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Murillo C, López-Sola M, Cagnie B, Suñol M, Smeets RJEM, Coppieters I, Cnockaert E, Meeus M, Timmers I. Gray Matter Adaptations to Chronic Pain in People with Whiplash-Associated Disorders are Partially Reversed After Treatment: A Voxel-based Morphometry Study. THE JOURNAL OF PAIN 2024; 25:104471. [PMID: 38232862 DOI: 10.1016/j.jpain.2024.01.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/04/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
Gray matter (GM) changes are often observed in people with chronic spinal pain, including those with chronic whiplash-associated disorders (CWAD). These GM adaptations may be reversed with treatment, at least partially. Pain neuroscience education combined with exercise (PNE+Exercise) is an effective treatment, but its neural underlying mechanisms still remain unexplored in CWAD. Here, we performed both cross-sectional and longitudinal voxel-based morphometry to 1) identify potential GM alterations in people with CWAD (n = 63) compared to age- and sex-matched pain-free controls (n = 32), and 2) determine whether these GM alterations might be reversed following PNE+Exercise (compared to conventional physiotherapy). The cross-sectional whole-brain analysis revealed that individuals with CWAD had less GM volume in the right and left dorsolateral prefrontal cortex and left inferior temporal gyrus which was, in turn, associated with higher pain vigilance. Fifty individuals with CWAD and 29 pain-free controls were retained in the longitudinal analysis. GM in the right dorsolateral prefrontal cortex increased after treatment in people with CWAD. Moreover, the longitudinal whole-brain analysis revealed that individuals with CWAD had decreases in GM volumes of the left and right central operculum and supramarginal after treatment. These changes were not specific to treatment modality and some were not observed in pain-free controls over time. Herewith, we provide the first evidence on how GM adaptations to CWAD respond to treatment. PERSPECTIVE: This article presents which gray matter adaptations are present in people with chronic pain after whiplash injuries. Then, we examine the treatment effect on these alterations as well as whether other neuroplastic effects on GM following treatment occur.
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Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Marina López-Sola
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, Spain
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - María Suñol
- Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, Spain
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Iris Coppieters
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Department of chronic diseases and metabolism, Faculty of Medicine, KU Leuven, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Elise Cnockaert
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
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2
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Ebbesen BD, Giordano R, Hedegaard JN, Calero JAV, Fernández-de-Las-Peñas C, Rasmussen BS, Nielsen H, Schiøttz-Christensen B, Petersen PL, Castaldo M, Arendt-Nielsen L. Prevalence and Risk Factors of Multitype Post-COVID Pain in a Cohort of Previously Hospitalized COVID-19 Survivors: A Danish Cross-Sectional Survey. THE JOURNAL OF PAIN 2024:104579. [PMID: 38796126 DOI: 10.1016/j.jpain.2024.104579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/06/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
This population-based study investigated the prevalence of de novo, multitype, post-coronavirus disease (COVID) pain and its associated risk factors in previously hospitalized coronavirus disease 2019 (COVID-19) survivors. The nationwide, cross-sectional study included a cohort of Danish residents previously hospitalized due to severe acute respiratory syndrome coronavirus-2 infection between March 2020 and December 2021. Demographic data, preexisting medical comorbidities, previous pain-related symptoms, medication use for pain management, pain intensity (4-point scale), and development of de novo, multitype, post-COVID pain were collected by a self-reported survey distributed via e-Boks (a secured national digital mail system used in Denmark to provide public information to residents). The sample comprised 4,712 previously hospitalized COVID-19 survivors (48.6% women, mean age: 60.1 ± 15.6 years). At the time of the study (21 ± 6 months after hospitalization), 18.0% (847) reported the presence of de novo, multitype, post-COVID pain, and 38.6% of any pain. A multivariate analysis revealed that female sex (Odds Ratio (OR) 1.711, 95% Confidence Interval (CI) 1.444-2.023), higher body mass index (OR 1.032, 95% CI 1.019-1.045), intensive care unit admission (OR 1.597, 95% CI 1.324-1.926), previous history of whiplash (OR 2.471, 95% CI 1.004-6.081), anxiety (OR 3.626, 95% CI 1.335-9.708), and younger age (OR .982, 95% CI .976-.987) were factors associated with development of de novo, multitype, post-COVID pain. High income (OR .635, 95% CI .494-.817) and high educational level (OR .774, 95% CI .609-.984) were protective factors. In conclusion, multitype pain as a de novo post-COVID symptom was present in 18.0% of previously hospitalized COVID-19 survivors more than 1 year after hospital discharge and as such can be considered as adding to the global burden of chronic pain. PERSPECTIVE: The study investigates the prevalence of de novo, multitype, post-COVID pain in previously hospitalized COVID-19 survivors. This article presents potential risk factors associated with developing new pain symptoms. The results will contribute to understanding the possibility of predicting postinfectious pain from COVID-19 for future analysis.
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Affiliation(s)
- Brian Duborg Ebbesen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark
| | - Rocco Giordano
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark
| | - Jakob Nebeling Hedegaard
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark
| | - Juan Antonio Valera Calero
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Bodil Steen Rasmussen
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark
| | - Henrik Nielsen
- Department of Clinical Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark
| | - Berit Schiøttz-Christensen
- Department of Regional Health Research, University of Southern Denmark, Region of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Central Denmark Region, Aarhus, Denmark
| | - Pernille Lykke Petersen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Capital Region of Denmark, Copenhagen, Denmark
| | - Matteo Castaldo
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark; Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark.
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3
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Wang W, Ji C, Andersen LL, Wang Y, Lin Y, Jiang L, Chen S, Xu Y, Zhang Z, Shi L, Wang Y. Effectiveness of manual therapy, computerised mobilisation plus home exercise, and home exercise only in treating work-related neck pain: study protocol for a randomised controlled trial. BMC Musculoskelet Disord 2022; 23:1119. [PMID: 36550505 PMCID: PMC9773538 DOI: 10.1186/s12891-022-06093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Work-related neck pain (WRNP) is a leading cause of disability and absenteeism. Patients with neck pain often have neck muscle tenderness and decreased cervical mobility, which are sometimes combined with psychosocial issues, such as pain catastrophising, thereby reducing their work ability. Whilst multidisciplinary treatments, including pharmacological interventions, manual therapy and specific neck exercises, have produced positive outcomes, effective personalised treatment modalities are still needed. Furthermore, manual therapies using the hands can bring fatigue to therapist. Occiflex is a computerised device that can provide personalised segmental joint mobilisation based on symptoms and injury of the patient and then provide a medium range of joint activities to improve range of cervical motion. This study aims to compare the effect of computerised mobilisation performed with Occiflex with that of traditional manual therapy on WRNP. METHODS We will conduct a prospective randomised controlled trial including 150 patients with WRNP. These patients will be randomly assigned to one of three groups: (i) home exercise (TE), (ii) home exercise plus Occiflex therapy and (iii) home exercise plus manual therapy delivered by a physical therapist. Ten treatment sessions will be performed in four weeks. During the trial, these patients will receive only the assigned treatment and the standard patient education and will be asked not to use any analgesics unless strictly necessary. Assessments by trained evaluators will occur at baseline, week 4 and week 12. The primary outcome measures will include visual analogue scale (VAS) for pain and neck disability index (NDI) at each time point. Secondary outcome measures will include cervical range of motion (CROM), pressure pain threshold (PPT), global perceived effect (GPE) and sick leave. Group by time differences will be analysed using linear mixed models with repeated measures. DISCUSSION This protocol describes the methods for a randomised controlled trial to compare the effectiveness of computerised versus manual mobilisation techniques in treating WRNP. The results will provide an alternative method (Occiflex) that is possibly effective for treating neck pain whilst minimising the manual work done by therapists. TRIAL REGISTRATION The study protocol was retrospectively registered at http://www.chictr.org.cn (registration number: ChiCTR2100053076) on November 10, 2021.
