Cardiac autonomic response to acute painful stimulus in individuals with chronic neck pain: A case-control study

PURPOSE

Characterize heart rate and cardiac autonomic response to painful stimulus on neck pain.

METHODS

Twenty-five individuals with neck pain and 25 healthy subjects were included. Heart rate variability and heart rate were assessed in the conditioned pain modulation test at pretest rest, during testing and in recovery. Heart rate variability indices were obtained using linear and nonlinear methods.

RESULTS

No significant differences were observed between groups regarding heart rate and the linear methods (p > 0.05). However, significant difference was observed between groups regarding nonlinear methods (standard deviation of the instantaneous variability of beat-to-beat interval variability, p = 0.005) CONCLUSIONS: Individuals with chronic neck pain showed autonomic responses similar to those of their healthy counterparts during the conditioning stimulus.

Pain, anxiety, and catastrophizing among pregnant women with dental pain, undergoing root canal treatment

This prospective study aims to evaluate dental pain, anxiety, and catastrophizing levels in pregnant women undergoing root canal treatment. Sixty pregnant and non-pregnant women presenting dental pain and an indication for root canal treatment were included in the study. Dental anxiety and catastrophizing were investigated using validated questionnaires. The endodontic intervention was performed, and a numerical scale measured preoperative and postoperative dental pain. The results were analyzed using STATA software 12.0. Unadjusted analyses assessed the association between pregnancy and pain, anxiety, and catastrophizing levels. Multiple linear regression models using 'forward stepwise' entry procedures were used to assess the independent effects of variables on pain scores. The significance level was set at 0.05. Initially, most patients experienced intense dental pain. The levels of dental pain, dental anxiety, and catastrophizing did not differ between pregnant and non-pregnant women. Logistic regression showed that postoperative pain was associated with irreversible pulpitis diagnosis (OR = 4.78; 95%CI 1.55-13.55) and high catastrophizing levels (OR = 1.96; 95%CI 1.01-3.84). Preoperative and postoperative pain rates and anxiety and catastrophizing were similar between pregnant and non-pregnant patients. Postoperative pain was associated with irreversible pulpitis diagnosis and high catastrophizing levels. The similarity between pregnant and non-pregnant women regarding preoperative and postoperative dental pain and catastrophizing and anxiety levels supports the indication of root canal treatment during the gestational period whenever necessary.

Multimodal benefits of hypnosis on pain, mental health, sleep, and quality of life in patients with chronic pain related to fibromyalgia: A randomized, controlled, blindly-evaluated trial

BACKGROUND AND PURPOSE

Fibromyalgia is a chronic syndrome marked by intense musculoskeletal pain often refractory to pharmacological treatment. Although studies have shown that hypnosis improves fibromyalgia pain, gaps in experimental design limit their reliability. This work aimed to evaluate the effects of hypnosis on pain, mental health, sleep, and quality of life in participants with fibromyalgia chronic pain.

METHODS

In this prospective, parallel, randomized, controlled, blindly-evaluated trial, participants of both sexes (n = 49) diagnosed with fibromyalgia and with moderate to severe chronic pain attended 8 weekly 1-h sessions with a hypnotherapist. For the hypnosis group (n = 24), sessions consisted in induction of hypnotic trance followed by suggestions to promote analgesia. For the control group (n = 25), sessions consisted in casual unscripted conversation. Participants were assessed at baseline (7 days before), post-intervention (7 days after), and follow-up (3 months after). The primary outcome was pain intensity. The secondary outcomes were the sensory and affective dimensions of pain; pain unpleasantness; pain catastrophizing; anxiety and depression; sleep quality; fibromyalgia impact; and quality of life.

RESULTS

Hypnosis significantly reduced pain scores both at post-intervention and follow-up in comparison with baseline. The analgesic effect of hypnosis combined with pharmacological treatment lasted for at least 3 months and was superior to analgesia promoted by first- and second-line pharmacological treatment alone. Hypnosis significantly improved all parameters evaluated as secondary outcomes both at post-intervention and follow-up without inducing adverse events.

CONCLUSION

Our results corroborate that clinical hypnosis is an effective and feasible tool for managing chronic pain and other symptoms of fibromyalgia.

Phenotypical characterization of exteroceptive sensation and pain symptoms on diabetic patients

BACKGROUD

Diabetic neuropathy (DN) is one of the most common complications of diabetes, affecting about half of individuals with the disease. Among the various symptoms of DN, the development of chronic pain stands out and manifests as exacerbated responses to sensorial stimuli. The conventional clinical treatments used for general neuropathy and associated painful symptoms, still brings uncomplete and unsatisfactory pain relief. Patients with neuropathic pain syndromes are heterogeneous. They present with a variety of sensory symptoms and pain qualities which difficult the correct diagnosis of sensory comorbidities and consequently, the appropriate chronic pain management.

AIMS

Herein, we aimed to demonstrate the existence of different sensory profiles on diabetic patients by investigating epidemiological and clinical data on the symptomatology of a group of patients with DN.

METHODS

This is a longitudinal and observational study, with a sample of 57 volunteers diagnosed with diabetes from outpatient day clinic of Hospital Universitário of the University of São Paulo-Brazil. After being invited and signed the Informed Consent Form (ICF), patients were submitted to clinical evaluation and filled out pain and quality of life questionnaires. They also performed quantitative sensory test (QST) and underwent skin biopsy for correlation with cutaneous neuropathology.

RESULTS

Data demonstrate that 70% of the studied sample presented some type of pain, manifesting in a neuropathic or nociceptive way, what has a negative impact on the life of patients with DM. We also demonstrated a positive association between pain and anxiety and depression, in addition to pain catastrophic thoughts. Three distinct profiles were identified in the sample, separated according to the symptoms of pain: (i) subjects without pain; (ii) with mild or moderate pain; (iii) subjects with severe pain. We also identified through skin biopsy that diabetic patients presented advanced sensory impairment, as a consequence of the degeneration of the myelinated and unmyelinated peripheral fibers. This study characterized the painful symptoms and exteroceptive sensation profile in these diabetic patients, associated to a considerable level of sensory degeneration, indicating, and reinforcing the importance of the long-term clinical monitoring of individuals diagnosed with DM, regarding their symptom profiles and exteroceptive sensitivity.

Which Scale to Assess Pain Self-efficacy Shows Better Measurement Properties in Chronic Low Back Pain? A Head-To-Head Comparison Study

OBJECTIVE

To compare the quality of the measurement properties of Pain Self-Efficacy Questionnaire (PSEQ)-10, PSEQ-4, PSEQ-2, Chronic Pain Self-Efficacy Scale (CPSS) long-form, and CPSS short-form (CPSS-SF) in patients with chronic low back pain (CLBP).

DESIGN

Cross-sectional and longitudinal studies (measurement properties).

SETTING

Outpatient rehabilitation.

PARTICIPANTS

Participants (N=245) with nonspecific CLBP (18-60y, 63% women) were enrolled in this study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Pain self-efficacy questionnaires were administered on 3 occasions: baseline assessment, 1 week after the first assessment (reliability), and after an 8-week exercise program (responsiveness). The intraclass correlation coefficient (ICC) and Cronbach α were used to assess reliability and internal consistency, respectively. Pearson correlation and confirmatory factor analyses were used to assess construct validity. The area under the curve and hypothesis testing were used to assess responsiveness.

RESULTS

No difference was observed for all the questionnaires regarding internal consistency (Cronbach α>.7), criterion validity (r>.88), and reliability (ICC>.7). The scales confirmed >75% of the hypotheses for the construct validity, except for CPSS-SF. PSEQ-2 did not meet the criterion for structural validity. PSEQ-10 met all the criteria for good measurement properties according to Consensus-Based Standards for the Selection of Health Measurement Instruments.

