disorders: Differences between Subgroups Based on the Central Sensitization Inventory. J Clin Med 2024; 13:482. [PMID: 38256616 PMCID: PMC10816827 DOI: 10.3390/jcm13020482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Physical exercise is an important element in the rehabilitation of chronic whiplash-associated disorders, with the physiological process underlying pain reduction called exercise-induced hypoalgesia. In chronic whiplash-associated disorders, exercise-induced hypoalgesia appears impaired, and the research suggests a relationship with symptoms of dysfunctional nociceptive processing, such as central sensitization. This study improves our understanding of exercise-induced hypoalgesia in chronic whiplash-associated disorders by examining the differences between the extent of exercise-induced hypoalgesia in subgroups based on scores on the central sensitization inventory (CSI). METHODS Data were collected from 135 participants with chronic whiplash-associated disorders who completed a set of questionnaires. Pain pressure thresholds and temporal summations were assessed before and after a submaximal aerobic bicycle exercise test. RESULTS We observed no interaction effect between exercise-induced hypoalgesia and the CSI scores for both pain pressure threshold and temporal summation. No overall statistical effect was measured in the analysis of the effect of time. The pain pressure threshold significantly related to the CSI. The temporal summation showed no correlation. CONCLUSIONS During this study, we did not find evidence for a difference in the presence of exercise-induced hypoalgesia when the subgroups were created based on the central sensitization cluster calculator. Limited evidence was found for the influence of CSI scores on the delta pain pressure threshold.
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Affiliation(s)
- Erwin Hendriks
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.H.); (I.C.); (L.V.)
- Rehabilitation Centre Drechtsteden/Haaglanden, Berkenhof 100, 3319 WB Dordrecht, The Netherlands
- Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, The Netherlands
- Unit Physiotherapy, Organizational Part of the Orthopedics Department, Erasmus Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Iris Coppieters
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.H.); (I.C.); (L.V.)
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translation Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Oude Markt 13, 3000 Leuven, Belgium
| | - Lennard Voogt
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.H.); (I.C.); (L.V.)
- Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK Rotterdam, The Netherlands
| | - Wilfried Cools
- Core Facility—Support for Quantitative and Qualitative Research (SQUASH), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium;
| | - Kelly Ickmans
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.H.); (I.C.); (L.V.)
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 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
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Aron V, Strul D, Vaegter HB, Pitance L, Armijo-Olivo S. Reliability and measurement error of exercise-induced hypoalgesia in pain-free adults and adults with musculoskeletal pain: A systematic review. Scand J Pain 2024; 24:sjpain-2023-0104. [PMID: 38619552 DOI: 10.1515/sjpain-2023-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/18/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES We systematically reviewed the reliability and measurement error of exercise-induced hypoalgesia (EIH) in pain-free adults and in adults with musculoskeletal (MSK) pain. METHODS We searched EMBASE, PUBMED, SCOPUS, CINAHL, and PSYCINFO from inception to November 2021 (updated in February 2024). In addition, manual searches of the grey literature were conducted in March 2022, September 2023, and February 2024. The inclusion criteria were as follows: adults - pain-free and with MSK pain - a single bout of exercise (any type) combined with experimental pre-post pain tests, and assessment of the reliability and/or measurement error of EIH. Two independent reviewers selected the studies, assessed their Risk of Bias (RoB) with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) RoB tool, and graded the individual results (COSMIN modified Grading of Recommendations Assessment, Development, and Evaluation). RESULTS We included five studies involving pain-free individuals (n = 168), which were deemed to have an overall "doubtful" RoB. No study including adults with MSK pain was found. The following ranges of parameters of reliability and measurement error of EIH were reported: intraclass correlation coefficients: 0-0.61; kappa: 0.01-0.46; standard error of measurement: 30.1-105 kPa and 10.4-21%; smallest detectable changes: 83.54-291.1 kPa and 28.83-58.21%. CONCLUSIONS We concluded, with a very low level of certainty, that the reliability and measurement error of EIH is, in pain-free adults, respectively, "insufficient" and "indeterminate." Future studies should focus on people with MSK pain and could consider using tailored exercises, other test modalities than pressure pain threshold, rater/assessor blinding, and strict control of the sources of variations (e.g., participants' expectations).
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Affiliation(s)
- Vladimir Aron
- Faculty of Medicine, Institute of Neuroscience (IoNS), Université Catholique de Louvain, Brussels B-1200, Belgium
| | | | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Department of Anesthesiology and Intensive Care Medicine, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Laurent Pitance
- Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
- Oral and Maxillofacial Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Susan Armijo-Olivo
- Faculty of Economics and Social Sciences, Osnabrück University of Applied Sciences, Osnabrück, Germany
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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8
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Zi‐Han X, Nan A, Rui CJ, Yong‐Long Y. Modulation of pain perceptions following treadmill running with different intensities in females. Physiol Rep 2023; 11:e15831. [PMID: 37749050 PMCID: PMC10519819 DOI: 10.14814/phy2.15831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
We aimed to compare the effects of three intensities of treadmill running on exercise-induced hypoalgesia (EIH) in healthy individuals. We anticipated that the primary and secondary changes in pain perception and modulation may differ between running intensities. Sixty-six women were randomly assigned to one of three treadmill running intensities for 35 min: 40% reserved heart rate (HRR), 55% HRR, or 70% HRR. The effects of EIH were assessed using pressure pain thresholds (PPT) and tolerance thresholds (PPTol). We measured conditional pain modulation (CPM). Compared with baseline, PPT and PPTol significantly increased in all groups during running and at the 5-10-min follow-up. The PPT and PPTol changes in the moderate- and low-intensity groups were significantly higher than those in the high-intensity group during running and 24 h after running, while the CPM responses of the high-intensity group were significantly reduced at the 24-h follow-up. Moderate- and low-intensity running may elicit significant primary and secondary (persisting over 24 h) EIH effects and increase CPM responses in females. However, high-intensity running induced only limited analgesic effects and reduced CPM responses, which may be attributed to the activation of endogenous pain modulation.
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Affiliation(s)
- Xu Zi‐Han
- School of Sport Medicine and RehabilitationBeijing Sport UniversityBeijingChina
| | - An Nan
- School of Sport Medicine and RehabilitationBeijing Sport UniversityBeijingChina
| | - Chang Jeremy Rui
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong KongChina
| | - Yang Yong‐Long
- School of Sport Medicine and RehabilitationBeijing Sport UniversityBeijingChina
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9
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Bilika P, Paliouras A, Savvoulidou K, Arribas-Romano A, Dimitriadis Z, Billis E, Strimpakos N, Kapreli E. Psychometric properties of quantitative sensory testing in healthy and patients with shoulder pain: A systematic review. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2023; 23:145-164. [PMID: 36856109 PMCID: PMC9976178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Quantitative Sensory Testing (QST) is a psychophysical battery of various tests developed to quantify the subjects' self-reported sensory experience. Although the use of QST is valuable for the clinical assessment of pain, standard evaluation protocols have not yet been established. This systematic review aimed to investigate the level of evidence for the psychometric properties of QST in healthy and patients with shoulder pain. Eight databases were searched for peer-reviewed studies published until August 2021. The methodological quality of studies was evaluated using the COSMIN checklist. Twelve studies were included for qualitative synthesis, which included three different tests (Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM) and Temporal Summation (TS)). As the body of evidence consisted of studies of low methodological quality, the psychometric properties of PPT, CPM, and TS in healthy and patients with shoulder pain were classified as unknown. Although there is a risk that the conclusions may be 'superficial' in nature, the reliability seems to be nearly excellent for the PPT, however, the protocols' variation and the low methodological quality of the studies do not allow for clear conclusions. Further studies are required for the CPM and TS in patients with shoulder pain.