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Affiliation(s)
- Weiming Wang
- grid.12981.330000 0001 2360 039XRehabilitation Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Province Guangzhou, China
| | - Chang Ji
- grid.443378.f0000 0001 0483 836XGuangzhou Sport University, Guangdong Province Guangzhou, China
| | - Lars Louis Andersen
- grid.418079.30000 0000 9531 3915National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Yafei Wang
- grid.12981.330000 0001 2360 039XRehabilitation Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Province Guangzhou, China
| | - Yangyang Lin
- grid.12981.330000 0001 2360 039XRehabilitation Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Province Guangzhou, China
| | - Li Jiang
- grid.12981.330000 0001 2360 039XRehabilitation Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Province Guangzhou, China
| | - Shuwei Chen
- grid.284723.80000 0000 8877 7471Medical College of Rehabilitation, Southern Medical University, Guangdong Province Guangzhou, China
| | - Yangfan Xu
- grid.12981.330000 0001 2360 039XRehabilitation Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Province Guangzhou, China
| | - Ziping Zhang
- grid.12981.330000 0001 2360 039XRehabilitation Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Province Guangzhou, China
| | - Le Shi
- grid.12981.330000 0001 2360 039XRehabilitation Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Province Guangzhou, China
| | - Yuling Wang
- grid.12981.330000 0001 2360 039XRehabilitation Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Province Guangzhou, China
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Kim BJ, Park AL, Hwang MS, Heo I, Park SY, Cho JH, Kim KW, Lee JH, Ha IH, Park KS, Hwang EH, Shin BC. Comparative Effectiveness and Safety of Concomitant Treatment with Chuna Manual Therapy and Usual Care for Whiplash Injuries: A Multicenter Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10678. [PMID: 36078394 PMCID: PMC9518174 DOI: 10.3390/ijerph191710678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We aimed to compare the effectiveness and safety of Chuna manual therapy combined with usual care to those of usual care alone for treating whiplash injuries. DESIGN A two-arm, parallel, assessor-blinded, multicenter pragmatic randomized clinical trial. SETTING Three hospitals in Korea. PARTICIPANTS Overall, 132 participants between 19 and 70 years of age, involved in traffic accidents and treated at three hospitals in Korea, >2 but <13 weeks prior to enrollment, with neck pain consistent with whiplash-associated disorder grades I and II and a numeric rating scale score ≥5 were included. INTERVENTIONS Participants were equally and randomly allocated to the Chuna manual therapy and usual care (n = 66) or usual care (n = 66) groups and underwent corresponding treatment for three weeks. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the number of days to achieve a 50% pain reduction. Secondary outcomes included areas under the 50% numeric rating scale reduction curve: pain, disability, quality of life, and safety. RESULTS The Chuna manual therapy + usual care group (23.31 ± 21.36 days; p = 0.01) required significantly fewer days to achieve 50% pain reduction compared to the usual care group (50.41 ± 48.32 days; p = 0.01). Regarding pain severity, functional index, and quality of life index, Chuna manual therapy and usual care were more effective than usual care alone. Safety was acceptable in both groups. CONCLUSIONS In patients with subacute whiplash injury, Chuna manual therapy showed a rapid rate of recovery, high effectiveness, and safety.
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Affiliation(s)
- Byung-Jun Kim
- School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Man-Suk Hwang
- School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
- Spine & Joint Center, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea
| | - In Heo
- School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
- Spine & Joint Center, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea
| | - Sun-Young Park
- School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
- Spine & Joint Center, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea
| | - Jae-Heung Cho
- Department of Korean Medicine Rehabilitation, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Koh-Woon Kim
- Department of Korean Medicine Rehabilitation, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea
- Korean Medicine Life Science, Campus of Korea Institute of Oriental Medicine, University of Science & Technology, Daejeon 34054, Korea
| | - In-Hyuk Ha
- Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine, Seoul 02453, Korea
| | - Kyoung-Sun Park
- Department of Korean Medicine Rehabilitation, Jaseng Hospital of Korean Medicine, Seoul 02453, Korea
| | - Eui-Hyoung Hwang
- School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
- Spine & Joint Center, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea
| | - Byung-Cheul Shin
- School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
- Spine & Joint Center, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea
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Aarnio M, Fredrikson M, Lampa E, Sörensen J, Gordh T, Linnman C. Whiplash injuries associated with experienced pain and disability can be visualized with [11C]-D-deprenyl positron emission tomography and computed tomography. Pain 2022; 163:489-495. [PMID: 34232928 PMCID: PMC8832543 DOI: 10.1097/j.pain.0000000000002381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Knowledge of etiological mechanisms underlying whiplash-associated disorders is incomplete. Localisation and quantification of peripheral musculoskeletal injury and inflammation in whiplash-associated disorders would facilitate diagnosis, strengthen patients' subjective pain reports, and aid clinical decisions, all of which could lead to improved treatment. In this longitudinal observational study, we evaluated combined [11C]-D-deprenyl positron emission tomography and computed tomography after acute whiplash injury and at 6-month follow-up. Sixteen adult patients (mean age 33 years) with whiplash injury grade II were recruited at the emergency department. [11C]-D-deprenyl positron emission tomography and computed tomography, subjective pain levels, self-rated neck disability, and active cervical range of motion were recorded within 7 days after injury and again at 6-month follow-up. Imaging results showed possible tissue injuries after acute whiplash with an altered [11C]-D-deprenyl uptake in the cervical bone structures and facet joints, associated with subjective pain locale and levels, as well as self-rated disability. At follow-up, some patients had recovered and some showed persistent symptoms and reductions in [11C]-D-deprenyl uptake correlated to reductions in pain levels. These findings help identify affected peripheral structures in whiplash injury and strengthen the idea that positron emission tomography and computed tomography detectable organic lesions in peripheral tissue are relevant for the development of persistent pain and disability in whiplash injury.
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Affiliation(s)
- Mikko Aarnio
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Lampa
- UCR, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- PET Centre, Department of Medical Imaging, Uppsala University Hospital, Sweden
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Clas Linnman
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, United States
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Bontinck J, Lenoir D, Cagnie B, Murillo C, Timmers I, Cnockaert E, Bernaers L, Meeus M, Coppieters I. Temporal changes in pain processing after whiplash injury, based on Quantitative Sensory Testing: A systematic review. Eur J Pain 2021; 26:227-245. [PMID: 34464486 DOI: 10.1002/ejp.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE After whiplash injury, some patients develop chronic whiplash-associated disorders. The exact pathophysiology of this chronification is still unclear and more knowledge is needed regarding the different post-injury phases. Therefore, studies were searched that examined temporal changes in pain processing, measured by Quantitative Sensory Testing (QST). DATABASES AND DATA TREATMENT This systematic review searched three electronic databases (Medline, Web of Science and Embase) for articles meeting the eligibility requirements. Risk of bias was assessed according to a modified Newcastle-Ottawa Scale. RESULTS The 12 included studies presented moderate to good methodological quality. These studies showed altered pain processing within the first month after injury and normalization within 3 months in 59%-78% of the patients. After 3 months, recovery stagnates during the following years. Thermal and widespread mechanical hyperalgesia occur already in the acute phase, but only in eventually non-recovered patients. CONCLUSIONS Differences in pain processing between recovering and non-recovering patients can be observed already in the acute phase. Early screening for signs of altered pain processing can identify patients with high risk for chronification. These insights in temporal changes show the importance of rehabilitation in the acute phase. Future research should target to develop a standardized (bed-site) QST protocol and collect normative data which could, in relation with self-reported pain parameters, allow clinicians to identify the risk for chronification. SIGNIFICANCE Altered pain processing is present soon after whiplash injury, but usually recovers within 3 months. Non-recovering patients show little to no improvements in the following years. Differences between recovering and non-recovering patients can be observed by Quantitative Sensory Testing already in the acute phase. Therefore, it is considered a feasible and effective tool that can contribute to the identification of high-risk patients and the prevention of chronification.
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Affiliation(s)
- Jente Bontinck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carlos Murillo
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Inge Timmers
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.,Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Elise Cnockaert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisa Bernaers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Iris Coppieters
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
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7
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Willaert W, Leysen L, Lenoir D, Meeus M, Cagnie B, Nijs J, Sterling M, Coppieters I. Combining Stress Management With Pain Neuroscience Education and Exercise Therapy in People With Whiplash-Associated Disorders: A Clinical Perspective. Phys Ther 2021; 101:6184954. [PMID: 33764474 DOI: 10.1093/ptj/pzab105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 02/28/2021] [Indexed: 11/12/2022]
Abstract
Individuals classified as having whiplash-associated disorder (WAD) grade II, which reflects approximately 93% of people with WAD who are commonly managed by health care professionals, exhibit both physical (eg, pain and disability) and psychological (eg, fear of movement, anxiety, posttraumatic stress) problems that, in approximately 50% of cases, persist beyond 3 months. There is still much ongoing debate regarding factors predictive of poor recovery. The strongest associations have been found for high initial pain and disability following whiplash injury. In addition, a growing body of evidence supports the clinical importance of characteristic features, such as disturbed nociceptive processing (eg, local or general hyperalgesia to cold and mechanical stimuli), inefficient cognitions and beliefs about pain/movement/recovery, and posttraumatic stress symptoms, in the development and maintenance of physical and psychological manifestations in individuals with WAD. For this reason, the field shifted away from single interventions that mainly follow a biomedical approach, such as exercise therapy and activity programs, to gold standard multimodal care (at least 2 distinct therapeutic modalities given by 1 or more health care professionals) that acknowledges the biopsychological nature of WAD. To date, there exist several multimodal care approaches to managing WAD; however, for most, the efficacy has been found to be rather limited. One may argue that the limited success of some approaches can be attributed to the fact that they focused mainly on rehabilitating the physical symptoms (eg, pain, disability) rather than also the associated cognitive (eg, catastrophizing) and psychological (eg, posttraumatic stress symptoms) symptoms of the condition, leaving much room for improvement. In this article, current and previous evidence is used to explain why and how a comprehensive and multimodal treatment for people with WAD-consisting of a combination of pain neuroscience education, cognition-targeted exercise therapy, and stress management-can be applied in clinical practice.