CONCLUSIONS

It was not possible to calculate structural validity for PSEQ-2, CPSS-SF did not meet the criterion for suitable hypothesis testing for construct validity, and all the questionnaires did not show suitable measurement error, except for the PSEQ-10. Hence, the PSEQ-10 was the unique scale that met all the criteria for good measurement properties for assessing pain self-efficacy in CLBP.

Influence of psychometric and sleep quality features on painful mechanical sensitivity and pain modulation in patients with temporomandibular disorders

Investigating the collective impact of psychometric properties and sleep quality on pain sensitivity in temporomandibular disorder (TMD) patients could improve clinical management strategies.

OBJECTIVE

Assessing whether combined psychometric properties and sleep quality impact painful mechanical sensitivity and pain modulation in TMD patients.

MATERIALS AND METHODS

A cross-sectional study using secondary data analysis of 77 TMD patients and 101 controls. All participants completed questionnaires characterizing their psychometric profile (anxiety, depression, stress and catastrophizing) and sleep quality, alongside psychophysical tests for painful mechanical sensory (mechanical pain threshold (MPT), pressure pain threshold (PPT), and wind-up ratio (WUR)) and conditioned pain modulation (CPM). Participants were grouped into "High distress" or "Low distress" categories based on psychometric properties and sleep quality using hierarchical cluster and k-means analyses. Multiple linear regression evaluated the influence of TMD, age, and the distress cluster on MPT, WUR, PPT, and CPM in masseter and thenar muscles. Differences were statistically significant when p < 0.05.

RESULTS

The presence of TMD was the strongest predictor of mechanical painful sensitivity in the trigeminal region (MPT[F(3,174) = 51.902;p < .001;R2 = .463]; TMD presence (β = -.682) / PPT[F(3,174) = 15.573;p < .001;R2 = .198] TMD presence (β = -.452), and extra-trigeminal (MPT[F(3,174) = 35.897;p < .001;R2 = .382] TMD (β = -.647) / CPM [F(3,174) = 4.106;p < .05;R2 = .050] TMD presence (β = .197). Furthermore, neither the high distress group nor the low distress group were able to significantly influence the variation of the values of any of the psychophysical variables evaluated (p > .05).

CONCLUSIONS

There is not a significant influence of impairment clusters based on psychological variables and sleep quality on painful mechanical sensitivity and pain modulation, regardless of the presence of TMD.

CLINICAL RELEVANCE

This outcome suggests that psychosocial factors and sleep quality may not play a decisive role in the sensory-discriminative aspect of pain, particularly concerning painful TMD.

Psychological factors show limited association with the severity of Achilles tendinopathy

BACKGROUND

This study aimed to investigate the association between psychosocial factors and the severity of Achilles tendinopathy, along with exploring their potential link to the pain's duration.

METHODS

A cross-sectional study involving 111 individuals with Achilles tendon pain was conducted.

METHODS

A cross-sectional study involving 111 individuals with Achilles tendon pain was conducted. Various psychological factors were assessed using the Pain Catastrophizing Scale, Chronic Pain Self-Efficacy Scale (CPSS), Tampa Scale for Kinesiophobia, and Hospital Anxiety and Depression Scale (HAD). Additionally, the severity of Achilles tendon pain was evaluated using the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A-Br). Regression analyses were employed to determine the association of these psychosocial factors with pain severity and duration.

RESULTS

Self-efficacy for chronic pain showed a slight association with Achilles tendon pain severity (β = 0.42 [95% CI: 0.06 to 0.16], p = 0.001), explaining only 19% of the dependent variable. The other variables, including anxiety, depression, pain catastrophizing, and fear of movement, did not exhibit significant associations.

CONCLUSION

The study suggests that psychological factors demonstrate limited association with the severity of Achilles tendinopathy. While self-efficacy for chronic pain was weakly associated, its clinical relevance remains uncertain. Future research, particularly longitudinal studies, should explore the influence of psychosocial factors on treatment adherence and response to enhance management strategies for Achilles tendon pain.

Anodal tDCS over the motor cortex improves pain but not physical function in chronic chikungunya arthritis: Randomized controlled trial

BACKGROUND

Chikungunya virus (CHIKV) is a globally prevalent pathogen, with outbreaks occurring in tropical regions. Chronic pain is the main symptom reported and is associated with decreased mobility and disability. Transcranial direct current stimulation (tDCS) is emerging as a new therapeutic tool for chronic arthralgia.

OBJECTIVE

To evaluate the effectiveness of 10 consecutive sessions of anodal tDCS on pain (primary outcome) in participants with chronic CHIKV arthralgia. Secondary outcomes included functional status, quality of life, and mood.

METHODS

In this randomized, double-blind, placebo-controlled trial, 30 participants with chronic CHIKV arthralgia were randomly assigned to receive either active (n = 15) or sham (n = 15) tDCS. The active group received 10 consecutive sessions of tDCS over M1 using the C3/Fp2 montage (2 mA for 20 min). Visual analog scale of pain (VAS), health assessment questionnaire (HAQ), short-form 36 health survey (SF-36), pain catastrophizing scale, Hamilton anxiety scale (HAS), timed up and go (TUG) test, lumbar dynamometry, 30-s arm curl and 2-min step test were assessed at baseline, day 10 and at 2 follow-up visits.

RESULTS

There was a significant interaction between group and time on pain (p = 0.03; effect size 95 % CI 0.9 (-1.67 to -0.16), with a significant time interaction (p = 0.0001). There was no interaction between time and group for the 2-minute step test (p = 0.18), but the groups differed significantly at day 10 (p = 0.01), first follow-up (p = 0.01) and second follow-up (p = 0.03). HAQ and SF-36 improved but not significantly. There was no significant improvement in mental health, and physical tests.

CONCLUSION

tDCS appears to be a promising intervention for reducing pain in participants with chronic CHIKV arthralgia, although further research is needed to confirm these findings and explore potential long-term benefits.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials (ReBEC): RBR-245rh7.

Pain Neuroscience Education in elective surgery patients: study protocol for a randomised controlled trial

BACKGROUND

Pain Neuroscience Education (PNE) consists of an educational strategy that seeks to understand the biological processes of pain and how to control it. The main objective of this study will be to evaluate the impact of PNE on outcomes related to the postoperative period. The hypothesis is that the intervention may positively influence postoperative recovery, contributing to pain control, clinical indications, acceptance and consumption of analgesics and other pharmacological drugs that contribute to its control, as well as psychological aspects, such as anxiety, depression and pain catastrophising.

METHODS AND ANALYSIS

This will be an open, parallel, multicentre and randomised controlled clinical trial. A total of 100 participants aged between 18 and 59 years of age, of both genders, who are going to have elective general surgery will be evaluated. The intervention group will participate in a preoperative pain neuroscience educational session and also receive usual preoperative care, while the control group receives usual preoperative care as well. The educational session will last 30 min and consists of a video (5:20 min), a questionnaire about the content, time for participants to express their beliefs, thoughts and doubts. Participants will be evaluated preoperatively and there will be one postintervention evaluation. The intensity and characteristics of pain and anxiety are evaluated as primary outcomes. As secondary outcomes, pain catastrophising and depression are taken into account.