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Affiliation(s)
- Paraskevi Bilika
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Achilleas Paliouras
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Konstantina Savvoulidou
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - Zacharias Dimitriadis
- Health Assessment and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Evdokia Billis
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Greece
| | - Nikolaos Strimpakos
- Health Assessment and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece.,Division of Musculoskeletal & Dermatological Sciences School of Biological Sciences Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
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10
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Ablin JN, Lang E, Catalogna M, Aloush V, Hadanny A, Doenyas-Barak K, Finci S, Polak N, Fishlev G, Korin C, Tzidky RY, Meir Genuth O, Efrati S. Hyperbaric oxygen therapy compared to pharmacological intervention in fibromyalgia patients following traumatic brain injury: A randomized, controlled trial. PLoS One 2023; 18:e0282406. [PMID: 36897850 PMCID: PMC10004612 DOI: 10.1371/journal.pone.0282406] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/08/2023] [Indexed: 03/11/2023] Open
Abstract
Fibromyalgia is a chronic pain syndrome with unsatisfactory response to current treatments. Physical trauma, including traumatic brain Injury (TBI) is among the etiological triggers. Hyperbaric Oxygen therapy (HBOT) is an intervention that combines 100% oxygen with elevated atmospheric pressure. HBOT has been applied as a neuro-modulatory treatment in central nervous system-related conditions. The current study investigated the utility of HBOT for TBI-related fibromyalgia. Fibromyalgia patients with a history of TBI were randomized to either HBOT or pharmacological intervention. HBOT protocol comprised 60 daily sessions, breathing 100% oxygen by mask at 2 absolute atmospheres (ATA) for 90 minutes. Pharmacological treatment included Pregabalin or Duloxetine. The primary outcome was subjective pain intensity on visual analogue scale (VAS); Secondary endpoints included questionnaires assessing fibromyalgia symptoms as well as Tc-99m-ECD SPECT brain imaging. Pain threshold and conditioned pain modulation (CPM) were also assessed. Results demonstrated a significant group-by-time interaction in pain intensity post-HBOT compared to the medication group (p = 0.001), with a large net effect size (d = -0.95) in pain intensity reduction following HBOT compared to medications. Fibromyalgia related symptoms and pain questionnaires demonstrated significant improvements induced by HBOT as well as improvements in quality of life and increase in pain thresholds and CPM. SPECT demonstrated significant group-by-time interactions between HBOT and medication groups in the left frontal and the right temporal cortex. In conclusion, HBOT can improve pain symptoms, quality of life, emotional and social function of patients suffering from FMS triggered by TBI. The beneficial clinical effect is correlated with increased brain activity in frontal and parietal regions, associated with executive function and emotional processing.
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Affiliation(s)
- Jacob N. Ablin
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- * E-mail:
| | - Erez Lang
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Merav Catalogna
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Valerie Aloush
- Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
| | - Amir Hadanny
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Keren Doenyas-Barak
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Shachar Finci
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Nir Polak
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Gregory Fishlev
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Calanit Korin
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Rachel Yehudit Tzidky
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Oshra Meir Genuth
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Shai Efrati
- Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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11
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Exercised-Induced Hypoalgesia following An Elbow Flexion Low-Load Resistance Exercise with Blood Flow Restriction: A Sham-Controlled Randomized Trial in Healthy Adults. Healthcare (Basel) 2022; 10:healthcare10122557. [PMID: 36554080 PMCID: PMC9778505 DOI: 10.3390/healthcare10122557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/29/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
We aimed to evaluate the hypoalgesic effect of an elbow flexion low-load resistance exercise with blood flow restriction (LLRE-BFR) when compared to high-load resistance exercise (HLRE) with sham-BFR in healthy individuals. Forty healthy young adults (17 women), with a mean age ± SD: 26.6 ± 6.8 years, and mean body mass index ± SD: 23.6 ± 2.7 were randomly assigned to either an LLRE-BFR (30% 1 repetition maximum, RM) or an HLRE with sham-BFR group (70% of 1 RM). Blood pressure and pressure pain thresholds (PPTs) were measured pre- and post-exercise intervention. The rating of perceived exertion (RPE) was recorded after each set. There were non-significant between-group changes in PPT at the dominant biceps (-0.61, 95%CI: -1.92 to 0.68) with statistically significant reductions between pre- and post-exercise in LLRE-BFR (effect size, d = 0.88) and HLRE-BFR (effect size, d = 0.52). No within- or between-group differences were recorded in PPT at non-exercising sites of measurement. No mediating effects of changes in blood pressure or RPE on the changes in pressure pain threshold were observed. LLRE-BFR produced a similar hypoalgesic effect locally compared to HLRE and can be used as an alternative intervention to decrease pain sensitivity when HLRE is contraindicated or should be avoided.
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Hansen S, Petersen KK, Sloth E, Manum LA, McDonald AK, Andersen PG, Vaegter HB. Hypoalgesia after exercises with painful vs. non-painful muscles in healthy subjects - a randomized cross-over study. Scand J Pain 2022; 22:614-621. [PMID: 34958721 DOI: 10.1515/sjpain-2021-0161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Exercise-induced hypoalgesia (EIH) is a decrease in the pain sensitivity after exercise. Individuals with chronic pain show less EIH after one exercise session compared with pain-free individuals possibly due to pain in exercising muscles. The primary aim of this randomized controlled cross-over study was to compare the EIH response at the exercising thigh muscle following exercises performed with painful vs. non-painful muscles. Secondary aims were to explore if a reduced EIH response was confined to the painful muscle, and whether the muscle pain intensity and the EIH responses were negatively associated. METHODS In two sessions, 34 pain-free participants received a painful (hypertonic saline, 5.8%) injection and a control (isotonic saline, 0.9%) injection in the right thigh muscle before performing a 3 min isometric wall squat exercise. Pressure pain thresholds (PPTs) were assessed at both thighs and the left neck/shoulder at baseline, after injections and after exercise. Pain intensities in the thighs were rated on numerical rating scales (NRS: 0-10). RESULTS Hypertonic saline induced moderate thigh pain at rest (NRS: 4.6 ± 2.1) compared to the control injection (NRS: 0.3 ± 0.4; p<0.001). EIH at the thighs and neck/shoulder were not different between sessions (Injected thigh: 0 kPa; 95% CI: -51 to 52; Contralateral thigh: -6 kPa; 95% CI: -42 to 30; neck/shoulder: 19 kPa; 95% CI: -6 to 44). No significant associations between pain intensity ratings immediately after the Painful injection and EIH responses at any assessment sites were found (right thigh: β=0.08, 95% CI: -12.95 to 20.64, p=0.64, left thigh: β=-0.33, 95% CI: -27.86 to 0.44, p=0.06; neck/shoulder: β=-0.18, 95% CI: -15.11 to 4.96, p=0.31). CONCLUSIONS Pain in the area of an exercising muscle did not reduce local or systemic EIH responses. TRIAL REGISTRATION NUMBER NCT04354948.
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Affiliation(s)
- Simon Hansen
- Department of Health Science and Technology, SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- Department of Health Science and Technology, SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Emilie Sloth
- School of Physiotherapy, University College Lillebaelt, Odense, Denmark
| | | | | | | | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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13
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Peterson JA, Lohman C, Larson RD, Bemben MG, Black CD. Body Composition does not influence Conditioned Pain Modulation and Exercise Induced Hyperalgesia in Healthy Males and Females. Eur J Pain 2022; 26:1800-1810. [PMID: 35802068 DOI: 10.1002/ejp.2005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/09/2022] [Accepted: 07/03/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obese individuals report a higher susceptibility to chronic pain. Females are more likely to have chronic pain and excess adipose tissue. Chronic pain is associated with dysfunctional pain modulatory mechanisms. Body composition differences may be associated with pain modulation differences in males and females. The purpose of this study was to investigate body composition (lean vs fat mass) differences and pain modulatory functioning in healthy males and females. METHODS Pressure pain thresholds (PPT) of 96 participants (47M; 49F) were assessed in both arms and legs before and after a double footed ice bath (2°C) for 1min and an isometric knee extension, time to failure task. The difference between post and pre measures was defined conditioned pain modulatory (CPM) response (ice bath) and exercise induced hypoalgesia (EIH) response. Whole body and site-specific fat and lean tissue were assessed via DXA scan. RESULTS Sex differences were found in whole body lean mass (61.5±6.7kg vs 41.2±5.4kg; P<0.001) but not fat mass amount (17.2±10.5kg vs 21.0±9.7kg; P=0.068). No effect of sex was found between limb CPM (P=0.237) and limb EIH (P=0.512). When controlling for lean mass there was no significant effect of sex on CPM (P=0.732) or EIH (P=0.474) response. Similar findings were found for fat mass. CONCLUSION The lack of difference suggests that males and females have similar modulatory functioning. It appears that in healthy adults free from chronic pain, neither fat mass nor lean mass has an influence on endogenous pain modulatory function.