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Affiliation(s)
- Ward Willaert
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Laurence Leysen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Dorine Lenoir
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Michele Sterling
- Recover Injury Research Centre and NHMRC CRE in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Queensland, Australia
| | - Iris Coppieters
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
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8
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Sillevis R, Trincado G, Shamus E. The immediate effect of a single session of pain neuroscience education on pain and the autonomic nervous system in subjects with persistent pain, a pilot study. PeerJ 2021; 9:e11543. [PMID: 34131526 PMCID: PMC8174152 DOI: 10.7717/peerj.11543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The autonomic nervous system is a system that operates at the subconscious level and has been associated with neurobehavioral aspects of pain. Overall, persistent pain has a stimulating effect on the sympathetic nervous system. A promising emerging nonpharmacological treatment to manage persistent pain is neuroscience-based pain education. The overarching goal of neuroscience-based pain education is to change cognitions about pain and the pain experience through education. The aim was to determine the immediate and short-term impact of a neuroscience-based pain education video on the autonomic nervous system and pain in a subgroup of individuals with persistent pain. METHODS A convenience sample of 26 subjects were recruited for this study. Each subject indicated their pain level at the time of testing using a Visual Analogue Scale. Automated pupillometry was utilized to measure pupil diameter. After two minutes of accommodation to the goggles, the pupil was measured continuously for 60 s. Following this a 5-minute video presentation "Understanding Pain" was watched, followed by a continuous pupil measurement for 60 s. Three minutes after this measure, the final pupil diameter measurement was taken for 60 s. After completing the final pupil measure, the subject was asked to fill out a second Visual Analogue Scale and a Global Rate of Change. OUTCOMES Each subject completed a Global Rating of Change Scale and the mean score was 1.14 (SD = 1.61 and a SEM = 0.), supporting the hypothesis of an overall self-perceived benefit from the intervention. There was a statistically significant difference in pain following the video, P < 0.01. A significant correlation was observed between the self-perceived decrease in pain level and the Global Rating of Change score, p = 0.02. There was no statistically significant difference in the mean pupil diameter following the video with p = 0.76 for the right eye and p = 0.250 for the left eye. DISCUSSION This pilot study demonstrated that a 5-minute neuroscience-based pain education video reduced perceived pain in a small sample of subjects with persistent pain. Watching the neuroscience-based pain education video did not seem to result in an immediate generalized autonomic nervous system response. However, it resulted in a different reaction on each eye. This unequal response might be the result of the hemispheric lateralization of the ANS. This study supports the fact that the pain experience is determined by the balance between conscious cognitive processes and subconscious processes based on previous psychological experiences.
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Affiliation(s)
- Rob Sillevis
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
| | - Gabriel Trincado
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
| | - Eric Shamus
- Rehabilitations Sciences, Florida Gulf Coast University, Ft. Myers, FL, United States of America
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9
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den Boer C, Dries L, Terluin B, van der Wouden JC, Blankenstein AH, van Wilgen CP, Lucassen P, van der Horst HE. Central sensitization in chronic pain and medically unexplained symptom research: A systematic review of definitions, operationalizations and measurement instruments. J Psychosom Res 2019; 117:32-40. [PMID: 30665594 DOI: 10.1016/j.jpsychores.2018.12.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Central sensitization (CS), a mechanism explaining the persistence of symptoms, has been the focus of many research projects. Explanations given to patients with chronic pain are often based on this mechanism. It is hypothesized that CS also plays an important role in the persistence of medically unexplained symptoms (MUS). However, definitions and operationalizations of CS vary. We conducted a systematic review of definitions, operationalizations and measurement instruments of CS. METHODS We searched in PubMed, EMBASE, PsycINFO, Cinahl and The Cochrane Library till September 2017 and included papers that addressed CS in relation to chronic pain and/or MUS. Two reviewers independently selected, analysed and classified information from the selected publications. We performed a thematic analysis of definitions and operationalizations. We listed the measurement instruments. RESULTS We included 126 publications, 79 publications concerned chronic pain, 47 publications concerned MUS. Definitions of CS consistently encompass the theme hyperexcitability of the central nervous system (CNS). Additional themes are variably present: CNS locations, nature of sensory input, reduced inhibition and activation and modulation of the NDMA receptor. Hyperalgesia and allodynia are widely mentioned as operationalizations of CS. Quantitative sensory testing (QST) and (f)MRI are the most reported measurement instruments. CONCLUSIONS There is consensus that hyperexcitability is the central mechanism of CS. Operationalizations are based on this mechanism and additional components. There are many measurement instruments available, whose clinical value has still to be determined. There were no systematic differences in definitions and operationalizations between the publications addressing MUS and those addressing chronic pain.
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Affiliation(s)
- Carine den Boer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands.
| | - Linne Dries
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
| | - Berend Terluin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
| | - Johannes C van der Wouden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
| | - Annette H Blankenstein
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
| | - C Paul van Wilgen
- Transcare, transdisciplinary pain management centre, Groningen, the Netherlands; Pain in Motion International Research Group, Department of Physiotherapy, Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Peter Lucassen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community care, Nijmegen, the Netherlands
| | - Henriëtte E van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of general practice and elderly care medicine, Amsterdam Public Health research institute, the Netherlands
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10
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Nystrom NA, Freeman MD. Central Sensitization Is Modulated Following Trigger Point Anesthetization in Patients with Chronic Pain from Whiplash Trauma. A Double-Blind, Placebo-Controlled, Crossover Study. PAIN MEDICINE 2019; 19:124-129. [PMID: 28419379 DOI: 10.1093/pm/pnx014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Central sensitization (CS) with low peripheral pain thresholds (PPTs) is a common finding among patients with chronic pain after whiplash (CPWI). While it has been proposed that myofascial myofascial trigger points (MTrPs) may act as modulators of central sensitization, previously reported findings are conflicting and inconclusive. The present study was designed to investigate immediate responsiveness of CS to alterations in nociceptive input. Design Controlled, double-blind, cross-over. Subjects Thirty-one patients with chronic pain (trapezius myalgia) and CS after whiplash. Methods Participants were referred by randomization to group A for injection of a single peripheral pain generator (MTrP or other discrete tender point) with local anesthetic or to group B for sham injection and cross-over. Documentation of PPT (Algometer), maximum jaw opening (caliper), and grip strength (Vigorimeter), as well as subjective overall pain (visual analog scale [VAS]), was made before and after each intervention. Results Statistical analysis of data (Student's t test, analysis of variance) confirmed that peripheral pain thresholds were significantly higher and maximum jaw opening significantly greater after anesthetizing a focal pain generator in the trapezius, but not after a sham injection. In contrast with the objective variables, subjective generalized pain improved (VAS) after not only an injection of local anesthetic, but also, and to a similar extent, after a sham injection. Conclusions CS, as expressed by lowered PPT, is a rapidly adjusting physiological response to nociceptive stimuli in some patients with chronic pain after whiplash. PPT are likely modulated by myofascial tender points in selected patients with CS. With reference to the present findings, surgical ablation of MTrPs is discussed as a potential treatment modality for CS.
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Affiliation(s)
- N Ake Nystrom
- Department of Hand and Plastic Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Michael D Freeman
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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11
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Clinical Outcomes and Central Pain Mechanisms are Improved After Upper Trapezius Eccentric Training in Female Computer Users With Chronic Neck/Shoulder Pain. Clin J Pain 2019; 35:65-76. [DOI: 10.1097/ajp.0000000000000656] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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The Impact of Psychosocial and Contextual Factors on Individuals Who Sustain Whiplash-Associated Disorders in Motor Vehicle Collisions. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9317-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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13
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Queme LF, Ross JL, Jankowski MP. Peripheral Mechanisms of Ischemic Myalgia. Front Cell Neurosci 2017; 11:419. [PMID: 29311839 PMCID: PMC5743676 DOI: 10.3389/fncel.2017.00419] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022] Open
Abstract
Musculoskeletal pain due to ischemia is present in a variety of clinical conditions including peripheral vascular disease (PVD), sickle cell disease (SCD), complex regional pain syndrome (CRPS), and even fibromyalgia (FM). The clinical features associated with deep tissue ischemia are unique because although the subjective description of pain is common to other forms of myalgia, patients with ischemic muscle pain often respond poorly to conventional analgesic therapies. Moreover, these patients also display increased cardiovascular responses to muscle contraction, which often leads to exercise intolerance or exacerbation of underlying cardiovascular conditions. This suggests that the mechanisms of myalgia development and the role of altered cardiovascular function under conditions of ischemia may be distinct compared to other injuries/diseases of the muscles. It is widely accepted that group III and IV muscle afferents play an important role in the development of pain due to ischemia. These same muscle afferents also form the sensory component of the exercise pressor reflex (EPR), which is the increase in heart rate and blood pressure (BP) experienced after muscle contraction. Studies suggest that afferent sensitization after ischemia depends on interactions between purinergic (P2X and P2Y) receptors, transient receptor potential (TRP) channels, and acid sensing ion channels (ASICs) in individual populations of peripheral sensory neurons. Specific alterations in primary afferent function through these receptor mechanisms correlate with increased pain related behaviors and altered EPRs. Recent evidence suggests that factors within the muscles during ischemic conditions including upregulation of growth factors and cytokines, and microvascular changes may be linked to the overexpression of these different receptor molecules in the dorsal root ganglia (DRG) that in turn modulate pain and sympathetic reflexes. In this review article, we will discuss the peripheral mechanisms involved in the development of ischemic myalgia and the role that primary sensory neurons play in EPR modulation.