ETHICS AND DISSEMINATION

The project was approved by the Research Ethics Committee of the Faculty of Ceilandia, the Research Ethics Committee of the Institute of Strategic Health Management of the Federal District and the Research Council of the Hospital of Brasília-Rede Dasa (CAAE: 28572420.3.0000.8093). Recruitment began in June of 2023. All participants were included in the study only after their written consent. All data obtained will be analysed and distributed through publication in journals and at scientific events.

TRIAL REGISTRATION NUMBER

Brazilian Registry of Clinical Trials (ReBEC) (RBR-23mr7yy).

Impact of multiple-session home-based transcranial direct current stimulation (M-HB-tDCS) on eating behavior in fibromyalgia: A factorial randomized clinical trial

BACKGROUND

Multiple-session home-based self-applied transcranial direct current stimulation (M-HB-self-applied-tDCS) has previously been found to effectively reduce chronic pain and enhance cognitive function. However, the effectiveness of this method for disordered eating behavior still needs to be studied.

OBJECTIVE

This study aimed to assess whether 20 sessions of M-HB-self-applied-tDCS, administered over four weeks to either the left dorsolateral prefrontal cortex (L-DLPFC) or primary motor cortex (M1), could improve various aspects of eating behavior, anthropometric measures, and adherence.

METHODS

We randomly assigned 102 fibromyalgia patients between the ages of 30 and 65 to one of four tDCS groups: L-DLPFC (anodal-(a)-tDCS, n = 34; sham-(s)-tDCS, n = 17) or M1 (a-tDCS, n = 34; s-tDCS, n = 17). Patients self-administered 20-min tDCS sessions daily with 2 mA under remote supervision following in-person training.

RESULTS

Generalized linear models revealed significant effects of M-HB-self-applied-tDCS compared to s-tDCS on uncontrolled eating (UE) (Wald χ2 = 5.62; df = 1; P = 0.018; effect size, ES = 0.55), and food craving (Wald χ2 = 5.62; df = 1; P = 0.018; ES = 0.57). Regarding fibromyalgia symptoms, we found a differentiated impact of a-tDCS on M1 compared to DLPFC in reducing food cravings. Additionally, M-HB-a-tDCS significantly reduced emotional eating and waist size. In contrast, M1 stimulation was more effective in improving fibromyalgia symptoms. The global adherence rate was high, at 88.94%.

CONCLUSION

These findings demonstrate that M-HB-self-applied-tDCS is a suitable approach for reducing uncontrolled and emotional eating, with greater efficacy in L-DLPFC. Furthermore, these results revealed the influence of fibromyalgia symptoms on M-HB-self-applied-tDCS's, with M1 being particularly effective in mitigating food cravings and reducing fibromyalgia symptoms.

Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain: a randomized double-blind clinical trial

The antinociceptive effect of BoNT-A have been well documented in animal studies; however, results of few but well-designed randomized placebo-controlled clinical trials about BoNT-A efficacy in masticatory myofascial pain (MFP) are inconsistent. Therefore, the present randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy of BoNT-A in patients with refractory MFP. Twenty-eight patients with pain reduction of less than 30% despite conservative treatment and with an average pain intensity of > 50 mm on the visual analogue scale (VAS) participated. Patients were randomly assigned to receive a total of 80 U of BoNT-A or saline solution (SS) injected into the masseter and anterior temporalis muscles. Pain intensity (VAS), quantitative sensory testing (QST), conditioned pain modulation (CPM), and psychosocial status were examined. Follow-up was performed at 1 and 6 months. For repeated-measure comparisons between evaluation times, Friedman test with Bonferroni correction was used for pain and somatosensory variables and the Wilcoxon test for the psychosocial variables. The Mann-Whitney test was used for all comparisons between groups. The BoNT-A group had a significant decrease in pain intensity at follow-ups compared with the SS group (p < 0.001). QST assessment revealed higher pressure pain threshold values in the masseter muscle for BoNT-A group compared to SS (p < 0.03) at all follow-ups. No differences were found for mechanical pain threshold and wind-up ratio values (p > 0.05) in the entire study. The BoNT-A group presented the most efficient CPM effect (p < 0.03) only at the 1 month follow-up in the masseter muscle. There was a significant time effect for BoNT-A in all psychosocial variables (p < 0.05) and a drug effect in the Central Sensitization Inventory (p < 0.01), Pittsburgh Sleep Quality Index (p < 0.004), and Healthy Survey 36 (p < 0.05) at 6 months follow-up. The study demonstrates that a single injection-session of BoNT-A has positive effects on the hall pain spectrum of patients with refractory masticatory myofascial pain.

Efficacy of Home-Based Transcranial Direct Current Stimulation Over the Primary Motor Cortex and Dorsolateral Prefrontal Cortex in the Disability Due to Pain in Fibromyalgia: A Factorial Sham-Randomized Clinical Study

This randomized, double-blind, controlled clinical trial compared the effectiveness of home-based-(HB) active transcranial direct current stimulation (a-tDCS) over the left dorsolateral prefrontal cortex (l-DLPFC) or primary motor cortex (M1) with their respective sham-(s)-tDCS to determine whether a-tDCS would be more effective than s-tDCS in reducing pain and improving disability due to pain. The study included 102 patients with fibromyalgia aged 30 to 65 years old randomly assigned to 1 of 4 tDCS groups using a ratio of 2:1:2:1. The groups included l-DLPFC (a-tDCS, n = 34) and (s-tDCS, n = 17), or tDCS on the M1 (a-tDCS, n = 34) or (s-tDCS, n = 17). Patients self-administered 20 sessions of tDCS, with 2 mA for 20 minutes each day under remote supervision after in-person training. The Mixed Model for Repeated Measurements revealed that a-tDCS on DLPFC significantly reduced pain scores by 36.53% compared to 25.79% in s-tDCS. From baseline to the fourth week of treatment, a-tDCS on M1 reduced pain scores by 45.89% compared to 22.92% over s-tDCS. A generalized linear model showed a significant improvement in the disability scale in the groups that received a-tDCS compared to s-tDCS over M1 20.54% versus 2.49% (χ2 = 11.06, df = 1, P < .001]), while on DLPFC the improvement was 14.29% and 5.77%, with a borderline significance (χ2 = 3.19, df = 1, P = .06]), respectively. A higher reduction in serum brain-derived neurotrophic factor from baseline to treatment end was positively correlated with decreased pain scores regardless of the treatment group. The application of a-tDCS over M1 increased the heat pain threshold and the function of the descending pain inhibitory system. PERSPECTIVE: These findings provide important insights: (1) HB-tDCS has effectively reduced pain scores and improved disability due to fibromyalgia. (2) The study provides evidence that HB-a-tDCS is a viable and effective therapeutic approach. (3) HB-a-tDCS over M1 improved the function of the descending pain inhibitory system and increased the heat pain threshold. Finally, our findings also emphasize that brain-derived neurotrophic factor, as an index of neuroplasticity, may serve as a valuable marker associated with changes in clinical pain measures. TRIAL REGISTRATION: Number NCT03843203.

Cognitive-affective changes mediate the mindfulness-based intervention effect on endometriosis-related pain and mental health: A path analysis approach

BACKGROUND

There is poor knowledge about the therapeutic mechanisms of the conservative interventions for endometriosis. We hypothesized that the effects of a brief mindfulness-based intervention (bMBI) on pelvic pain intensity (PPI), pain unpleasantness (PU) and quality of life mental health (QoL-MH) are mediated by direct and indirect paths of changes in pain catastrophizing (PC), positive affect (PA) and negative affect (NA).

METHODS

A secondary analysis of a pilot randomized controlled trial of women with endometriosis, assigned to standard medical treatment (n = 32) and standard medical treatment plus bMBI (n = 31). We tested a series of parallel and serial mediators (PC, PA and NA) of the relationship between bMBI and outcomes (PPI, PU and QoL-MH).