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Affiliation(s)
- Jessica A Peterson
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK.,Department of Community Dentistry and Behavioral Science, University of Florida Gainesville, FL
| | - Cameron Lohman
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
| | - Rebecca D Larson
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
| | - Michael G Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
| | - Christopher D Black
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
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14
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Mechanisms and manifestations in musculoskeletal pain: from experimental to clinical pain settings. Pain 2022; 163:S29-S45. [PMID: 35984370 DOI: 10.1097/j.pain.0000000000002690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
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15
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Impaired conditioned pain modulation was restored after a single exercise session in individuals with and without fibromyalgia. Pain Rep 2022; 7:e996. [PMID: 35399187 PMCID: PMC8984585 DOI: 10.1097/pr9.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Submaximal isometric exercise improved impaired conditioned pain modulation acutely in individuals with and without fibromyalgia, regardless of health status. Introduction: Exercise is an effective nonpharmacological intervention for individuals with fibromyalgia syndrome (FMS); however, considerable variability is observed in their pain response after a single exercise session that could be due to differences in baseline central pain inhibition (ie, conditioned pain modulation [CPM]). Objectives: This study examined the effect of isometric exercise on CPM in people with FMS and control participants. A subaim was to identify whether pain inhibition after exercise was due to differences in baseline CPM. Methods: Twenty-one individuals with FMS (50.5 ± 14.9 years) and 22 age-matched and sex-matched controls (49.2 ± 13.3 years) participated in a familiarization session and 2 randomized experimental sessions: (1) low-intensity isometric exercise and (2) quiet rest control. Conditioned pain modulation was measured before and after each experimental session. In addition, body composition and physical activity levels were collected to determine potential group differences. Results: Both groups had comparable body composition and physical activity levels and reported similar exercise-induced hypoalgesia (increase in pressure pain thresholds) at the exercising muscle (quadriceps muscle) and systemically (deltoid muscle). Both groups had a decrease in CPM after exercise and quiet rest; however, in both FMS and control participants with impaired baseline CPM, there was an increase in CPM at the deltoid muscle after exercise. Conclusion: In persons with low CPM, irrespective of health status, isometric exercise enhanced CPM at a site distal from the exercising muscle. Our results support the use of isometric exercise when initiating an exercise program especially for individuals with impaired CPM.
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Nuwailati R, Bobos P, Drangsholt M, Curatolo M. Reliability of conditioned pain modulation in healthy individuals and chronic pain patients: a systematic review and meta-analysis. Scand J Pain 2022; 22:262-278. [PMID: 35142147 DOI: 10.1515/sjpain-2021-0149] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/21/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Conditioned pain modulation (CPM) is a psychophysical parameter that is used to reflect the efficacy of endogenous pain inhibition. CPM reliability is important for research and potential clinical applications. The aim of this systematic review and meta-analysis was to evaluate the reliability of CPM tests in healthy individuals and chronic pain patients. METHODS We searched three databases for peer-reviewed studies published from inception to October 2020: EMBASE, Web of Science and NCBI. Risk of bias and the quality of the included studies were assessed. A meta-analysis with a random effects model was conducted to estimate intraclass correlation coefficients (ICCs). RESULTS Meta-analysis was performed on 25 papers that examined healthy participants (k=21) or chronic pain patients (k=4). The highest CPM intra-session reliability was with pressure as test stimulus (TS) and ischemic pressure (IP) or cold pressor test (CPT) as conditioning stimulus (CS) in healthy individuals (ICC 0.64, 95% CI 0.45-0.77), and pressure as TS with CPT as CS in patients (ICC 0.77, 95% CI 0.70-0.82). The highest inter-session ICC was with IP as TS and IP or CPT as CS (ICC 0.51, 95% CI 0.42-0.59) in healthy subjects. The only data available in patients for inter-session reliability were with pressure as TS and CPT as CS (ICC 0.44, 95% CI 0.11-0.69). Quality ranged from very good to excellent using the QACMRR checklist. The majority of the studies (24 out of 25) scored inadequate in Kappa coefficient reporting item of the COSMIN-ROB checklist. CONCLUSIONS Pressure and CPT were the TS and CS most consistently associated with good to excellent intra-session reliability in healthy volunteers and chronic pain patients. The inter-session reliability was fair or less for all modalities, both in healthy volunteers and chronic pain patients.
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Affiliation(s)
- Rania Nuwailati
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Pavlos Bobos
- Applied Health Research Centre (AHRC), The HUB, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Clinical Epidemiology and Health Care Research, Dalla Lana School of Public Health, Institute of Healthy Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mark Drangsholt
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- CLEAR Research Center for Musculoskeletal Disorders, Seattle, WA, USA
- Department of Health Science and Technology, Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Kuithan P, Rushton A, Heneghan NR. [Pain modulation through exercise : Exercise-induced hypoalgesia in physiotherapy]. Schmerz 2022; 36:237-241. [PMID: 35166902 DOI: 10.1007/s00482-022-00623-3] [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: 07/28/2021] [Revised: 10/05/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Abstract
Exercise prescription is a central tenet of physiotherapy. One of the numerous benefits of exercise is its influence on endogenous pain modulation. Exercise-induced hypoalgesia (EIH) refers to a short-term change in pain sensitivity following an acute bout of exercise. Interest in this phenomenon has grown considerably with over 150 articles published, including four systematic reviews in 2020 alone.This narrative review provides an overview of EIH including a definition and summary of the underlying mechanisms and mediating factors. Recent systematic reviews assessing EIH in people with and without musculoskeletal complaints were evaluated using AMSTAR2. Review findings confirm the presence of EIH. For asymptomatic people, confidence in the evidence was low to very low due to high heterogeneity of included studies, risk of bias, and study eligibility. For people with pain, there is very low confidence, at best, that subgroups or isometric exercise show altered EIH. Despite the growing body of evidence, challenges within the available evidence due to its complex nature are highlighted. Recommendations regarding outcome measures and exercise parameters are required, and further understanding of reliability and validity of EIH is needed. There is a demand to further elucidate these parameters and contextual factors to advance our understanding of EIH. Additional clinical research, especially in patient populations, is required to then provide implications for rehabilitation.
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Affiliation(s)
- Pauline Kuithan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, B15 2TT, Edgbaston, Birmingham, Großbritannien. .,School of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Coventry University, Jordan Well, CV1 5RW, Coventry, Großbritannien.