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Affiliation(s)
- Luis F Queme
- Department of Anesthesia, Division of Pain Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jessica L Ross
- Department of Anesthesia, Division of Pain Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Michael P Jankowski
- Department of Anesthesia, Division of Pain Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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14
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Castaldo M, Catena A, Chiarotto A, Fernández-de-Las-Peñas C, Arendt-Nielsen L. Do Subjects with Whiplash-Associated Disorders Respond Differently in the Short-Term to Manual Therapy and Exercise than Those with Mechanical Neck Pain? PAIN MEDICINE 2017; 18:791-803. [PMID: 28034987 DOI: 10.1093/pm/pnw266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective To compare the short-term effects of manual therapy and exercise on pain, related disability, range of motion, and pressure pain thresholds between subjects with mechanical neck pain and whiplash-associated disorders. Methods Twenty-two subjects with mechanical neck pain and 28 with whiplash-associated disorders participated. Clinical and physical outcomes including neck pain intensity, neck-related disability, and pain area, as well as cervical range of motion and pressure pain thresholds over the upper trapezius and tibialis anterior muscles, were obtained at baseline and after the intervention by a blinded assessor. Each subject received six sessions of manual therapy and specific neck exercises. Mixed-model repeated measures analyses of covariance (ANCOVAs) were used for the analyses. Results Subjects with whiplash-associated disorders exhibited higher neck-related disability ( P = 0.021), larger pain area ( P = 0.003), and lower pressure pain thresholds in the tibialis anterior muscle ( P = 0.009) than those with mechanical neck pain. The adjusted ANCOVA revealed no between-group differences for any outcome (all P > 0.15). A significant main effect of time was demonstrated for clinical outcomes and cervical range of motion with both groups experiencing similar improvements (all P < 0.01). No changes in pressure pain thresholds were observed in either group after treatment ( P > 0.222). Conclusions The current clinical trial found that subjects with mechanical neck pain and whiplash-associated disorders exhibited similar clinical and neurophysiological responses after a multimodal physical therapy intervention, suggesting that although greater signs of central sensitization are present in subjects with whiplash-associated disorders, this does not alter the response in the short term to manual therapy and exercises.
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Affiliation(s)
- Matteo Castaldo
- Private practice, Poliambulatorio FisioCenter, Collecchio, Parma, Italy.,SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Physical Therapy, University of Siena, Siena, Italy
| | - Antonella Catena
- Private practice, Poliambulatorio FisioCenter, Collecchio, Parma, Italy
| | - Alessandro Chiarotto
- Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO+ Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - César Fernández-de-Las-Peñas
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lars Arendt-Nielsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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15
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Mackey IG, Dixon EA, Johnson K, Kong JT. Dynamic Quantitative Sensory Testing to Characterize Central Pain Processing. J Vis Exp 2017. [PMID: 28287532 PMCID: PMC5407598 DOI: 10.3791/54452] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Central facilitation and modulation of incoming nociceptive signals play an important role in the perception of pain. Disruption in central pain processing is present in many chronic pain conditions and can influence responses to specific therapies. Thus, the ability to precisely describe the state of central pain processing has profound clinical significance in both prognosis and prediction. Because it is not practical to record neuronal firings directly in the human spinal cord, surrogate behavior tests become an important tool to assess the state of central pain processing. Dynamic QST is one such test, and can probe both the ascending facilitation and descending modulation of incoming nociceptive signals via TS and CPM, respectively. Due to the large between-individual variability in the sensitivity to noxious signals, standardized TS and CPM tests may not yield any meaningful data in up to 50% of the population due to floor or ceiling effects. We present methodologies to individualize TS and CPM so we can capture these measures in a broader range of individuals than previously possible. We have used these methods successfully in several studies at the lab, and data from one ongoing study will be presented to demonstrate feasibility and potential applications of the methods.
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Affiliation(s)
- Ian G Mackey
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Eric A Dixon
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Kevin Johnson
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Jiang-Ti Kong
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine;
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16
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Zippo AG, Valente M, Caramenti GC, Biella GEM. The thalamo-cortical complex network correlates of chronic pain. Sci Rep 2016; 6:34763. [PMID: 27734895 PMCID: PMC5062566 DOI: 10.1038/srep34763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/15/2016] [Indexed: 12/30/2022] Open
Abstract
Chronic pain (CP) is a condition with a large repertory of clinical signs and symptoms with diverse expressions. Though widely analyzed, an appraisal at the level of single neuron and neuronal networks in CP is however missing. The present research proposes an empirical and theoretic framework which identifies a complex network correlate nested in the somatosensory thalamocortical (TC) circuit in diverse CP models. In vivo simultaneous extracellular neuronal electrophysiological high-density recordings have been performed from the TC circuit in rats. Wide functional network statistics neatly discriminated CP from control animals identifying collective dynamical traits. In particular, a collapsed functional connectivity and an altered modular architecture of the thalamocortical circuit have been evidenced. These results envisage CP as a functional connectivity disorder and give the clue for unveiling innovative therapeutic strategies.
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Affiliation(s)
- Antonio G. Zippo
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate (Milan), Italy
| | - Maurizio Valente
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate (Milan), Italy
| | - Gian Carlo Caramenti
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate (Milan), Italy
| | - Gabriele E. M. Biella
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate (Milan), Italy
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17
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Falla D, Peolsson A, Peterson G, Ludvigsson M, Soldini E, Schneebeli A, Barbero M. Perceived pain extent is associated with disability, depression and self-efficacy in individuals with whiplash-associated disorders. Eur J Pain 2016; 20:1490-501. [DOI: 10.1002/ejp.873] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 11/10/2022]
Affiliation(s)
- D. Falla
- Pain Clinic; Center for Anesthesiology, Emergency and Intensive Care Medicine; University Hospital Göttingen; Germany
- School of Sport; Exercise and Rehabilitation Sciences; College of Life and Environmental Sciences; University of Birmingham; Birmingham UK
| | - A. Peolsson
- Department of Medical and Health Sciences; Division of Physiotherapy; Linköping University; Sweden
| | - G. Peterson
- Department of Medical and Health Sciences; Division of Physiotherapy; Linköping University; Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Sweden
| | - M.L. Ludvigsson
- Department of Medical and Health Sciences; Division of Physiotherapy; Linköping University; Sweden
- Rehab Väst; County Council of Östergötland; Motala Sweden
| | - E. Soldini
- Department of Business Economics, Health and Social Care; University of Applied Sciences and Arts of Southern Switzerland (SUPSI); Manno Switzerland
| | - A. Schneebeli
- Rehabilitation Research Laboratory; Department of Business Economics; Health and Social Care; University of Applied Sciences and Arts of Southern Switzerland; Manno Switzerland
| | - M. Barbero
- Rehabilitation Research Laboratory; Department of Business Economics; Health and Social Care; University of Applied Sciences and Arts of Southern Switzerland; Manno Switzerland
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18
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Watson DH, Drummond PD. The Role of the Trigemino Cervical Complex in Chronic Whiplash Associated Headache: A Cross Sectional Study. Headache 2016; 56:961-75. [PMID: 27091393 DOI: 10.1111/head.12805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/05/2016] [Accepted: 02/15/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate signs of central sensitization in a cohort of patients with chronic whiplash associated headache (CWAH). BACKGROUND Central sensitization is one of the mechanisms leading to chronicity of primary headache, and thus might contribute to CWAH. However, the pathophysiological mechanism of CWAH is poorly understood and whether it is simply an expression of the primary headache or has a distinct pathogenesis remains unclear. Thus, the factors involved in the genesis of CWAH require further investigation. METHODS Twenty-two patients with CWAH (20 females, 2 males; age 25-50 years, mean age 36.3 years) and 25 asymptomatic participants (13 females, 12 males; age 18-50 years, mean age 35.6 years) rated glare and light-induced discomfort in response to light from an ophthalmoscope. Hyperalgesia evoked by a pressure algometer was assessed bilaterally on the forehead, temples, occipital base, and the middle phalanx of the third finger. The number, latency, area under the curve, and recovery cycle of nociceptive blink reflexes elicited by a supraorbital electrical stimulus were also recorded. RESULTS Eight and 6 CWAH patients had migrainous and tension-type headache (TTH) profiles, respectively; the remainder had features attributable to both migraine and TTH. Patients in the whiplash group reported significantly greater light-induced pain than controls (8.48 ± .35 vs 6.66 ± .43 on a 0-10 scale; P = .001). The CWAH patients reported significantly lower pressure pain thresholds at all sites. For stimuli delivered at 20 second intervals, whiplash patients were more responsive than controls (4.8 ± .6 blinks vs 3.0 ± .6 blinks in a block of 10 stimuli; P = .036). While R2 latencies and the area under the curve for the 20 second interval trials were comparable in both groups, there was a significant reduction of the area under the curve from the first to the second of the 2-second interval trials only in controls (99 ± 8% of baseline in whiplash patients vs 68 ± 7% in controls; P = .009). The recovery cycle was comparable for both groups. CONCLUSIONS Our results corroborate previous findings of mechanical hypersensitivity and photophobia in CWAH patients. The neurophysiological data provide further evidence for hyperexcitability in central nociceptive pathways, and endorse the hypothesis that CWAH may be driven by central sensitization.