RESULTS

The bMBI group demonstrated improvement in PA (Cohen's f2  = 0.12 [0.01, 0.36]), decreases in NA (Cohen's f2  = 0.06 [0.00, 0.24]) and PC (Cohen's f2  = 0.16 [0.02, 0.42]). The PC reduction mediated the effect of the bMBI on PPI and PU directly; however, the PC effect through PA increase mediated the PU marginally but not PPI changes. bMBI effect on Qol-MH was mediated directly by PA and NA. The PC improved Qol-MH through PA increase and Pain decrease but not via NA.

CONCLUSIONS

Our findings showed that bMBI impacts pain through changes in pain-related cognitive-affective factors. bMBI can improve QoL-MH by multiple pathways, including but not limited to pain reduction, highlighting the independent potential of improvement in affect to restore mental health in endometriosis.

SIGNIFICANCE

Brief mindfulness-based intervention improves endometriosis pain through pain-related cognitive-affective factors and quality of life mental health via pain and affect changes unrelated to pain.

Muscle synergies analysis shows altered neural strategies in women with patellofemoral pain during walking

Several studies suggest that the central nervous system coordinates muscle activation by modulating neural commands directed to groups of muscles combined to form muscle synergies. Individuals with patellofemoral pain (PFP) move differently from asymptomatic individuals. Understanding the neural strategies involved in the execution of tasks such as walking can help comprehend how the movement is planned and better understand this clinical condition. The objective of this study was to compare muscle synergies between women with and without PFP during walking. Eleven women with PFP and thirteen asymptomatic women were assessed using three-dimensional kinematics and electromyography (EMG) while walking at self-selected speed. Kinematics of the trunk, pelvis and lower limbs were analyzed through the Movement Deviation Profile. Muscle synergies were extracted from the EMG signals of eight lower limb muscles collected throughout the whole gait cycle. Kinematic differences between the two groups (p<0.001, z-score = 3.06) were more evident during loading response, terminal stance, and pre-swing. PFP group presented a lower number of muscle synergies (p = 0.037), and greater variability accounted for (VAFtotal) when using 3 (p = 0.017), 4 (p = 0.004), and 5 (p = 0.012) synergies to reconstruct all EMG signals. The PFP group also presented higher VAFmuscle for rectus femoris (p = 0.048) and gastrocnemius medialis (p = 0.019) when considering 4 synergies. Our results suggest that women with PFP show lower motor complexity and deficit in muscle coordination to execute gait, indicating that gait in PFP is the result of different neural commands compared to asymptomatic women.

Classification of pain intensity with the pain beliefs and perceptions inventory (PBPI) and the pain catastrophizing scales (PCS)

PURPOSE

The pain beliefs and perceptions inventory (PBPI) and the pain catastrophizing scales (PCS) characterize beliefs or distress dimensions of the pain experience. It is relatively unknown, however, to what degree the PBPI and the PCS are well suited to classifying pain intensity.

METHODS

This study applied a receiver operating characteristic (ROC) approach to these instruments against the criterion of a visual analogue scale (VAS) of pain intensity with fibromyalgia and chronic back pain patients (n = 419).

RESULTS

The largest areas under the curve (AUC) were moderate and limited to the constancy subscale (71%) and total score (70%) of the PBPI and to the helplessness subscale (75%) and total score (72%) of the PCS. The best cut-off scores for the PBPI and PCS were better off at detecting true negatives than true positives, with larger specificity than sensitivity values.

CONCLUSION

Whereas, the PBPI and PCS are certainly useful instruments to evaluate diverse pain experiences, they may be inappropriate to classify intensity. The PCS performs marginally better than the PBPI for classifying pain intensity.

Adaptation and Validation of the International Pelvic Pain Society's Quality of Life Questionnaire in Portuguese

OBJECTIVE

 In the present study, our aim was to translate, adapt, and validate the Pelvic Health History Form (a quality of life [QoL] questionnaire) of the International Pelvic Pain Society (IPPS) from English to Portuguese.

METHODS

 The study was approved by the Ethics and Research Committee (CEP, in the Portuguese acronym) and the IPPS. The "Transcultural Adaptation" method comprised 5 stages: translation, synthesis, backtranslation, expert review, and pretest. Cultural adaptation and validation included cognitive interviews and statistical analysis of unanswered items (> 15%) in 14 clinic patients from CPP and endometriosis clinic at Santa Casa de São Paulo.

RESULTS

 Strong equivalences were established between the USA and Brazil questionnaires in terms of semantics, idioms, experiences, and concepts. Eighteen culturally inappropriate items were identified and adjusted using the revised response rate index. The subjective form underwent rigorous assessments, confirming its accurate measurement of intended targets.

CONCLUSION

 The methodology showed efficiency and equivalence, confirming its validity. The user-friendly format and inclusion of translated, adapted, and validated instruments in Portuguese make the form valuable for evaluating pelvic health, with potential for future research.

Additional effect of pain neuroscience education to spinal manipulative therapy on pain and disability for patients with chronic low back pain: a randomized controlled trial

BACKGROUND

Spinal manipulative therapy (SMT) demonstrates small effects on pain intensity in low back pain. Combining SMT with a psychosocial intervention like pain neuroscience education (PNE) could promote additional effect.

OBJECTIVES

To evaluate the additional effect of PNE when combined to SMT on pain intensity and low back pain-related disability in patients with chronic low back pain (CLBP).

METHOD

One hundred and four patients with CLBP of both sexes aged between 18 and 55 years were treated with PNE + SMT compared to SMT alone. The primary outcome measures were pain intensity and disability post-treatment (4 weeks). Secondary outcomes were fear-avoidance beliefs, global perceived effect of improvement, and pain self-efficacy. Results were obtained immediately post-treatment and at three follow-ups (30-days, 90-days, and 180-days).

RESULTS

No significant between-group difference was observed for pain intensity and disability post-treatment. In contrast, our results showed a significantly longer additional effect for the group treated with SMT + PNE for the following outcomes: pain intensity (change baseline to 90 day follow-up = -0.90 [95% CI= -1.76, -0.4] and change baseline to 180 day follow-up = -1.19 [95% CI= -2.06, -0.32]) and low back pain-related disability, global perceived effect of improvement and pain self-efficacy (180th day follow-up).

CONCLUSION

The results of this trial suggest the addition of PNE to SMT did not bring any additional effect on pain intensity and disability in the short term, but SMT + PNE can result in longer-lasting effects in patients with CLBP and that such an effect could be related to a possible mediator effect of pain self-efficacy.

Implicit Motor Imagery for Chronic Pelvic Pain: A Cross-Sectional Case-Control Study

Implicit motor imagery (IMI), with an image laterality discrimination (LD) task, has been proposed as a useful therapeutic tool to restore body schema in patients with chronic pelvic pain (CPP). The aim of this study was to analyse the existence of differences between patients with CPP and healthy individuals in order to justify the use of IMI. An observational, cross-sectional study with non-probabilistic sampling was designed as a one-to-one matched case-control study. Through a web link designed for this purpose, a total of 40 abdominoperineal images were shown to 130 participants during the laterality task. Outcome measures were pain intensity (visual analogue scale, VAS), accuracy, response time (RT), and CPPQ-Mohedo score (Chronic Pelvic Pain Questionnaire-Mohedo). This was an observational, cross-sectional study with a total of 64 CPP patients and 66 healthy individuals. The comparative analysis between groups revealed significant differences in accuracy, CPPQ-Mohedo and VAS (p < 0.001), but not in RT; in patients with CPP, accuracy was correlated with a lower CPPQ-Mohedo score and RT and, the greater the pain intensity, the higher the CPPQ-Mohedo score and RT, and the lower the accuracy. In the LD task, the patients with CPP made more mistakes than the healthy individuals. IMI could be a useful and complementary tool in the therapeutic approach for patients with CPP.