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, B15 2TT, Edgbaston, Birmingham, Großbritannien.,School of Physical Therapy, Faculty of Health Science, Western University, Richmond Street, N6A 3K7, London, Ontario, Kanada
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, B15 2TT, Edgbaston, Birmingham, Großbritannien
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Wu B, Zhou L, Chen C, Wang J, Hu LI, Wang X. Effects of Exercise-induced Hypoalgesia and Its Neural Mechanisms. Med Sci Sports Exerc 2022; 54:220-231. [PMID: 34468414 DOI: 10.1249/mss.0000000000002781] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Exercise-induced hypoalgesia is frequently documented in the literature. However, the underlying neural mechanism of this phenomenon remains unclear. Here, we explored the effects of different intensities of isometric exercise on pain perception with a randomized controlled design and investigated its neural mechanisms through tracing the dynamic changes of heat-evoked brain responses. METHODS Forty-eight participants were randomly assigned to one of the three groups with different exercise intensities (i.e., high, low, and control). Their subjective pain reports and brain responses elicited by heat stimuli before and after exercise were assessed. RESULTS We observed 1) the increased pressure pain thresholds and heat pain thresholds on the dorsal surface of the hand and the biceps brachii muscle of the exercised limb (closed to the contracting muscle), and the decreased pressure pain ratings at the indexed finger of the unexercised limb; 2) more reduction of pain sensitivity on both the biceps brachii muscle and the dorsal surface of the hand induced by the high-intensity isometric exercise than the low-intensity isometric exercise; and 3) both the high-intensity and the low-intensity isometric exercise induced the reduction of N2 amplitudes and N2-P2 peak-to-peak amplitudes, as well as the reduction of event-related potential magnitudes elicited by the heat stimuli on the exercised limb. CONCLUSIONS The hypoalgesic effects induced by the isometric exercise were not only localized to the moving part of the body but also can be extended to the distal part of the body. The exercise intensities play a vital role in modulating these effects. Exercise-induced hypoalgesia could be related to the modulation of nociceptive information transmission via a spinal gating mechanism and also rely on a top-down descending pain inhibitory mechanism.
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Affiliation(s)
| | - Lili Zhou
- School of Psychology, Shanghai University of Sport, Shanghai, CHINA
| | - Changcheng Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, CHINA
| | - Juan Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, CHINA
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Abstract
BACKGROUND Pain is a complex and highly subjective phenomenon that can be modulated by several factors. On the basis of results from experimental and clinical studies, the existence of endogenous pain modulatory mechanisms that can increase or diminish the experience of pain is now accepted. METHODS In this narrative review, the pain modulatory effects of exercise, stress, and cognitions in humans are assessed. RESULTS Experimental studies on the effect of exercise have revealed that pain-free participants show a hypoalgesic response after exercise. However, in some patients with chronic pain, this response is reduced or even hyperalgesic in nature. These findings will be discussed from a mechanistic point of view. Stress is another modulator of the pain experience. Although acute stress may induce hypoalgesia, ongoing clinical stress has detrimental effects on pain in many patients with chronic pain conditions, which have implications for the understanding, assessment, and treatment of stress in patients with pain. Finally, cognitive strategies play differing roles in pain inhibition. Two intuitive strategies, thought suppression and focused distraction, will be reviewed as regards experimental, acute, and chronic pain. CONCLUSION On the basis of current knowledge on the role of exercise, stress, and cognitive pain control strategies on the modulation of pain, implications for treatment will be discussed.
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Varela-Rodríguez S, Sánchez-González JL, Sánchez-Sánchez JL, Delicado-Miralles M, Velasco E, Fernández-de-las-Peñas C, Calderón-Díez L. Effects of Percutaneous Electrolysis on Endogenous Pain Modulation: A Randomized Controlled Trial Study Protocol. Brain Sci 2021; 11:brainsci11060801. [PMID: 34204415 PMCID: PMC8235332 DOI: 10.3390/brainsci11060801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 01/02/2023] Open
Abstract
Percutaneous electrolysis consists of the application of a galvanic electrical current throughout an acupuncture needle. It has been previously hypothesized that needling procedures' neurophysiological effects may be related to endogenous pain modulation (EPM). This protocol study describes the design of a double-blind (participant, assessor) randomized controlled trial with the aim to investigate whether percutaneous electrolysis is able to enhance EPM and whether the effect is different between two applications depending on the dosage of the galvanic electrical current. Seventy-two asymptomatic subjects not reporting the presence of pain symptoms the previous 6 months before the study, aged 18-40 years, are randomized into one of four groups: a control group who does not receive any intervention, a needling group who receives a needling intervention without electrical current, a low-intensity percutaneous electrolysis group (0.3 mA × 90 s), and a high-intensity percutaneous electrolysis group (three bouts of 3 mA × 3 s). Needling intervention consists of ultrasound-guided insertion of the needle on the common extensor tendon of the lateral epicondyle. The primary outcome is conditioned pain modulation (CPM), and secondary outcomes include widespread pressure pain sensitivity (pressure pain thresholds (PPT) over the lateral epicondyle, the cervical spine, and the tibialis anterior muscle) and temporal summation (TS). We expected that percutaneous electrolysis would have a greater influence on CPM than an isolated needling procedure and no intervention. In addition, we also postulated that there might be differences in outcome measures depending on the intensity of the electrical current during the percutaneous electrolysis application. This study makes a new contribution to the field of neurophysiological effects of percutaneous electrolysis and needling interventions.
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Affiliation(s)
- Sergio Varela-Rodríguez
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (S.V.-R.); (J.L.S.-G.); (J.L.S.-S.); (L.C.-D.)
| | - Juan Luis Sánchez-González
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (S.V.-R.); (J.L.S.-G.); (J.L.S.-S.); (L.C.-D.)
| | - José Luis Sánchez-Sánchez
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (S.V.-R.); (J.L.S.-G.); (J.L.S.-S.); (L.C.-D.)
| | | | - Enrique Velasco
- Instituto de Neurociencias de Alicante (CSIC-UMH), 03550 Alicante, Spain; (M.D.-M.); (E.V.)
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Correspondence: or ; Tel.: +34-91-488-88-84
| | - Laura Calderón-Díez
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (S.V.-R.); (J.L.S.-G.); (J.L.S.-S.); (L.C.-D.)
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Moreira LPC, Mendoza C, Barone M, Rocha RS, Dias Dos Santos R, Hazime FA. Reduction in Pain Inhibitory Modulation and Cognitive-Behavioral Changes in Patients With Chronic Low Back Pain: A Case-Control Study. Pain Manag Nurs 2021; 22:599-604. [PMID: 34127394 DOI: 10.1016/j.pmn.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent studies indicate that the assessment of conditioned pain modulation (CPM) responses and emotional factors can provide important information regarding chronification mechanisms, choices for more efficient therapeutic strategies, and clinical variables supporting a therapeutic prognosis. AIMS To investigate the impact of nonspecific chronic low back pain (NSCLBP) on CPM and psychosocial factors in individuals with NSCLBP compared with healthy controls. DESIGN Case-control study. METHODS Eighteen patients with NSCLBP and 18 healthy controls were recruited for this study. Pain intensity and affective-emotional aspects of pain, functional disability, kinesiophobia, depression, anxiety, and catastrophizing pain were obtained using a questionnaire. A CPM protocol was established to assess the functioning of the descending inhibitory system, with a cold pressor test as a conditioning stimulus and pressure pain threshold as a test stimulus. The maximal isometric strength of the trunk extensors also was evaluated. RESULTS Healthy participants demonstrated a greater CPM response than those with NSCLBP. Patients with NSCLBP exhibited significantly lower pressure pain threshold than healthy subjects. Moreover, patients with NSCLBP presented with a considerable exacerbation of cognitive-behavioral changes. NSCLBP patients showed diminished maximal isometric strength of the trunk extensor compared to healthy subjects. CONCLUSIONS The endogenous pain inhibition system is reduced in patients with NSCLBP, with significant cognitive-behavioral changes indicated by high levels of anxiety and moderate pain intensity. SETTING Clinical School of Physical Therapy of the Federal University of Delta of Parnaíba, Piauí - Brazil. PARTICIPANTS/SUBJECTS 36 subjects with and without NSCLBP.
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Affiliation(s)
| | - Cristian Mendoza
- Department of Physical Therapy, Musculoskeletal Research Unit, UIM, University Center for Assistance, Teaching and Research, CUADI, Universidad del Gran Rosario, UGR, Rosario, Argentina
| | - Mauro Barone
- Department of Physical Therapy, Musculoskeletal Research Unit, UIM, University Center for Assistance, Teaching and Research, CUADI, Universidad del Gran Rosario, UGR, Rosario, Argentina
| | - Raquel Sales Rocha
- Department of Physical Therapy, Federal University of Delta of Parnaíba, Parnaíba, Piauí, Brazil
| | - Renato Dias Dos Santos
- Department of Physical Therapy, Federal University of Delta of Parnaíba, Parnaíba, Piauí, Brazil
| | - Fuad Ahmad Hazime
- Department of Physical Therapy, Federal University of Delta of Parnaíba, Parnaíba, Piauí, Brazil; Biomedical Master Science Program, Federal University of Delta of Parnaíba, Parnaíba, Piauí, Brazil.