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Affiliation(s)
- Dean H Watson
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Peter D Drummond
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
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19
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Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2016; 17:755-74. [PMID: 26844416 DOI: 10.1016/j.jpain.2016.01.473] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 12/05/2015] [Accepted: 01/14/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. Because it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioral/psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Ten electronic databases were searched for randomized controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (eg, if the study compared 2 physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioral/psychologically informed, and combined interventions were assessed using meta-analyses. Twenty-four studies were included. No clinically significant differences were found for pain and disability between physical, behavioral/psychologically informed, and combined interventions. The simple categorization of interventions into physical, behavioral/psychologically informed, and combined could be considered a limitation of this review, because these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring rehabilitation to individual patients and their perceived risk of chronicity, as seen in recent RCTs for low back pain, can enhance outcomes in NSCSP. PERSPECTIVE In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioral/psychologically informed, and combined interventions.
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20
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Shah N, Ginzburg N, Morrissey D, Whitmore K. Update in Diagnosis and Treatment of Chronic Pelvic Pain Syndromes. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0302-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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21
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Ability of the Central Sensitization Inventory to Identify Central Sensitivity Syndromes in an Outpatient Chronic Pain Sample. Clin J Pain 2015; 31:323-32. [DOI: 10.1097/ajp.0000000000000113] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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23
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24
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Castaldo M, Ge HY, Chiarotto A, Villafane JH, Arendt-Nielsen L. Myofascial Trigger Points in Patients with Whiplash-Associated Disorders and Mechanical Neck Pain. PAIN MEDICINE 2014; 15:842-9. [DOI: 10.1111/pme.12429] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Neziri AY, Limacher A, Jüni P, Radanov BP, Andersen OK, Arendt-Nielsen L, Curatolo M. Ranking of tests for pain hypersensitivity according to their discriminative ability in chronic neck pain. Reg Anesth Pain Med 2014; 38:308-20. [PMID: 23759706 DOI: 10.1097/aap.0b013e318295a3ea] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Quantitative sensory testing (QST) is widely used to investigate peripheral and central sensitization. However, the comparative performance of different QST for diagnostic or prognostic purposes is unclear. We explored the discriminative ability of different quantitative sensory tests in distinguishing between patients with chronic neck pain and pain-free control subjects and ranked these tests according to the extent of their association with pain hypersensitivity. METHODS We performed a case-control study in 40 patients and 300 control subjects. Twenty-six tests, including different modalities of pressure, heat, cold, and electrical stimulation, were used. As measures of discrimination, we estimated receiver operating characteristic curves and likelihood ratios. RESULTS The following quantitative sensory tests displayed the best discriminative value: (1) pressure pain threshold at the site of the most severe neck pain (fitted area under the receiver operating characteristic curve, 0.92), (2) reflex threshold to single electrical stimulation (0.90), (3) pain threshold to single electrical stimulation (0.89), (4) pain threshold to repeated electrical stimulation (0.87), and (5) pressure pain tolerance threshold at the site of the most severe neck pain (0.86). Only the first 3 could be used for both ruling in and out pain hypersensitivity. CONCLUSIONS Pressure stimulation at the site of the most severe pain and parameters of electrical stimulation were the most appropriate QST to distinguish between patients with chronic neck pain and asymptomatic control subjects. These findings may be used to select the tests in future diagnostic and longitudinal prognostic studies on patients with neck pain and to optimize the assessment of localized and spreading sensitization in chronic pain patients.
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Affiliation(s)
- Alban Y Neziri
- University Department of Anesthesiology and Pain Therapy, Bern University Hospital, Inselspital, Bern, Switzerland
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Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). J Physiother 2014; 60:5-12. [PMID: 24856935 DOI: 10.1016/j.jphys.2013.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 01/27/2023] Open
Affiliation(s)
- Michele Sterling
- Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland and Griffith University, Australia
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River Y, Aharony S, Bracha J, Levital T, Gerwin R. Three-dimensional computerized mobilization of the cervical spine for the treatment of chronic neck pain: a pilot study. PAIN MEDICINE 2014; 15:1091-9. [PMID: 24400987 DOI: 10.1111/pme.12329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Manual therapies for chronic neck pain are imprecise, inconsistent, and brief due to therapist fatigue. A previous study showed that computerized mobilization of the cervical spine in the sagittal plane is a safe and potentially effective treatment of chronic neck pain. OBJECTIVE To investigate the safety and efficacy of computerized mobilization of the cervical spine in a three-dimensional space for the treatment of chronic neck pain. DESIGN Pilot, open trial. SETTING Physical therapy outpatient department. PARTICIPANTS Nine patients with chronic neck pain. INTERVENTIONS A computerized cradle capable of three-dimensional neck mobilizations was used. Treatment sessions lasted 20 minutes, biweekly, for six weeks. MAIN OUTCOME MEASURES Visual analog scale (VAS) for pain, cervical range of motion (CROM), neck disability index (NDI), joint position error (JPE), and muscle algometry. RESULTS Comparing baseline at week one with week six (end of treatment), the VAS scores dropped by 2.9 points (P < 0.01). The six directions of movement studied by the CROM showed a combined increase of 11% (P = 0.01). The NDI decreased significantly from 16 to 10 (P = 0.03), and the JPE decreased significantly from 3.7° to 1.9° (P = 0.047). There was no change in the pressure pain threshold in any muscle tested. There were no significant adverse effects. CONCLUSIONS These preliminary results demonstrate that this novel, computerized, three-dimensional cervical mobilization device is probably safe. The data also suggest that this method is effective in alleviating neck pain and associated headache, and in increasing the CROM, although the sample size was small in this open trial.
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Affiliation(s)
- Yaron River
- Department of Neurology, Hillel Yaffe Medical Center, Hadera, Israel
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Smith AD, Jull G, Schneider G, Frizzell B, Hooper RA, Sterling M. Cervical Radiofrequency Neurotomy Reduces Central Hyperexcitability and Improves Neck Movement in Individuals with Chronic Whiplash. PAIN MEDICINE 2014; 15:128-41. [DOI: 10.1111/pme.12262] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Chiarotto A, Fernandez-de-las-Peñas C, Castaldo M, Negrini S, Villafañe JH. Widespread pressure pain hypersensitivity in elderly subjects with unilateral thumb carpometacarpal osteoarthritis. Hand (N Y) 2013; 8:422-9. [PMID: 24426960 PMCID: PMC3840760 DOI: 10.1007/s11552-013-9537-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Widespread pressure hypersensitivity is one of the signs that characterize central pain sensitization in subjects with knee and hip osteoarthritis (OA). The purpose of this study was to evaluate whether widespread pressure pain hyperalgesia is a feature of individuals with unilateral symptomatic thumb carpometacarpal (CMC) OA. METHODS A total of 16 patients with unilateral symptomatic thumb CMC OA and 16 healthy sex- and age-matched controls were recruited. Pressure pain thresholds (PPTs) were assessed bilaterally over the first CMC joint; the C5-C6 zygapophyseal joint; the median, ulnar, and radial nerves; and tibialis anterior muscle. Grip and key strength, intensity of pain, and function QuickDASH were also measured. RESULTS The analyses showed that patients with thumb CMC OA present bilaterally decreased PPTs over the first CMC joint, the C5-C6 zygapophyseal joint, and the tibialis anterior, median, ulnar and radial nerve as compared to controls (all, P < 0.01). Patients with thumb CMC OA also exhibited a bilateral reduction in pinch and grip strength than controls (P < 0.05). A significant correlation was found between PPT over the radial nerve and QuickDASH (r = 0.546, P = 0.029). CONCLUSION This study revealed bilateral widespread pressure pain hypersensitivity in individuals with unilateral symptomatic thumb CMC OA, suggesting that central pain processing mechanisms might be a feature of this pain population. These results should be taken into consideration when addressing future treatment approaches.