Effects of custom insoles for symptomatic hallux valgus: protocol for a sham-controlled randomised trial

INTRODUCTION

Hallux valgus (HV) is one of the most prevalent forefoot deformities, and its frequency increases with age, reaching nearly 23% in adulthood (females are usually more affected). Studies on customised insoles and orthoses for HV showed inconclusive results. There is no consensus in literature regarding the ideal insole or length of use for pain relief or functional improvement in individuals with HV. This study will assess the effects of a customised insole with retrocapital bar associated with an infracapital bar of the first metatarsal on pain and function of individuals with symptomatic HV.

METHODS

This is the protocol for a blinded, sham-controlled randomised clinical trial. Eighty participants with symptomatic HV will be randomised into two groups (40 per group): customised insole or sham insole. Assessments will be performed at baseline (T0), six (T6) and 12 weeks (T12) of intervention. A follow-up will occur after 4 weeks of intervention (T16). The primary and secondary outcomes will be pain (Numerical Pain Scale) and function (Foot Function Index), respectively.

STATISTICAL ANALYSIS

Analysis of variance with a mixed design or Friedman's test will be considered according to data distribution; post-hoc analyses will be performed using Bonferroni test. Time × group interaction and within-group and between-group differences will also be assessed. The intent-to-treat analysis will be used. A significance level of 5% and 95% s will be adopted for all statistical analyses.

ETHICS AND DISSEMINATION

This protocol was approved by the research ethics committee of the Faculty of Health Sciences of Trairi/Federal University of Rio Grande do Norte (UFRN/FACISA; opinion number 5411306). The study results will be disseminated to participants, submitted to a peer-reviewed journal and presented in scientific meetings.

TRIAL REGISTRATIONS NUMBER

NCT05408156.

Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial

QUESTION

How much are the reductions in pain intensity and improvements in physical function from Pilates exercise mediated by changes in pain catastrophising and kinesiophobia?

DESIGN

This was a secondary causal mediation analysis of a four-arm randomised controlled trial testing Pilates exercise dosage (once, twice or thrice per week) against a booklet control.

PARTICIPANTS

Two hundred and fifty-five people with chronic low back pain.

DATA ANALYSIS

All analyses were conducted in R software (version 4.1.2) following a preregistered analysis plan. A directed acyclic graph was constructed to identify potential pre-treatment mediator-outcome confounders. For each mediator model, we estimated the intervention-mediator effect, the mediator-outcome effect, the total natural indirect effect (TNIE), the pure natural direct effect (PNDE), and the total effect (TE).

RESULTS

Pain catastrophising mediated the effect of Pilates exercise compared with control on the outcomes pain intensity (TNIE MD -0.21, 95% CI -0.47 to -0.03) and physical function (TNIE MD -0.64, 95% CI -1.20 to -0.18). Kinesiophobia mediated the effect of Pilates exercise compared with control on the outcomes pain intensity (TNIE MD -0.31, 95% CI -0.68 to -0.02) and physical function (TNIE MD -1.06, 95% CI -1.70 to -0.49). The proportion mediated by each mediator was moderate (21 to 55%).

CONCLUSION

Reductions in pain catastrophising and kinesiophobia partially mediated the pathway to improved pain intensity and physical function when using Pilates exercise for chronic low back pain. These psychological components may be important treatment targets for clinicians and researchers to consider when prescribing exercise for chronic low back pain.

Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes

OBJECTIVES

It is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP conditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc).

METHODS

Patients underwent a standardized assessment of clinical pain, conditioned pain modulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excitability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex- and age-matched healthy volunteers.

RESULTS

60 patients (42 women, 55.1±9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8±1.3), and Sc (6.4±1.4)] than in those with ns-LBP (4.7±1.0, P<0.001). The same was shown for pain interference (5.9±2.0, 5.9±1.8, 3.2±1.9, P<0.001), disability (16.4±3.3, 16.3±4.3, 10.4±4.3, P<0.001), and catastrophism (31.1±12.3, 33.0±10.4, 17.4±10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8±1.9, -14.1±16.7, respectively) compared to ns-LBP (-25.4±16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group compared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were correlated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS.

CONCLUSIONS

Different types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.

Effects of an online program including mindfulness, exercise therapy and patient education compared to online exercise therapy and patient education for people with Patellofemoral Pain: protocol for a randomized clinical trial

BACKGROUND

Patellofemoral pain (PFP) is a common knee disorder that causes persistent pain, lower self-reported function and quality of life. People with PFP also present with altered psychological factors, which are associated with higher levels of pain and dysfunction. Mindfulness-based interventions (MBI) generally consist of meditative practices developed to provide a holistic approach to chronic conditions. However, the effects of MBI on clinical and psychological outcomes for people with PFP remains understudied.

METHODS

This assessor-blinded, parallel, two-arm randomized clinical trial aims to investigate the effects of adding an 8-week online MBI program to exercise therapy and patient education on clinical and psychological factors for people with PFP. We also aim to investigate whether psychological factors mediate changes in pain and function. Sixty-two participants with PFP will be recruited and randomized into one of two treatment groups (Mindfulness or Control group). Both groups will receive an 8-week intervention involving exercise therapy and education delivered through an online platform. The Mindfulness group will additionally receive a MBI component including formal and informal practices. Outcomes will be assessed online at baseline, intervention endpoint (follow-up 1) and 12 months after intervention completion (follow-up 2). Comparisons between groups will be performed at all time points with linear mixed models. A mediation analysis will be performed using a 3-variable framework.

DISCUSSION

Exercise therapy and patient education are considered the "best management" options for PFP. However, unsatisfactory long-term prognosis remains an issue. It is known that people with PFP present with altered psychological factors, which should be considered during the evaluation and treatment of people with PFP. Adding a MBI to the current best treatment for PFP may improve short and long-term effects by addressing the underlying psychological factors.

TRIAL REGISTRATION

Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-4yhbqwk, registered in April 6, 2021.

Effect of two suspension training programs on pain and musculoskeletal function in chronic low back pain: study protocol

The aim of this study is to compare the effects of two suspension training (ST) protocols on pain and musculoskeletal function in women with chronic low back pain (CLBP). The study will be randomized, controlled, blinded clinical trial. Women aged 18-60 years who present CLBP will be selected. They will be randomized into three groups: STG1, which will carry out the program with difficulty progression in the exercises; STG2, in which the progression will be made by increasing the number of sets; and control group. STG1 and STG2 will perform the training two-times a week for 60 min for 12 weeks. It is expected that ST will effectively reduce pain and improve functionality in CLBP and that the best protocol will be verified. Clinical Trial Registration: RBR-10rv3fqt.

Investigating the hypoalgesic effects of spinal manipulative therapy using hidden pain conditioning and positive expectation in patients with chronic low back pain: protocol for a randomised controlled trial

INTRODUCTION

Placebo effects are responses capable of modulating pain and influencing treatment response. Two mechanisms are commonly related to placebo effects: expectations and conditioning. However, the research in this field is focused on laboratory studies with healthy participants. This study aims to identify whether a conditioning procedure with positive induced expectations about spinal manipulative therapy (SMT) will result in greater hypoalgesic effects in adults with chronic low back pain (CLBP) in a clinical trial design.