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Balasch-Bernat M, Lluch E, Vaegter HB, Dueñas L. Should Exercises be Painful or not? Effects on Clinical and Experimental Pain in Individuals with Shoulder Pain. THE JOURNAL OF PAIN 2021; 22:1246-1255. [PMID: 33887445 DOI: 10.1016/j.jpain.2021.03.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
Exercise can reduce pain, however the effect of painful versus non-painful exercises is uncertain. The primary aim of this randomized crossover study was to compare the effect of painful versus nonpainful isometric shoulder exercises on pain intensity after exercise in individuals with rotator cuff-related shoulder pain. Secondary exploratory aims were to describe the effects on pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and muscle strength. On separate days, 35 individuals performed painful isometric shoulder exercises (external rotation; 20% above pain threshold), nonpainful isometric shoulder exercises (external rotation; 20% below pain threshold), and a rest condition, in randomised order. Shoulder pain intensity, PPTs, CPM, and external rotation strength were assessed before, immediately after and 45 minutes after conditions. No significant differences were observed between painful and nonpainful exercises. Visual analogue scale scores increased immediately after both painful and non-painful exercises compared with rest (P = .047, partial ƞ2 = .07), but were similar to preexercise levels after 45 minutes. No changes in PPTs, CPM, or muscle strength after exercises compared with rest were observed. Painful and non-painful isometric exercises caused a moderate but short-lasting increase in shoulder pain in individuals with RCRSP. Isometric exercises had no effect on pain sensitivity and shoulder muscle strength or CPM. Perspective: This study evaluated for the first time in individuals with rotator cuff-related shoulder pain the effects of painful versus non-painful isometric exercises on different pain-related outcome measures. Both painful and non-painful isometric exercises caused a moderate but relatively short-lasting increase in shoulder pain in individuals with rotator cuff-related shoulder pain. Trial registration number: (ClinicalTrials.gov) NCT03675399.
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Affiliation(s)
- M Balasch-Bernat
- Department of Physiotherapy, University of Valencia, Spain; Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain
| | - E Lluch
- Department of Physiotherapy, University of Valencia, Spain; Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain; Departments of Human Physiology and Rehabilitation Sciences, "Pain in Motion" International Research Group, Brussels, Belgium.
| | - H B Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - L Dueñas
- Department of Physiotherapy, University of Valencia, Spain; Department of Physiotherapy, Physiotherapy in Motion. Multi-speciality Research group (PTinMOTION), University of Valencia, Spain
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Bonello C, Girdwood M, De Souza K, Trinder NK, Lewis J, Lazarczuk SL, Gaida JE, Docking SI, Rio EK. Does isometric exercise result in exercise induced hypoalgesia in people with local musculoskeletal pain? A systematic review. Phys Ther Sport 2021; 49:51-61. [PMID: 33601254 DOI: 10.1016/j.ptsp.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this review was to investigate if exercise induced hypoalgesia (EIH) occurs following isometric muscle contraction in people with local musculoskeletal symptoms. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL & SportDiscus electronic databases were searched (inception to April 2020). ELIGIBILITY CRITERIA Two authors independently evaluated eligibility. Randomised controlled and crossover (repeated measures) trials that measured the effects of isometric exercise in participants with localised musculoskeletal pain during, and up to 2 hours after isometric exercise were included. Other inclusion criteria included comparison to another intervention, or comparison to healthy controls. Primary outcomes were experimentally induced pain thresholds and secondary outcomes included measures of pain sensitivity from clinical testing. RESULTS 13 studies with data from 346 participants were included for narrative synthesis. EIH was reported in some upper and lower limb studies but there were no consistent data to show isometric exercises were superior to comparison interventions. CONCLUSION There was no consistent evidence for EIH following isometric exercise in people with musculoskeletal pain. These findings are different to those reported in asymptomatic populations (where EIH is consistently demonstrated) as well as conditions associated with widespread symptoms such as fibromyalgia (where isometric exercise may induce hyperalgesia). Although well tolerated when prescribed, isometric exercise did not induce EIH consistently for people seeking care for local musculoskeletal symptoms. The variance in the dose, location of contraction and intensity of protocols included in this review may explain the inconsistent findings. Further work is required to better understand endogenous analgesia in musculoskeletal pain conditions.
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Affiliation(s)
- Christian Bonello
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Michael Girdwood
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Keith De Souza
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Nicola K Trinder
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Stephanie L Lazarczuk
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Jamie E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Australian Capital Territory, Australia
| | - Sean I Docking
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Ebonie K Rio
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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Exercise-Induced Hypoalgesia in Healthy Individuals and People With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2021; 22:21-31. [DOI: 10.1016/j.jpain.2020.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 02/06/2023]
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Exercise-induced hypoalgesia after acute and regular exercise: experimental and clinical manifestations and possible mechanisms in individuals with and without pain. Pain Rep 2020; 5:e823. [PMID: 33062901 PMCID: PMC7523781 DOI: 10.1097/pr9.0000000000000823] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/02/2020] [Accepted: 04/21/2020] [Indexed: 01/07/2023] Open
Abstract
This review describes methodology used in the assessment of the manifestations of exercise-induced hypoalgesia in humans and previous findings in individuals with and without pain. Possible mechanisms and future directions are discussed. Exercise and physical activity is recommended treatment for a wide range of chronic pain conditions. In addition to several well-documented effects on physical and mental health, 8 to 12 weeks of exercise therapy can induce clinically relevant reductions in pain. However, exercise can also induce hypoalgesia after as little as 1 session, which is commonly referred to as exercise-induced hypoalgesia (EIH). In this review, we give a brief introduction to the methodology used in the assessment of EIH in humans followed by an overview of the findings from previous experimental studies investigating the pain response after acute and regular exercise in pain-free individuals and in individuals with different chronic pain conditions. Finally, we discuss potential mechanisms underlying the change in pain after exercise in pain-free individuals and in individuals with different chronic pain conditions, and how this may have implications for clinical exercise prescription as well as for future studies on EIH.
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Exercise-induced pain threshold modulation in healthy subjects: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2020; 6:11-28. [PMID: 33409362 DOI: 10.21801/ppcrj.2020.63.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background The use of exercise is a potential treatment option to modulate pain (exercise-induced hypoalgesia). The pain threshold (PT) response is a measure of pain sensitivity that may be a useful marker to assess the effect of physical exercise on pain modulation. Aim The aim of this systematic review and meta-analysis is to evaluate the PT response to exercise in healthy subjects. Methods We searched in MEDLINE, EMBASE, Web of Science, Lilacs, and Scopus using a search strategy with the following search terms: "exercise" OR "physical activity" AND "Pain Threshold" from inception to December 2nd, 2019. As criteria for inclusion of appropriate studies: randomized controlled trials or quasi-experimental studies that enrolled healthy subjects; performed an exercise intervention; assessed PT. Hedge's effect sizes of PT response and their 95% confidence intervals were calculated, and random-effects meta-analyses were performed. Results For the final analysis, thirty-six studies were included (n=1326). From this we found a significant and homogenous increase in PT in healthy subjects (ES=0.19, 95% CI= 0.11 to 0.27, I2=7.5%). According to subgroup analysis the effect was higher in studies: with women (ES=0.36); performing strength exercise (ES=0.34), and with moderate intensity (ES=0.27), and no differences by age were found. Confirmed by the meta-regression analysis. Conclusion This meta-analysis provides evidence of small to moderate effects of exercise on PT in healthy subjects, being even higher for moderate strength exercise and in women. These results support the idea of modulation of the endogenous pain system due to exercise and highlight the need of clinical translation to chronic pain population.