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Affiliation(s)
| | - Cesar Fernandez-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid Spain ,Esthesiology Laboratory, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - Stefano Negrini
- Physical and Rehabilitation Medicine, University of Brescia, Brescia, Italy ,IRCCS Don Gnocchi Foundation, Milan, Italy
| | - Jorge Hugo Villafañe
- IRCCS Don Gnocchi Foundation, Milan, Italy ,Regione Generala 11/16, 10045 Piossasco, Turin Italy
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A comparison of physical and psychological features of responders and non-responders to cervical facet blocks in chronic whiplash. BMC Musculoskelet Disord 2013; 14:313. [PMID: 24188899 PMCID: PMC3819261 DOI: 10.1186/1471-2474-14-313] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 10/11/2013] [Indexed: 11/16/2022] Open
Abstract
Background Cervical facet block (FB) procedures are often used as a diagnostic precursor to radiofrequency neurotomies (RFN) in the management of chronic whiplash associated disorders (WAD). Some individuals will respond to the FB procedures and others will not respond. Such responders and non-responders provided a sample of convenience to question whether there were differences in their physical and psychological features. This information may inform future predictive studies and ultimately the clinical selection of patients for FB procedures. Methods This cross-sectional study involved 58 individuals with chronic WAD who responded to cervical FB procedures (WAD_R); 32 who did not respond (WAD_NR) and 30 Healthy Controls (HC)s. Measures included: quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test); nociceptive flexion reflex (NFR); motor function (cervical range of movement (ROM); activity of the superficial neck flexors during the cranio-cervical flexion test (CCFT). Self-reported measures were gained from the following questionnaires: neuropathic pain (s-LANSS); psychological distress (General Health Questionnaire-28), post-traumatic stress (PDS) and pain catastrophization (PCS). Individuals with chronic whiplash attended the laboratory once the effects of the blocks had abated and symptoms had returned. Results Following FB procedures, both WAD groups demonstrated generalized hypersensitivity to all sensory tests, decreased neck ROM and increased superficial muscle activity with the CCFT compared to controls (p < 0.05). There were no significant differences between WAD groups (all p > 0.05). Both WAD groups demonstrated psychological distress (GHQ-28; p < 0.05), moderate post-traumatic stress symptoms and pain catastrophization. The WAD_NR group also demonstrated increased medication intake and elevated PCS scores compared to the WAD_R group (p < 0.05). Conclusions Chronic WAD responders and non-responders to FB procedures demonstrate a similar presentation of sensory disturbance, motor dysfunction and psychological distress. Higher levels of pain catastrophization and greater medication intake were the only factors found to differentiate these groups.
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Biurrun Manresa JA, Nguyen GP, Curatolo M, Moeslund TB, Andersen OK. Probabilistic model for individual assessment of central hyperexcitability using the nociceptive withdrawal reflex: a biomarker for chronic low back and neck pain. BMC Neurosci 2013; 14:110. [PMID: 24088299 PMCID: PMC3850924 DOI: 10.1186/1471-2202-14-110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/01/2013] [Indexed: 11/25/2022] Open
Abstract
Background The nociceptive withdrawal reflex (NWR) has been proven to be a valuable tool in the objective assessment of central hyperexcitability in the nociceptive system at spinal level that is present in some chronic pain disorders, particularly chronic low back and neck pain. However, most of the studies on objective assessment of central hyperexcitability focus on population differences between patients and healthy individuals and do not provide tools for individual assessment. In this study, a prediction model was developed to objectively assess central hyperexcitability in individuals. The method is based on statistical properties of the EMG signals associated with the nociceptive withdrawal reflex. The model also supports individualized assessment of patients, including an estimation of the confidence of the predicted result. Results up to 80% classification rates were achieved when differentiating between healthy volunteers and chronic low back and neck pain patients. EMG signals recorded after stimulation of the anterolateral and heel regions and of the sole of the foot presented the best prediction rates. Conclusions A prediction model was proposed and successfully tested as a new approach for objective assessment of central hyperexcitability in the nociceptive system, based on statistical properties of EMG signals recorded after eliciting the NWR. Therefore, the present statistical prediction model constitutes a first step towards potential applications in clinical practice.
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Affiliation(s)
- José A Biurrun Manresa
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, Aalborg, Øst 9220, Denmark.
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Defrin R, Ginzburg K, Mikulincer M, Solomon Z. The long-term impact of tissue injury on pain processing and modulation: A study on ex-prisoners of war who underwent torture. Eur J Pain 2013; 18:548-58. [DOI: 10.1002/j.1532-2149.2013.00394.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 11/08/2022]
Affiliation(s)
- R. Defrin
- Department of Physical Therapy; School of Allied Health Professions; Sackler Medical School; Tel-Aviv University; Israel
| | - K. Ginzburg
- Bob Shapel School of Social work; Tel-Aviv University; Israel
| | - M. Mikulincer
- School of Psychology; Interdisciplinary Center; Herzliya Israel
| | - Z. Solomon
- Bob Shapel School of Social work; Tel-Aviv University; Israel
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Chiarotto A, Fernandez-de-Las-Peñas C, Castaldo M, Villafañe JH. Bilateral pressure pain hypersensitivity over the hand as potential sign of sensitization mechanisms in individuals with thumb carpometacarpal osteoarthritis. PAIN MEDICINE 2013; 14:1585-92. [PMID: 23802919 DOI: 10.1111/pme.12179] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether bilateral deep tissue pressure hyperalgesia exists in individuals with unilateral thumb carpometacarpal osteoarthritis (CMC OA). METHODS A total of 32 patients with CMC OA (29 females and 3 males, aged 69-90 years old) and 32 healthy matched controls (29 females and 3 males, aged 70-90 years) were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over the first CMC joint, the hamate bone and the lateral epicondyle in a blinded design. Mixed models analyses of variance were conducted to determine the differences in pressure pain sensitivity between groups and sides. RESULTS The results showed that PPTs were significantly decreased over the first CMC joint (F = 6.551, P = 0.012) and the hamate bone (F = 9.783, P = 0.002) but not over the lateral epicondyle (F = 2.712, P = 0.102) in patients with thumb CMC OA as compared with healthy controls; patients with unilateral thumb CMC OA exhibited bilateral pressure pain hyperalgesia in both hands compared with healthy people. PPTs were not significantly associated to the intensity of pain (all, P > 0.05). DISCUSSION This study revealed bilateral localized pressure pain hypersensitivity over the hand in individuals with unilateral thumb CMC OA, suggesting spinal cord sensitization mechanisms in this population. Future studies should analyze the presence of widespread pressure pain sensitivity in patients with thumb CMC OA to further determine the presence of central sensitization mechanisms.
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Affiliation(s)
- Alessandro Chiarotto
- Private Practice, Torino; Research Office, A.I.FI. Piemonte Valle d' Aosta, Torino
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Schliessbach J, Siegenthaler A, Streitberger K, Eichenberger U, Nüesch E, Jüni P, Arendt-Nielsen L, Curatolo M. The prevalence of widespread central hypersensitivity in chronic pain patients. Eur J Pain 2013; 17:1502-10. [PMID: 23703952 DOI: 10.1002/j.1532-2149.2013.00332.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic pain is associated with generalized hypersensitivity and impaired endogenous pain modulation (conditioned pain modulation; CPM). Despite extensive research, their prevalence in chronic pain patients is unknown. This study investigated the prevalence and potential determinants of widespread central hypersensitivity and described the distribution of CPM in chronic pain patients. METHODS We examined 464 consecutive chronic pain patients for generalized hypersensitivity and CPM using pressure algometry at the second toe and cold pressor test. Potential determinants of generalized central hypersensitivity were studied using uni- and multivariate regression analyses. Prevalence of generalized central hypersensitivity was calculated for the 5th, 10th and 25th percentile of normative values for pressure algometry obtained by a previous large study on healthy volunteers. CPM was addressed on a descriptive basis, since normative values are not available. RESULTS Depending on the percentile of normative values considered, generalized central hypersensitivity affected 17.5-35.3% of patients. 23.7% of patients showed no increase in pressure pain threshold after cold pressor test. Generalized central hypersensitivity was more frequent and CPM less effective in women than in men. Unclearly classifiable pain syndromes showed higher frequencies of generalized central hypersensitivity than other pain syndromes. CONCLUSIONS Although prevalent in chronic pain, generalized central hypersensitivity is not present in every patient. An individual assessment is therefore required in order to detect altered pain processing. The broad basic knowledge about central hypersensitivity now needs to be translated into concrete clinical consequences, so that patients can be offered an individually tailored mechanism-based treatment.