METHODS AND ANALYSIS

This trial will enrol 264 patients with non-specific CLBP, aged 18-60 years. Patients will undergo a calibration test to determine the thermal pain threshold for the hidden pain conditioning procedure. Afterward, they will be randomised to one of the three groups: hidden pain conditioning with positive induced expectations-group one (G1); positive expectations-group two (G2) and neutral expectations-group three (G3). Patients will receive instructions to manipulate the expectations. The pretreatment heat pain test will be performed before the SMT and after the intervention patients will undergo again the heat pain intensity test. However, only patients in G1 will receive hidden pain conditioning to reinforce the association between SMT and pain intensity reduction. All patients will undergo five sessions of SMT. The outcomes will be assessed immediately after the last session and at the 6 weeks and 3-month follow-ups. All statistical analyses will be conducted following intention-to-treat principles, and the treatment effects will be determined with linear mixed models.

ETHICS AND DISSEMINATION

The Federal University of São Carlos approved this research (Process n° 52359521.1.0000.5504). All participants will give written informed consent. Dissemination of the results will include publications in peer-reviewed journals and presentations at conferences. If positive expectations and classical conditioning improve outcomes, it may support the administration of such intervention.

TRIAL REGISTRATION NUMBER

NCT05202704.

Education-Enhanced Conventional Care versus Conventional Care Alone for Temporomandibular Disorders: A Randomized Controlled Trial

The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18-55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3-8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. PERSPECTIVE: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767.

Effects of Hypnotic Analgesia and Transcranial Direct Current Stimulation on Pain Tolerance and Corticospinal Excitability in Individuals with Fibromyalgia: A Cross-Over Randomized Clinical Trial

Objective

We compare the effect of HAS, a-tDCS on the left dorsolateral prefrontal cortex (l-DLPFC), and rest-testing on pain measures [(cold pressor test (CPT) (primary outcome) and heat pain threshold]. We also compare their effects on the motor evoked potential (MEP) (primary outcome), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP).

Methods

This randomized, blind, crossover trial included 18 women with fibromyalgia, aged from 18 to 65 years old. They received at random and in a crossover order a-tDCS over the l-DLPFC (2mA), HAS, or a rest-testing.

Results

HAS compared to a-tDCS increased the pain tolerance with a moderate effect size (ES) [Cohen's f=-0.78; (CI 95%; -1.48 to -0.12)]. While compared to rest-testing, HAS increased the CPT with a large ES [Cohen's f=-0.87; (CI 95%; -1.84 to -0.09)]. The a-tDCS compared to HAS increased the MEP amplitude with large ES [Cohen's f=-1.73 (CI 95%; -2.17 to -0.17)]. Likewise, its ES compared to rest-testing in the MEP size was large [Cohen's f=-1.03; (CI 95%; -2.06 to -0.08)].

Conclusion

These findings revealed that HAS affects contra-regulating mechanisms involved in perception and pain tolerance, while the a-tDCS increased the excitability of the corticospinal pathways. They give a subsidy to investigate their effect as approaches to counter regulate the maladaptive neuroplasticity involved in fibromyalgia.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier - NCT05066568.

Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features

Background

This is a protocol for a prospective longitudinal study that aims to investigate: (1) group-by-time changes over a minimum of 15 months follow-up in patellofemoral pain (PFP) symptoms, biomechanical, muscle function, pain processing, and psychological features; (2) the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, health-related quality of life (HRQOL), and physical activity level.

Methods

Individuals with PFP (n = 144) and control individuals (n = 85) without PFP were assessed at baseline. Outcomes assessed included: 3D kinematics and kinetics during single leg squat, step-down and single leg hop; maximal torque and rate of torque development of hip abductors and knee extensors/flexors; force steadiness of hip abductors and knee extensors; anterior and lateral trunk endurance; pressure pain thresholds at the center of patella and contralateral shoulder; kinesiophobia (Tampa Scale for Kinesiophobia); pain catastrophizing (Pain Catastrophizing Scale); worst self-reported pain (Visual Analogue Scale); physical performance measures (Single Leg Hop Test and Forward Step-Down Test); self-reported function (Anterior Knee Pain Scale); HRQOL (Medical Outcome Short-Form 36), and physical activity level (Baecke's Questionnaire). Follow-up assessments will be identical to the baseline and will be performed after a minimum of 15 months. Generalized linear mixed model (GLMM) will be used to investigate group-by-time differences. Linear regression models will be used to determine the extent to which changes in biomechanical, muscle function, pain processing, and psychological features are associated with changes in self-reported pain, physical performance measures, self-reported function, HRQOL, and physical activity level.

Discussion

Physical and non-physical features have been previously associated with PFP. However, the present study will be the first to investigate their integrated evolution as part of the natural history of PFP and its progression. In doing so, we will be able to determine their behavior in the long-term, as well as how they prospectively associate with each other and with clinical outcomes. Ultimately, this will provide a greater understanding of predictors of long-term outcome and possible targets for interventions.

Can high pain intensity and catastrophizing interfere with the cognitive performance of women with chronic pain related TMD? A cross-sectional study

OBJECTIVE

Interventions based on pain education and self-management are dependent on factors such as attention, memory, concentration, and executive function. To explore the relationship between cognitive performance and the variables pain intensity, central sensitization, catastrophizing, and hypervigilance in women diagnosed with chronic pain-related TMD.

METHODOLOGY

This is a cross-sectional study. A total of 33 women (mean age: 38±4.6 years; range: 18 to 66 years) with chronic pain-related TMD (myalgia and/or arthralgia) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Specific questionnaires were used to evaluate cognitive performance, overall pain intensity, central sensitization, hypervigilance, and pain catastrophizing. The data were analyzed using Pearson's correlation coefficient and backward stepwise multiple linear regression (statistical significance at 5% alpha).

RESULTS

Approximately 53% of the study sample showed decreased cognitive performance. High central sensitization, hypervigilance, and pain catastrophizing were observed. A significant negative correlation was observed between cognitive performance and hypervigilance (p=.003, r=-.49), cognitive performance and catastrophizing (p<.001, r=-.58), and cognitive performance and pain intensity (p<.001, r=-.58). Regarding the partial regression coefficients, only catastrophizing and pain intensity showed statistical significance (t=-2.12, p=.043; t=-2.64, p=.014, respectively), indicating a significant role in explaining cognitive performance at the sample.

CONCLUSION

High pain intensity and the presence of catastrophic thoughts regarding pain can predict impaired cognitive performance in women with chronic pain-related TMD. Management strategies addressing psychosocial dimensions such as reducing catastrophizing and ensuring complete understanding of the condition are important.

Primary somatosensory cortex and periaqueductal gray functional connectivity as a marker of the dysfunction of the descending pain modulatory system in fibromyalgia

Background

Resting-state functional connectivity (rs-FC) may aid in understanding the link between pain-modulating brain regions and the descending pain modulatory system (DPMS) in fibromyalgia (FM). This study investigated whether the differences in rs-FC of the primary somatosensory cortex in responders and non-responders to the conditioned pain modulation test (CPM-test) are related to pain, sleep quality, central sensitization, and the impact of FM on quality of life.

Methods

This cross-sectional study included 33 females with FM. rs-FC was assessed by functional magnetic resonance imaging. Change in the numerical pain scale during the CPM-test assessed the DPMS function. Subjects were classified either as non-responders (i.e., DPMS dysfunction, n = 13) or responders (n = 20) to CPM-test. A generalized linear model (GLM) and a receiver operating characteristic (ROC) curve analysis were performed to check the accuracy of the rs-FC to differentiate each group.