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van der Vlist AC, van Veldhoven PLJ, van Oosterom RF, Verhaar JAN, de Vos RJ. Isometric exercises do not provide immediate pain relief in Achilles tendinopathy: A quasi-randomized clinical trial. Scand J Med Sci Sports 2020; 30:1712-1721. [PMID: 32474979 PMCID: PMC7496962 DOI: 10.1111/sms.13728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
Background Isometric exercises may provide an immediate analgesic effect in patients with lower‐limb tendinopathy and have been proposed as initial treatment and for immediate pain relief. Current evidence is conflicting, and previous studies were small. Objective To study whether isometric exercises result in an immediate analgesic effect in patients with chronic midportion Achilles tendinopathy. Methods Patients with clinically diagnosed chronic midportion Achilles tendinopathy were quasi‐randomized to one of four arms: isometric calf‐muscle exercises (tiptoes), isometric calf‐muscle exercises (dorsiflexed ankle position), isotonic calf‐muscle exercises, or rest. The primary outcome was pain measured on a visual analogue scale (VAS) score (0‐100) during a functional task (10 unilateral hops) both before and after the intervention. Between‐group differences were analyzed using a generalized estimation equations model. Results We included 91 patients. There was no significant reduction in pain on the 10 hop test after performing any of the four interventions: isometric (tiptoes) group 0.2, 95%CI −11.2 to 11.5; isometric (dorsiflexed) group −1.9, 95%CI −13.6 to 9.7; isotonic group 1.4, 95%CI −8.3 to 11.1; and rest group 7.2, 95%CI −2.4 to 16.7. There were also no between‐group differences after the interventions. Conclusion The isometric exercises investigated in this study did not result in immediate analgesic benefit in patients with chronic midportion Achilles tendinopathy. We do not recommend isometric exercises if the aim is providing immediate pain relief. Future research should focus on the use of isometric or isotonic exercise therapy as initial treatment as all exercise protocols used in this study were well‐tolerated.
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Affiliation(s)
- Arco C van der Vlist
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Robert F van Oosterom
- Department of Sports Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Smith A, Ritchie C, Warren J, Sterling M. Exercise-induced Hypoalgesia Is Impaired in Chronic Whiplash-associated Disorders (WAD) With Both Aerobic and Isometric Exercise. Clin J Pain 2020; 36:601-611. [DOI: 10.1097/ajp.0000000000000845] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liaghat B, Eshoj H, Juul-Kristensen B, Arendt-Nielsen L, Skou ST. Pressure pain sensitivity in patients with traumatic first-time and recurrent anterior shoulder dislocation: a cross-sectional analysis. Scand J Pain 2020; 20:387-395. [PMID: 31586969 DOI: 10.1515/sjpain-2019-0091] [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: 06/28/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Traumatic anterior shoulder dislocation (ASD) is frequent in active populations and associated with a 39% higher risk of recurrent dislocation, which may cause persistent shoulder problems, pain, and impaired shoulder-related quality of life. While local and distant pressure pain sensitivity has been demonstrated in other shoulder conditions, little is known about the link between pressure pain sensitivity and ASD. The interesting aspect is whether recurrent dislocation - resulting in symptoms of longer duration - is associated with more pronounced pressure pain sensitivity, or if presence of pressure pain sensitivity may be part of the reasons why patients develop recurrent dislocation. Therefore, this study aimed at evaluating whether patients with recurrent ASD display greater pressure pain sensitivity and more painful body sites than patients with first-time ASD. Methods This was a cross-sectional analysis of baseline data from a randomized controlled trial including 34 patients with first-time ASD [82% male, mean (SD) age 26 (7) years] and 22 patients with recurrent ASD [96% male, mean (SD) age 25 (5) years]. Patients were assessed as follows: (1) assessment of local and distant pressure pain sensitivity evaluated by pressure pain thresholds (PPTs) using a handheld algometer on mm. trapezius superior, levator scapula, pectorales major, deltoideus, and tibialis anterior, (2) pain intensity at rest during the previous 24 h, (3) number of ASD, and (4) number of painful body sites on a region-divided body chart. Results The PPTs were not significantly different between first-time and recurrent ASD [mean (SD) kPa for m. trapezius superior 264 (110) vs. 261 (88), m. levator scapula 301 (157) vs. 325 (163), m. pectorales major 234 (163) vs. 269 (130), m. deltoideus 290 (166) vs. 352 (173), m. tibialis anterior 420 (202) vs. 449 (184)], two-way ANCOVA, adjusted for sex and age, F (4,263) = 0.29, p = 0.88. For both groups, the PPTs were lower at the shoulder sites than at m. tibialis anterior (difference 117-184 kPa, 95% CI range 33-267). Females had lower PPTs than males (difference 124 kPa, 95% CI 64-183). The number (SD) of painful body sites were 2.2 (1.9) for first-time ASD and 2.6 (5.4) for recurrent ASD, with no between-group differences, one-way ANCOVA, adjusted for sex and age, F (1, 52) = 0.24, p = 0.63. There was a strong correlation between PPTs at the shoulder and lower leg, r = 0.84, p < 0.01. Conclusions This study demonstrated no differences in local and distant pressure pain sensitivity or number of painful body sites between patients with first-time and recurrent ASD. Females had lower PPTs than males, and a strong correlation was found between PPTs at the shoulder and lower leg. Implications Patients with first-time and recurrent ASD seem to have similar pressure pain sensitivity, but lower PPTs compared to existing normative data, suggesting that it is relevant to evaluate the status of the pain system in these patients to prevent triggering or worsening of their symptoms. However, it remains unanswered how these changes affect the patients' ability to undergo rehabilitation, symptom response and long-term shoulder function.
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Affiliation(s)
- Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Eshoj
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Quality of Life Research Center, Odense University Hospital, Department of Haematology, Odense, Denmark
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Morales Tejera D, Fernandez-Carnero J, Suso-Martí L, Cano-de-la-Cuerda R, Lerín-Calvo A, Remón-Ramiro L, La Touche R. Comparative study of observed actions, motor imagery and control therapeutic exercise on the conditioned pain modulation in the cervical spine: a randomized controlled trial. Somatosens Mot Res 2020; 37:138-148. [PMID: 32340585 DOI: 10.1080/08990220.2020.1756244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aim: The aim of this study was to compare the effects of cervical exercise, motor imagery (MI) and action observation (AO) of cervical exercise actions on conditioned pain modulation and pressure pain thresholds. The second objective was to assess the effects of these interventions on cervical motor activity (ranges of motion and muscle endurance), attention, and the ability to generate motor images.Study design: Single-blinded randomized controlled trial.Materials and methods: Fifty-four healthy subjects were randomly assigned to each group. Response conditioned pain modulation, pressure pain threshold, were the main variables. The secondary outcome measures included, cervical range of motion, Neck flexor endurance test, mental movement representation associated and psychosocial variables.Results: All groups showed significant differences in time factor for all evaluated variables (p < .01) except pressure pain threshold over the tibial region. The post hoc analysis revealed significant within-group differences in the AE and AO groups in conditioned pain modulation (p < .05), with medium effect size in time [AE (d -0.61); AO (d -0.74)].Conclusion: The results showed that within-group changes in conditioned pain modulation, cervical muscle endurance, and attention where founded only in the AE and AO groups. Variations in pain thresholds at pressure in the trapezium area were also obtained in the three groups. Changes in the ranges of flexion-extension and rotation movement were presented exclusively in the exercise group, and in the capacity to generate motor images only in the AO group. However, there was no difference in the pressure pain threshold over the tibial region.