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Affiliation(s)
- J Schliessbach
- University Department of Anesthesiology and Pain Therapy, Inselspital Bern, Switzerland
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Kong JT, Schnyer RN, Johnson KA, Mackey S. Understanding central mechanisms of acupuncture analgesia using dynamic quantitative sensory testing: a review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:187182. [PMID: 23762107 PMCID: PMC3666367 DOI: 10.1155/2013/187182] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 03/17/2013] [Accepted: 03/29/2013] [Indexed: 01/14/2023]
Abstract
We discuss the emerging translational tools for the study of acupuncture analgesia with a focus on psychophysical methods. The gap between animal mechanistic studies and human clinical trials of acupuncture analgesia calls for effective translational tools that bridge neurophysiological data with meaningful clinical outcomes. Temporal summation (TS) and conditioned pain modulation (CPM) are two promising tools yet to be widely utilized. These psychophysical measures capture the state of the ascending facilitation and the descending inhibition of nociceptive transmission, respectively. We review the basic concepts and current methodologies underlying these measures in clinical pain research, and illustrate their application to research on acupuncture analgesia. Finally, we highlight the strengths and limitations of these research methods and make recommendations on future directions. The appropriate addition of TS and CPM to our current research armamentarium will facilitate our efforts to elucidate the central analgesic mechanisms of acupuncture in clinical populations.
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Affiliation(s)
- Jiang-Ti Kong
- Stanford Systems Neuroscience & Pain Laboratory, Department of Anesthesiology, Division of Pain Medicine, School of Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| | - Rosa N. Schnyer
- School of Nursing, The University of Texas at Austin, Austin, TX 78701, USA
| | - Kevin A. Johnson
- Stanford Systems Neuroscience & Pain Laboratory, Department of Anesthesiology, Division of Pain Medicine, School of Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| | - Sean Mackey
- Stanford Systems Neuroscience & Pain Laboratory, Department of Anesthesiology, Division of Pain Medicine, School of Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
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Røe C. Amplification of osteoarthritis pain by peripheral and central nervous systems pain mechanisms. Scand J Pain 2013; 4:109-110. [PMID: 29913897 DOI: 10.1016/j.sjpain.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Oslo, Norway
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Spinal neuronal plasticity is evident within 1 day after a painful cervical facet joint injury. Neurosci Lett 2013; 542:102-6. [PMID: 23523644 DOI: 10.1016/j.neulet.2013.03.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 02/20/2013] [Accepted: 03/04/2013] [Indexed: 01/17/2023]
Abstract
Excessive stretch of the cervical facet capsular ligament induces persistent pain and spinal plasticity at later time points. Yet, it is not known when such spinal modifications are initiated following this painful injury. This study investigates the development of hyperalgesia and neuronal hyperexcitability in the spinal cord after a facet joint injury. Behavioral sensitivity was measured in a model of painful C6/C7 facet joint injury in the rat, and neuronal hyperexcitability in the spinal cord was evaluated at 6h and 1 day after injury or a sham procedure, in separate groups. Extracellular recordings of C6/C7 dorsal horn neuronal activity (229 neurons) were used to quantify spontaneous and evoked firing. Rats exhibited no change in sensitivity to mechanical stimulation of the forepaw at 6h, but did exhibit increased sensitivity at 1 day after injury (p=0.012). At 6h, both spontaneous neuronal activity and firing evoked by light brushing, pinch, and von Frey filaments (1.4-26g) applied at the forepaw were not different between sham and injury. At 1 day, spontaneous firing was noted in a greater number of neurons after injury than sham (p<0.04). Evoked firing was also increased 1 day after injury compared to normal and sham (p<0.03). Dorsal horn hyperexcitability and increased spontaneous firing developed between 6 and 24h after painful facet injury, suggesting that the development of hyperalgesia parallels dorsal horn hyperexcitability following mechanical facet joint injury, and these spinal mechanisms are initiated as early as 1 day after injury.
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Yoganandan N, Stemper BD, Rao RD. Patient Mechanisms of Injury in Whiplash-Associated Disorders. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.semss.2012.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chua NHL, Timmerman H, Vissers KC, OH WS. Multi-modal Quantitative Sensory Testing in Patients with Unilateral Chronic Neck Pain: An Exploratory Study. ACTA ACUST UNITED AC 2012. [DOI: 10.3109/10582452.2012.733803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Dry needling is a common treatment technique in orthopedic manual physical therapy. Although various dry needling approaches exist, the more common and best supported approach targets myofascial trigger points. This article aims to place trigger point dry needling within the context of pain sciences. From a pain science perspective, trigger points are constant sources of peripheral nociceptive input leading to peripheral and central sensitization. Dry needling cannot only reverse some aspects of central sensitization, it reduces local and referred pain, improves range of motion and muscle activation pattern, and alters the chemical environment of trigger points. Trigger point dry needling should be based on a thorough understanding of the scientific background of trigger points, the differences and similarities between active and latent trigger points, motor adaptation, and central sensitize application. Several outcome studies are included, as well as comments on dry needling and acupuncture.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA ; Myopain Seminars, Bethesda, MD, USA
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Shimoji K, Takahashi N, Nishio Y, Koyanagi M, Aida S. Pain relief by transcutaneous electric nerve stimulation with bidirectional modulated sine waves in patients with chronic back pain: a randomized, double-blind, sham-controlled study. Neuromodulation 2012; 10:42-51. [PMID: 22151811 DOI: 10.1111/j.1525-1403.2007.00086.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives. Newly developed bidirectional modulated sine waves (BMW) might provide some derived benefit to patients with low back pain. Pain relief by transcutaneous electric nerve stimulation (TENS) with BMWs was tested. Materials and Methods. Analgesic effects of BMWs and conventional bidirectional pulsed waves on chronic back pain in 28 patients were compared, and effects of repeated TENS using BMWs on chronic back pain were investigated in 21 patients by means of a randomized double-blind, sham-controlled, parallel-group method. Pain intensity was assessed using numerical rating scale (NRS). Results. There was significant immediate reduction in NRS in patients receiving BMWs, and 60 min after treatment compared to sham TENS. Weekly repeated treatments using massage and TENS with BMWs for 5 weeks resulted in a decrease of NRS, but there were no significant differences between the TENS plus massage and sham TENS plus massage groups. Conclusions. This study shows that TENS with BMWs significantly inhibits chronic back pain, and treatment effects are attained within a day. The results also suggest that there were no statistically significant long-term effects of TENS with BMW in the repeated treatment.
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Affiliation(s)
- Koki Shimoji
- Department of Human Sciences, Ube Frontier University Graduate School, Ube, Yamaguchi, Japan; Takahashi Clinic and Research and Development Department, Business Development Center, Omron Healthcare Co. Ltd., Kyoto, Japan; and Department of Anesthesiology, Saitama Medical School, Moroyama, Saitama, Japan
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Cold hyperalgesia as a prognostic factor in whiplash associated disorders: A systematic review. ACTA ACUST UNITED AC 2012; 17:402-10. [DOI: 10.1016/j.math.2012.02.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 02/15/2012] [Accepted: 02/22/2012] [Indexed: 11/23/2022]
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Tobbackx Y, Meeus M, Wauters L, De Vilder P, Roose J, Verhaeghe T, Nijs J. Does acupuncture activate endogenous analgesia in chronic whiplash-associated disorders? A randomized crossover trial. Eur J Pain 2012; 17:279-89. [PMID: 22968837 DOI: 10.1002/j.1532-2149.2012.00215.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many patients with chronic pain, including those with chronic whiplash-associated disorders (WAD), show features of central sensitization. Randomized trials examining whether treatments are able to influence the process of central sensitization in patients with chronic WAD are emerging. Therefore, the present study aimed at examining whether acupuncture results in activation of endogenous analgesia and relief in symptoms in patients with chronic WAD. METHODS In this randomized crossover pilot trial with blinded assessors, each patient (n = 39) received two treatment sessions of identical duration, with acupuncture and relaxation therapy randomly crossed over in visit 2. Primary outcome measurement included immediate activation of endogenous analgesia i.e., pressure pain sensitivity and conditioned pain modulation. Secondary outcome measurements included pain relief and reduced disability level. RESULTS Local pressure pain sensitivity at baseline and during conditioned pain modulation decreased significantly more following acupuncture compared with relaxation (time × group interactions: p < 0.001), both in the neck and at a site distinct from the painful region. When comparing the effects of acupuncture versus relaxation, no differences were observed on conditioned pain modulation, temporal summation of pressure pain, neck disability or symptom severity (all p-values >0.05). CONCLUSION It was shown that one session of acupuncture treatment results in acute improvements in pressure pain sensitivity in the neck and calf of patients with chronic WAD. Acupuncture had no effect on conditioned pain modulation or temporal summation of pressure pain. Both acupuncture and relaxation appear to be well-tolerated treatments for people with chronic WAD. These findings suggest that acupuncture treatment activates endogenous analgesia in patients with chronic WAD.