Results

Non-responders showed a decreased rs-FC between the left somatosensory cortex (S1) and the periaqueductal gray (PAG) (P < 0.001). The GLM analysis revealed that the S1-PAG rs-FC in the left-brain hemisphere was positively correlated with a central sensitization symptom and negatively correlated with sleep quality and pain scores. ROC curve analysis showed that left S1-PAG rs-FC offers a sensitivity and specificity of 85% or higher (area under the curve, 0.78, 95% confidence interval, 0.63-0.94) to discriminate who does/does not respond to the CPM-test.

Conclusions

These results support using the rs-FC patterns in the left S1-PAG as a marker for predicting CPM-test response, which may aid in treatment individualization in FM patients.

Impairment on Cardiovascular Autonomic Modulation in Women with Migraine

Autonomic dysfunction, such as reduced vagally mediated heart rate variability, has been suggested in headache patients but is still uncertain when considering primary headache disorders. This study aims to compare the heart rate and blood pressure variability and baroreflex sensitivity between women with migraine and controls. A migraine (n = 20) and a control group (n = 20) of age-matched women without headache were evaluated. Heart rate variability was analyzed through frequency-domain using spectral analysis presenting variance, low-frequency (LF; 0.04-0.15 Hz) and high-frequency (HF; 0.15-0.4 Hz) bands and by time domain (root mean square of successive R-R interval differences, RMSSD). Blood pressure variability was analyzed with spectral analysis and baroreflex sensitivity with the sequence method. Migraine group had lower heart rate variability characterized by a reduction in total variance, LF oscillations (sympathetic/vagal modulation) and HF oscillations (vagal modulation), and a reduction in SD and RMSSD compared to control group. No difference was found in the blood pressure variability analysis. Regarding baroreflex sensitivity, migraine group had decreased values of total gain, gain down and up compared to control group. Women with migraine exhibited autonomic modulation alterations, expressed by decreased values of heart rate variability and baroreflex sensitivity, but not by differences in blood pressure variability.

Translation, cross-cultural adaptation and validation of the Argentine version of the Pain Catastrophizing Scale in patients with chronic low back pain

INTRODUCTION

Low back pain (LBP) is the leading cause of years lived with disability worldwide. Higher levels of catastrophizing were found in patients with LBP and this variable is associated with self-reported disability. The Pain Catastrophizing Scale (PCS) is a self-report questionnaire that assesses catastrophizing in the presence of pain. Currently, an Argentine version of the PCS is not available.

OBJECTIVE

To translate and cross-culturally adapt the PCS into Argentine Spanish and test the psychometric properties of the new version with chronic LBP patients.

STUDY DESIGN

Study of diagnostic accuracy/assessment scale.

METHODS

The study was carried out in three consecutive phases following the COSMIN guidelines: translation, cross-cultural adaptation and validation. We included Argentine residents over 18 years with chronic LBP. We used the PCS and the Global rating of change (GROC) to assess the psychometric properties.

RESULTS

No difficulties were present in the translation processes and the PCS-Arg was developed. The alfa Cronbach coefficient was 0.89. The standard error of measurement and the minimal detectable change were 5.4 and 15.1 points, respectively. In the explanatory factorial analysis 3 components were identified. For the construct validity, the correlation between the PCS-Arg and disability and pain were r = 0.35 and rho = 0.04, respectively. The mean PCS score was 29.9. The lowest and highest scores were 3 and 52 points, therefore, no roof or ceiling effects of the total score were observed.

CONCLUSION

The PCS-Arg is a viable, reliable and valid tool for the assessment of catastrophizing in patients with chronic LBP.

The effect of home-based transcranial direct current stimulation in cognitive performance in fibromyalgia: A randomized, double-blind sham-controlled trial

Background

Transcranial Direct Current Stimulation (tDCS) is a promising approach to improving fibromyalgia (FM) symptoms, including cognitive impairment. So, we evaluated the efficacy and safety of home-based tDCS in treating cognitive impairment. Besides, we explored if the severity of dysfunction of the Descendant Pain Modulation System (DPMS) predicts the tDCS effect and if its effect is linked to changes in neuroplasticity as measured by the brain-derived neurotrophic factor (BDNF).

Methods

This randomized, double-blind, parallel, sham-controlled clinical trial, single-center, included 36 women with FM, aged from 30 to 65 years old, assigned 2:1 to receive a-tDCS (n = 24) and s-tDCS (n = 12). The primary outcome was the Trail Making Test's assessment of executive attention, divided attention, working memory (WM), and cognitive flexibility (TMT-B-A). The secondary outcomes were the Controlled Oral Word Association Test (COWAT), the WM by Digits subtest from the Wechsler Adult Intelligence Scale (WAIS-III), and quality of life. Twenty-minute daily sessions of home-based tDCS for 4 weeks (total of 20 sessions), 2 mA anodal-left (F3) and cathodal-right (F4) prefrontal stimulation with 35 cm² carbon electrodes.

Results

GLM showed a main effect for treatment in the TMT-B-A [Wald χ2 = 6.176; Df = 1; P = 0.03]. The a-tDCS improved cognitive performance. The effect size estimated by Cohen's d at treatment end in the TMT-B-A scores was large [-1.48, confidence interval (CI) 95% = -2.07 to-0.90]. Likewise, the a-tDCS effects compared to s-tDCS improved performance in the WM, verbal and phonemic fluency, and quality-of-life scale. The impact of a-tDCS on the cognitive tests was positively correlated with the reduction in serum BDNF from baseline to treatment end. Besides, the decrease in the serum BDNF was positively associated with improving the quality of life due to FM symptoms.

Conclusion

These findings revealed that daily treatment with a home-based tDCS device over l-DLPFC compared to sham stimulation over 4 weeks improved the cognitive impairment in FM. The a-tDCS at home was well-tolerated, underlining its potential as an alternative treatment for cognitive dysfunction. Besides, the a-tDCS effect is related to the severity of DPMS dysfunction and changes in neuroplasticity state.

Clinical trial registration

[www.ClinicalTrials.gov], identifier [NCT03843203].

Effects of insoles adapted in flip-flop sandals for persistent heel pain: a protocol for a sham-controlled randomised trial

INTRODUCTION

Persistent heel pain is a prevalent complaint affecting up to 10% of the population. Insoles adapted in flip-flop sandals are an alternative treatment for pain and function of individuals with persistent heel pain, showing improvement within 12 weeks of treatment. Most studies considered foot posture and biomechanics to prescribe insoles for persistent heel pain, but few verified the effects of a 12-week treatment on pain catastrophising. This study will investigate the effects of insoles adapted in flip-flop sandals on pain intensity, function, functional walking capacity and pain catastrophising of individuals with persistent heel pain.

METHODS AND ANALYSIS

This is a protocol for a sham-controlled randomised trial. Eighty individuals with persistent heel pain will be assessed and randomised into two intervention groups: insoles adapted in flip-flop sandals and flip-flop sandals with sham (ie, flat) insoles. Assessments will be conducted at baseline (T0), after 6 weeks (T6), 12 weeks postintervention (T12) and after a 4-week follow-up (T16). The primary outcome will be the pain intensity, and secondary outcomes will be foot function, functional walking capacity and pain catastrophising. Analysis of variance with mixed design (if normal distribution) or Friedman's test (if not normal distribution) will verify intergroup and intragroup differences. Bonferroni post hoc tests will be performed in case of significant group or time interaction. Intent-to-treat analysis will be used, and a significance level of 5% and 95% CIs will be considered.