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Affiliation(s)
- David Morales Tejera
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Josue Fernandez-Carnero
- La Paz Hospital Institute for Health Research, IdiPAZ, 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, España.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain.,Grupo Multidisciplinar de Investigación y Tratamiento del Dolor. Grupo de Excelencia Investigadora, URJC-Banco de Santander, 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, España.,Departament of Physiotherapy, Universidad CEU Cardenal Herrera, CEU Universities, Valencia, Spain
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - Alfredo Lerín-Calvo
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - Lorena Remón-Ramiro
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España
| | - Roy La Touche
- La Paz Hospital Institute for Health Research, IdiPAZ, 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, España.,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, España
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Pain inhibition is not affected by exercise-induced pain. Pain Rep 2020; 5:e817. [PMID: 32440610 PMCID: PMC7209813 DOI: 10.1097/pr9.0000000000000817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/06/2019] [Accepted: 12/02/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction: Offset analgesia (OA) and conditioned pain modulation (CPM) are frequently used paradigms to assess the descending pain modulation system. Recently, it was shown that both paradigms are reduced in chronic pain, but the influence of acute pain has not yet been adequately examined. Objectives: The aim of this study is to investigate OA and CPM after exercise-induced pain to evaluate whether these tests can be influenced by delayed-onset muscle soreness (DOMS) at a local or remote body site. Methods: Forty-two healthy adults were invited to 3 separate examination days: a baseline appointment, the consecutive day, and 7 days later. Participants were randomly divided into a rest (n = 21) and an exercise group (n = 21). The latter performed a single intensive exercise for the lower back. Before, immediately after, and on the following examination days, OA and CPM were measured at the forearm and the lower back by blinded assessor. Results: The exercise provoked a moderate pain perception and a mild delayed-onset muscle soreness on the following day. Repeated-measurements analysis of variance showed no statistically significant main effect for either OA or CPM at the forearm or lower back (P > 0.05). Conclusion: Delayed-onset muscle soreness was shown to have no effect on the inhibitory pain modulation system neither locally (at the painful body part), nor remotely. Thus, OA and CPM are robust test paradigms that probably require more intense, different, or prolonged pain to be modulated.
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Hoeger Bement M, Petersen KK, Sørensen LB, Andersen HH, Graven‐Nielsen T. Temporal aspects of endogenous pain modulation during a noxious stimulus prolonged for 1 day. Eur J Pain 2020; 24:752-760. [DOI: 10.1002/ejp.1523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Marie Hoeger Bement
- Center for Neuroplasticity and Pain (CNAP) Aalborg University Aalborg Denmark
- Department of Physical Therapy Marquette University Milwaukee WI USA
| | | | - Line B. Sørensen
- Center for Neuroplasticity and Pain (CNAP) Aalborg University Aalborg Denmark
| | - Hjalte H. Andersen
- Laboratory of Cutaneous Experimental Pain SMIAalborg University Aalborg Denmark
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Hughes L, Patterson SD. Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect. Med Hypotheses 2019; 132:109370. [PMID: 31442920 DOI: 10.1016/j.mehy.2019.109370] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022]
Abstract
Exercise-induced hypoalgesia is characterised by a reduction in pain sensitivity following exercise. Recently, low intensity exercise performed with blood flow restriction has been shown to induce hypoalgesia. The purpose of this manuscript is to discuss the mechanisms of exercise-induced hypoalgesia and provide rationale as to why low intensity exercise performed with blood flow restriction may induce hypoalgesia. Research into exercise-induced hypoalgesia has identified several potential mechanisms, including opioid and endocannabinoid-mediated pain inhibition, conditioned pain modulation, recruitment of high threshold motor units, exercise-induced metabolite production and an interaction between cardiovascular and pain regulatory systems. We hypothesise that several mechanisms consistent with prolonged high intensity exercise may drive the hypoalgesia effect observed with blood flow restriction exercise. These are likely triggered by the high level of intramuscular stress in the exercising muscle generated by blood flow restriction including hypoxia, accumulation of metabolites, accelerated fatigue onset and ischemic pain. Therefore, blood flow restriction exercise may induce hypoalgesia through similar mechanisms to prolonged higher intensity exercise, but at lower intensities, by changing local tissue physiology, highlighting the importance of the blood flow restriction stimulus. The potential to use blood flow restriction exercise as a pain modulation tool has important implications following acute injury and surgery, and for several load compromised populations with chronic pain.
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Affiliation(s)
- Luke Hughes
- Faculty of Sport, Health and Applied Science, St Mary's University, London TW1 4SX, UK.
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Straszek CL, Rathleff MS, Graven‐Nielsen T, Petersen KK, Roos EM, Holden S. Exercise‐induced hypoalgesia in young adult females with long‐standing patellofemoral pain – A randomized crossover study. Eur J Pain 2019; 23:1780-1789. [DOI: 10.1002/ejp.1452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Christian L. Straszek
- Center for General Practice at Aalborg UniversityAalborg Denmark
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark
| | - Michael S. Rathleff
- Center for General Practice at Aalborg UniversityAalborg Denmark
- SMI Department of Health Science and Technology Faculty of Medicine Aalborg University Aalborg Denmark
| | - Thomas Graven‐Nielsen
- Center for Neuroplasticity and Pain (CNAP) SMI Department of Health Science and TechnologyAalborg University Aalborg Denmark
| | - Kristian K. Petersen
- Center for Neuroplasticity and Pain (CNAP) SMI Department of Health Science and TechnologyAalborg University Aalborg Denmark
| | - Ewa M. Roos
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark
| | - Sinead Holden
- Center for General Practice at Aalborg UniversityAalborg Denmark
- SMI Department of Health Science and Technology Faculty of Medicine Aalborg University Aalborg Denmark
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36
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Walking increases pain tolerance in humans: an experimental cross-over study. Scand J Pain 2019; 19:813-822. [DOI: 10.1515/sjpain-2019-0070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/06/2019] [Indexed: 01/27/2023]
Abstract
Abstract
Background and aims
Exercise is commonly used as treatment for chronic pain with positive long-term effects on pain and pain-related disability. In pain-free subjects, hypoalgesia following an acute bout of exercise compared with a control condition has consistently been demonstrated also known as exercise-induced hypoalgesia (EIH). Walking exercise, a low intensity aerobic exercise, is frequently used in clinical practice as an easily applicable intervention for patients with chronic pain. Walking exercise is furthermore recommended as an effective treatment for patients with chronic musculoskeletal pain conditions to alleviate pain and reduce disability, however, the effect of walking on pain sensitivity is currently unknown. The aims of the present study were to investigate (1) the acute effect of walking on pain sensitivity, and (2) the relative (between-subjects) and absolute (within-subject) test-retest reliability of the hypoalgesic response across two sessions separated by 1 week.
Methods
In this randomised experimental cross-over study including two identical sessions, 35 pain-free subjects performed a standardized 6 min walking test and a duration-matched quiet rest condition in a randomized and counterbalanced order in each session. Before and after both conditions, handheld pressure pain thresholds (PPTs) were assessed at the thigh and shoulder, and pressure pain thresholds (cPPT) and pain tolerance (cPTT) were assessed with computer-controlled cuff algometry at the lower leg. Change in the pain sensitivity measures were analysed with repeated-measures ANOVAs, and test-retest reliability with intraclass correlation coefficients (ICC) and agreements in classification of EIH responders/non-responders between the two sessions.
Results
All subjects completed the walking conditions in both session 1 and session 2. The perceived intensity of walking assessed with rating of perceived exertion (RPE) and walking distance did not differ significantly between session 1 (distance: 632.5 ± 75.2 meters, RPE: 10.9 ± 1.9) and session 2 (distance: 642.1 ± 80.2 meters, RPE: 11.0 ± 2.4) (p > 0.11). Moreover, RPE showed excellent relative reliability with an ICC value of 0.95 [95%CI: 0.90–0.97]. Walking increased pain tolerance (mean difference: 2.6 kPa [95%CI: 0.5–4.9 kPa; p = 0.02]), but not pain thresholds compared with rest in both sessions. Hypoalgesia after walking demonstrated fair to good relative reliability (ICC = 0.61), however the agreement in classification of EIH responders/non-responders (absolute reliability) across sessions was low and not significant (κ = 0.19, p = 0.30).
Conclusions
Walking consistently increased pain tolerance but not pain thresholds compared with a duration-matched control condition with fair to good relative reliability between sessions. Based on classification of EIH responders/non-responders the absolute reliability between the two sessions was low indicating individual variance in the EIH response. Future studies should investigate the hypoalgesic effect of a walking exercise in a clinical pain population.