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Affiliation(s)
- Y Tobbackx
- Chronic Pain and Chronic Fatigue Research Group, Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
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Slater H, Graven-Nielsen T, Wright A, Schug SA. Low-Dose Sublingual Ketamine Does Not Modulate Experimentally Induced Mechanical Hyperalgesia in Healthy Subjects. PAIN MEDICINE 2012; 13:1235-46. [DOI: 10.1111/j.1526-4637.2012.01444.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Manual therapies for chronic neck pain (NP) are imprecise, inconsistent, and brief because of therapist fatigue. OBJECTIVE Investigate the safety and efficacy of computerized mobilization of the cervical spine in the sagittal plane for the treatment of chronic NP. DESIGN Pilot open trial. SETTING : Physical therapy outpatient department. PARTICIPANTS Ten patients with chronic NP. INTERVENTIONS A computerized cradle capable of 3-dimensional neck mobilization was utilized. However, in the present trial the cradle was only utilized in the sagittal plane. Treatment sessions lasted 20 minutes, biweekly, for 6 weeks. MAIN OUTCOME MEASURES : Numerical rating scale for pain, Neck Disability Index questionnaire, muscle algometry, cervical range of motion (CROM), surface electromyography, and 36-item Short Form Health Survey questionnaire. RESULTS Treatment was not associated with any significant adverse effects. Pain scores reduced by 2 ± 0.5 numerical rating scale points. CROM showed significant improvement at the end of the study (P<0.05). Neck Disability Index showed marked improvement by the fourth week, end of study, and 2 weeks after treatment (P<0.05); headache subscale showed marked reduction. CONCLUSIONS These preliminary results demonstrate the safety of a novel computerized mobilization of the cervical spine. In addition, the data suggest that this method is effective in increasing CROM and in alleviating NP and associated headache.
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Persson M, Sörensen J, Gerdle B. Whiplash Associated Disorders (WAD): Responses to pharmacological challenges and psychometric tests. Scand J Pain 2012; 3:151-163. [PMID: 29913863 DOI: 10.1016/j.sjpain.2012.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
Abstract
Objectives The present study challenges chronic Whiplash Associated Disorders (WAD)-subjects to a pharmacological intravenous (i.v.) test with morphine, ketamine, and active placebo (midazolam). The aim was to describe the short-term responses to drugs and the assumed heterogeneity in the patterns of responses. We related the different responder groups to the results from psychometric tests. Methods The study includes 95 patients, all with chronic WAD and referred to our departments. They answered a questionnaire including the following psychometric instruments relevant for chronic pain: Beck Depression Inventory, Coping Strategies Questionnaire, Multidimensional Pain Inventory, Life Satisfaction Checklist, SF36 and EuroQol. The subjects also went through sessions with separate infusions of morphine (0.3 mg/kg), ketamine (0.3 mg/kg) and midazolam (0.05 mg/kg). Infusion time was 30 min followed by a 2-h post-infusion assessment. Assessments were made using a Visual Analogue Scale (VAS) for pain intensity and unpleasantness and by statements of per cent pain relieved. A categorical pain rating scale was also used. A positive response was defined as ≥50% decrease of the VAS-level on two consecutive assessment points during the test sessions, anything less was a non response. The placebo responders were defined as those with a positive response to the active placebo infusion. Results The tests were completed by 94 subjects and 26% of these were placebo responders. Among the placebo non responders, 47% responded to morphine, 41% to ketamine, 25% to both drugs and 37% to neither morphine nor ketamine (pain intensity assessments). Similar proportions were found in the assessments of pain unpleasantness and per cent pain relieved. Approximately one in four subjects (27%, pain intensity assessment) did not respond to any of the drugs tested. This relatively high proportion of non responders seemed to be worst cases in some aspects of the psychometric tests. Generally, this non responder group had a trend to score worse for most items in the psychometric tests with some reaching significance in a univariate analysis. This result was confirmed in a multivariate context, although the results indicated only small differences between the groups. All three substances showed significant pain relief compared to baseline on all assessment points. On most variables, morphine and ketamine were significantly more effective compared to the active placebo. Conclusions There are different subgroups among subjects with chronic WAD with variations in responses to i.v. morphine, ketamine, and midazolam (active placebo). Subjects with chronic WAD who did not respond to any of the drugs tested scored badly in some aspects of the psychometric instruments. Implications The present study confirms one aspect of the heterogeneity in the population with chronic WAD. The study does not elucidate precise pain mechanisms but taken together with other studies exploring other aspects, it stresses the importance of individualizing the assessment and treatment of subjects with chronic WAD. A common clinical experience is that depression, anxiety and maladaptive coping strategies often are obstacles for successful medical treatment of chronic pain. The present study supports this experience and emphasizes the need for assessment of psychometric variables when planning the treatment of chronic WAD.
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Affiliation(s)
- Mats Persson
- Clinical Department of Operation and Intensive Care, Pain Unit, County Hospital Ryhov,SE-551 85 Jönköping, Sweden.,Rehabilitation Medicine, Faculty of Health Sciences, SE-581 85 Linköping, Sweden
| | - Jan Sörensen
- Rehabilitation Medicine, Faculty of Health Sciences, SE-581 85 Linköping, Sweden.,Pain and Rehabilitation Centre, University Hospital, SE-58185 Linköping, Sweden
| | - Björn Gerdle
- Rehabilitation Medicine, Faculty of Health Sciences, SE-581 85 Linköping, Sweden.,Pain and Rehabilitation Centre, University Hospital, SE-58185 Linköping, Sweden
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Staud R, Weyl EE, Price DD, Robinson ME. Mechanical and heat hyperalgesia highly predict clinical pain intensity in patients with chronic musculoskeletal pain syndromes. THE JOURNAL OF PAIN 2012; 13:725-35. [PMID: 22739051 DOI: 10.1016/j.jpain.2012.04.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 04/09/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Multiple abnormalities in pain processing have been reported in patients with chronic musculoskeletal pain syndromes. These changes include mechanical and thermal hyperalgesia, decreased thresholds to mechanical and thermal stimuli (allodynia), and central sensitization, all of which are fundamental to the generation of clinical pain. Therefore, we hypothesized that quantitative sensory tests may provide useful predictors of clinical pain intensity of such patients. Our previous studies of fibromyalgia (FM) patients have shown statistically significant correlations of quantitative sensory test results with clinical pain intensity, including mechanical spatial summation, number of pain areas, wind-up, and wind-up aftersensations. Although these tests predicted up to 59% of the variance in FM clinical pain intensity, their expense and technical complexities limited widespread use in clinical practice and trials. Thus, we developed practical tests of primary (mechanical) and secondary (heat) hyperalgesia that also strongly predict clinical pain intensity in patients with chronic musculoskeletal pain disorders. Thirty-six individuals with FM, 24 with local musculoskeletal pain, and 23 normal controls underwent testing of mechanical and heat hyperalgesia at the shoulders and hands. All subjects rated experimental pains using an electronic visual analog scale. Using either heat or pressure pain ratings as well as tender point counts and negative affect as predictors, up to 49.4% of the patients' variance of clinical pain intensity could be estimated. Results of this study emphasize the important contributions of peripheral and central factors to both local and widespread chronic pain. Overall, measures of mechanical and heat hyperalgesia in combination with tender point and negative affect provided powerful predictors of clinical pain intensity in chronic musculoskeletal pain patients that can be readily used in clinical practice and trials. PERSPECTIVE Simple tests of mechanical and heat hyperalgesia can predict large proportions of the variance in clinical pain intensity of chronic musculoskeletal pain patients and thus are feasible to be included in clinical practice and clinical trials.
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Affiliation(s)
- Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida 32610-0221, USA.
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Bou Khalil R. Pentoxifylline's theoretical efficacy in the treatment of fibromyalgia syndrome. PAIN MEDICINE 2012; 14:549-50. [PMID: 22568683 DOI: 10.1111/j.1526-4637.2012.01381.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arendt-Nielsen L, Graven-Nielsen T. Translational musculoskeletal pain research. Best Pract Res Clin Rheumatol 2012; 25:209-26. [PMID: 22094197 DOI: 10.1016/j.berh.2010.01.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2010] [Indexed: 01/25/2023]
Abstract
Diagnosis and management of musculoskeletal pain is a major clinical challenge. Fundamental knowledge of nociception from deep somatic structures and related mechanisms of sensitisation have been characterised in animals but the translation into clinical sciences is still lacking. Development and refinement of mechanism-based quantitative sensory testing in healthy volunteers and pain patients have provided new opportunities to assess pain and hyperalgesic reactions. The current technologies can provide information about, for example, peripheral and central sensitisation, descending pain control, central integration and structure specific sensitisation. Such a mechanistic approach can be used for differentiated diagnosis and for target validating new and existing analgesics. Mechanistic pain assessment of new compounds under development provides opportunities for target validation in proof-of-concept studies, which generate information to be used for selecting the most optimal patients for later clinical trials. New safe and efficient compounds are highly needed in the area of musculoskeletal pain management.
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Affiliation(s)
- Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7, Aalborg, Denmark.
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