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Larsen JB, Madeleine P, Arendt-Nielsen L. Development of a new bed-side-test assessing conditioned pain modulation: a test-retest reliability study. Scand J Pain 2019; 19:565-574. [DOI: 10.1515/sjpain-2018-0353] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/04/2019] [Indexed: 01/08/2023]
Abstract
Abstract
Background and aims
Conditioned pain modulation (CPM) is of considerable interest within pain research. Often CPM testing is conducted in experimental settings using complicated instrumentation, thus challenging the implementation in clinical settings. Being able to assess CPM in a fast and reliable way in clinical settings could lead to a new diagnostic tool allowing improved profiling of pain patients.
Methods
A test-retest reliability study and a methodological development study were conducted based on different populations. The reliability study included 22 healthy subjects, mean age 23.6 years (SD: 2.4) and the methodological study included 29 healthy subjects, mean age 21.5 years (SD: 1.6). As painful phasic test stimulus, a 6–10 kg handheld, spring-based pressure algometer was applied perpendicularly to the muscle belly of the tibialis anterior muscle for 10 s and as painful tonic conditioning stimulus, 1–2 standard clamps, inducing a force of 1.3 kg, were applied extra-segmentally at the ipsilateral earlobe for 60–120 s. Four different test protocols were evaluated, of which one protocol was investigated for reliability. Test protocol 1 used a 6 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 60 s as painful tonic conditioning stimulus. Test protocol 2 used a 10 kg pressure algometer as painful phasic test stimulus, and two clamps applied for 60 s as painful tonic conditioning stimulus. Test protocol 3 used a 10 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 120 s as painful tonic conditioning stimulus. Test protocol 4 used a 6 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 120 s as painful tonic conditioning stimulus.
Results
None of the stimuli caused any adverse events, e.g. bruises. In the reliability study (test protocol (1), non-significant CPM effects of 0.3 (SD: 1.6) and 0.2 (SD: 1.0) were observed in session 1 and 2, respectively. The intra-class correlations were 0.67 and 0.72 (p = < 0.01) and limits of agreement (LoA) ranged from −2.76 to 3.31. Non-significant CPM effects of 0.2 (SD: 1.0), −0.1 (SD: 1.1), and 0.0 (SD: 1.2) were observed for test protocol 2, 3, and 4, respectively).
Conclusions
The bedside test developed for investigating CPM was feasible and easy to use in healthy volunteers. No significant CPM effects were measured and a large variation in CPM effect ranging from −0.14 to 0.32 was observed. Intra-class correlation (ICC) values for the pressure algometer were interpreted as “good relative reliability” (test protocol 1), and LoA revealed a somewhat low absolute reliability.
Implications
The pressure algometer provided reproducible measurements and was useful for inducing phasic test stimuli. Since no significant CPM effects were detected, no recommendations for the bedside test can yet be made. Further examinations will have to establish if the “one size fits all” application of both test and conditioning stimuli is useful. Future bedside studies involving patient populations are warranted to determine the usefulness of the method.
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Affiliation(s)
- Jesper Bie Larsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine , Aalborg University , Aalborg East , Denmark
- Sports Sciences, Department of Health Science and Technology, School of Medicine , Aalborg University , Aalborg East , Denmark
| | - Pascal Madeleine
- Sports Sciences, Department of Health Science and Technology, School of Medicine , Aalborg University , Aalborg East , Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine , Aalborg University , Fredrik Bajers Vej 7, Bld. D3 , DK-9220 Aalborg East , Denmark
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Deering R, Pashibin T, Cruz M, Hunter SK, Hoeger Bement M. Fatiguing Trunk Flexor Exercise Decreases Pain Sensitivity in Postpartum Women. Front Physiol 2019; 10:315. [PMID: 30971949 PMCID: PMC6445131 DOI: 10.3389/fphys.2019.00315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/07/2019] [Indexed: 01/13/2023] Open
Abstract
Background Low back pain (LBP) is common in the general population and among postpartum women. Abdominal muscle exercise is often used to treat LBP, but it is unknown if fatiguing abdominal muscle exercise can produce exercise-induced hypoalgesia (EIH). Objectives To assess pressure pain thresholds (PPTs) at rest and following fatiguing trunk flexor exercise (EIH) in (1) nulligravid and postpartum women to evaluate the impact of pregnancy and childbirth and (2) nulligravid women and men to examine sex differences. Methods Seventy healthy adults (31 postpartum women, 23 nulligravid women, 16 men) participated. Postpartum and nulligravid women were tested twice (16-18 weeks apart) to identify changes in EIH with postpartum recovery. PPTs were measured at the nailbed and superior rectus abdominis before and after exercise to investigate systemic and local EIH, respectively. Rectus abdominis muscle thickness was assessed with ultrasound. Results Postpartum women reported lower PPTs than nulligravid women at the abdomen (p < 0.05) whereas postpartum women had lower PPTs at the nailbed during the first session only. Men reported higher nailbed PPTs (p = 0.047) and similar PPTs at the abdomen than women (p = 0.294). All groups demonstrated EIH at the abdomen (p < 0.05). Systemic EIH was absent in postpartum and nulligravid women (p > 0.05), while men demonstrated hyperalgesia. Local EIH was positively associated with muscle thickness for men and women, which was not significant at the second timepoint. Limitations Acute exercise response may not reflect changes that occur with exercise training. Conclusion Fatiguing trunk flexor exercise produced local EIH for all groups including postpartum and nulligravid women. Clinically, trunk exercises may be useful for acute pain relief for clinical populations that are characterized by pain and/or weakness in the abdominal region muscles in populations with abdominal pain syndromes.
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Affiliation(s)
- Rita Deering
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States.,William S. Middleton Veterans Hospital, Madison, WI, United States.,Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Tatyana Pashibin
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Meredith Cruz
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sandra K Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Marie Hoeger Bement
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
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Pasterczyk-Szczurek A, Pogwizd P, Bigosińska M. Parameters of vibration stimulation for the relief of pain of different origins and locations. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0012.6875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of vibration stimulation in alleviating pain is an issue appearing more and more often in modern rehabilitation.
The aim of the work was to review literature regarding the therapeutic usage of vibrations in analgesic activity.
Searches based on the effect of alleviating pain with the help of vibrotherapy in the therapy of diseases of various origins and localizations, as well as with various physical therapy treatments and modalities. The most important parameters were determined, such as: frequency, amplitude, places of application, and exposure time, and were described on the basis of selected tests. Both the Polish and English-language literature has been discussed. Most of the studies were English-language (over 93%). The searches were carried out among the following databases: Medline, Embase, Cochrane, ScienceDirect, PubMed, IEEE Xplore, Wiley Online Library. The key words used were: pain, vibration, WBV, analgesics. The mentioned sources were qualified on the basis of: availability, data verification, selection of research material and regularity of update.
While acute pain is, by definition, a short and self-limiting process, chronic pain begins to dominate life and concerns the patient and his/her family. In addition to significant deterioration in quality of life, chronic pain imposes a large financial burden. The use of vibrotherapy can be a solution. Therefore, it is proposed to further analyse the parameters of vibrotherapy in analgesic activity, which may lay the foundation for "personalized pain relief medicine", which will clearly define the standards of vibrational therapy parameters.
pain, vibration, WBV, analgesics
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Affiliation(s)
- Alicja Pasterczyk-Szczurek
- Dział Badawczo Rozwojowy Firmy Vitberg, Nowy Sącz / Research and Development Department of Vitberg, Nowy Sącz, Poland
| | - Paweł Pogwizd
- Dział Badawczo Rozwojowy Firmy Vitberg, Nowy Sącz / Research and Development Department of Vitberg, Nowy Sącz, Poland
| | - Monika Bigosińska
- Zakład Wychowania Fizycznego, Instytut Kultury Fizycznej, Państwowa Wyższa Szkoła Zawodowa, Nowy Sącz / Department of Physical Education, Institute of Physical Education, State University of Applied Science, Nowy Sącz, Poland
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