ETHICS AND DISSEMINATION

This study was approved by the research ethics committee of the Federal University of Rio Grande do Norte (registry no. 4,018,821). Results will be disseminated to individuals, submitted to a peer-reviewed journal and disclosed in scientific meetings.

TRIAL REGISTRATION NUMBER

NCT04784598.

Functional connectivity response to acute pain assessed by fNIRS is associated with BDNF genotype in fibromyalgia: an exploratory study

Fibromyalgia is a heterogenous primary pain syndrome whose severity has been associated with descending pain modulatory system (DPMS) function and functional connectivity (FC) between pain processing areas. The brain-derived neurotrophic factor (BDNF) Val66Met single nucleotide polymorphism has been linked to vulnerability to chronic pain. In this cross-sectional imaging genetics study, we investigated fibromyalgia, the relationship between BDNF Val66Met heterozygous genotypes (Val/Met), and the functional connectivity (FC) response pattern to acute pain stimulus in the motor (MC) and prefrontal (PFC) cortex assessed by near-infrared spectroscopy (fNIRS) before and after a cold pressor test utilizing water (0-1 °C). Also, we assessed the relationship between this genotype with the DPMS function and quality of life. We included 42 women (Val/Val = 30; Val/Met = 12) with fibromyalgia, ages 18-65. The MANCOVA comparing Val/Met to Val/Val genotypes showed higher ΔFC between left(l)-PFC-l-MC (β = 0.357, p = 0.048), l-PFC-right(r)-PFC (β = 0.249, p = 0.012), l-PFC-r-MC (β = 0.226, p = 0.022), and l-MC-r-PFC (β = 0.260, p = 0.016). Val/Met genotypes showed higher efficiency of the DPMS and lower disability due to pain. Here we show that fibromyalgia patients carrying the Val/Met BDNF genotype presented an increased ΔFC across MC and PFC in response to acute pain associated with differences in acute pain perception and fibromyalgia symptoms.

What factors contribute to the Scapular Assistance Test result? A classification and regression tree approach

The aim of this study was to determine predictive factors related to the Scapular Assistance Test in individuals with shoulder pain during arm elevation, and to analyze how these predictors interact in a nonlinear manner to discriminate the result of a positive and negative Scapular Assistance Test. Eighty-four individuals with shoulder pain with positive (n = 47, average age 38.4 years) and negative (n = 37, average age 37.8 years) Scapular Assistance Test completed the study. Demographic data, affected shoulder, pain duration, pain at rest, angular onset of pain, scapular dyskinesis, serratus anterior and lower trapezius muscle strength, Disabilities of Arm, Shoulder and Hand questionnaire and Pain Catastrophizing Scale were assessed in all participants. The Classification and Regression Tree analysis was used to determine which factors would predict the occurrence of a positive or negative Scapular Assistance Test and possible interactions among them. The resulting tree presented seven levels that combine the following variables: angular onset of pain, presence of scapular dyskinesis, pain catastrophizing, serratus anterior and lower trapezius muscle strength. The angular onset of pain during arm elevation was the main predictor of a positive Scapular Assistance Test selected by the Classification and Regression Tree. This study indicates that the Scapular Assistance Test result may be explained not only by biomechanical variables, but also by psychological factors. Disability of the upper limbs does not seem to contribute to the Scapular Assistance Test result.

Parenting Styles, Mental Health, and Catastrophizing in Women with Chronic Pelvic Pain: A Case-Control Study

Chronic pelvic pain (CPP) in women is a highly prevalent condition worldwide and requires multimodal treatment. Adverse childhood experiences have been associated with CPP in women, while allodynia and poor outcomes have been linked to pain catastrophizing in these patients. Pain perception has been associated with parenting style during childhood. The objective of this study was to investigate the association between parenting style, pain catastrophizing, anxiety, depression and CPP in women. A case-control study was conducted between May 2018 and August 2021 with 123 women with CPP and 123 pain-free controls. Questionnaires were used to collect participants' data. The association between parenting style and CPP was assessed using multiple logistic regression, with odds ratios (OR) and 95% confidence intervals (CI) being calculated. The correlation between catastrophizing, pain intensity, pain duration, anxiety, depression, and parenting style in women with CPP was assessed using Spearman's rank correlation coefficient (r). A higher frequency of low maternal care (60.7% versus 45.2%; p = 0.026), anxiety (79.7% versus 56.9%; p < 0.001), depression (73.2% versus 56.1%; p = 0.008) and physical violence (31.7% versus 14.6%; p = 0.003) was found in the CPP group compared to the controls. There was no association between parenting style and CPP in the adjusted analysis. A positive correlation was found between catastrophizing and pain intensity (r = 0.342; p < 0.001), anxiety (r = 0.271; p = 0.002), depression (r = 0.272; p = 0.002), and maternal overprotection (r = 0.185; p = 0.046). A negative correlation was found between anxiety and maternal (r = -0.184; p = 0.047) and paternal (r = -0.286; p = 0.006) care and between depression and maternal (r = -0.219; p = 0.018) and paternal (r = -0.234; p = 0.026) care. The present results suggest a significant but weak association of parenting style with pain catastrophizing, the mental health of women with CPP, and the way in which they experience pain.

Association between descending pain modulatory system and cognitive impairment in fibromyalgia: A cross-sectional exploratory study

Background

The successful regulation of sensory input to the central nervous system depends on the descending pain modulatory system (DPMS). For the effective regulation of sensory input to the central nervous system and behavioral responses to pain, the DPMS is required. Its connection to fibromyalgia (FM)-related cognitive dysfunction has not yet been investigated. Therefore, this study tested whether measures of verbal fluency, sustained attention, and short-term and working memory could distinguish FM patients from healthy controls (HC). Additionally, it investigated, using a standardized paradigm, the link between cognitive ability and the function of the DPMS in responders and non-responders to the conditioned pain modulation test (CPM-test).

Materials and methods

We enrolled 21 HC women and 69 FM patients, all of whom ranged in age from 30 to 65. We employed scores from the Trail Making Test (TMTB-A) (sustained and divided attention), the Controlled Oral Word Association Test (COWAT) (orthographic and semantic fluency), and the Digits subtest of the Wechsler Adult Intelligence Scale (WAIS-III) as dependent variables.

Results

A generalized linear model (GLM) adjusted by educational level revealed significantly lower scores in FM than HC on the Span digits forward, COWAT-orthographic, and TMTB-A. For FM patients, multilevel MANCOVA revealed that the cognitive performance of non-responders compared to responders to CPM-test showed lower adjusted scores in Span digits forward (Partial-η² = 0.358, P = 0.001), Span digits backward (Partial-η² = 0.358, P = 0.001), COWAT-orthographic (Partial-η² = 0.551, P = 0.001), COWAR-semantic (Partial-η² = 0.355, P = 0.001), and TMTB-A (Partial-η² = 0.360, P = 0.001). The association between the cognitive tests and the DPMS is moderated by the serum level of brain-derived neurotrophic factor (BDNF). Additionally, these cognitive assessments had a positive correlation with antidepressant use and pain threshold. The cognitive assessments, on the other hand, were conversely associated with a life of quality.

Conclusion

Based on these findings, it can be shown that HC performed substantially better on cognitive exams than FM did. They demonstrated a link between clinical complaints about attention and memory and decreased DPMS effectiveness. Additionally, they demonstrated that the BDNF is a moderating element in a potential relationship between the severity of cognitive impairment and DPMS dysfunction.

Efficacy of the cognitive functional therapy (CFT) in patients with chronic nonspecific low back pain: a study protocol for a randomized sham-controlled trial

Background

Chronic low back pain is a public health problem, and there is strong evidence that it is associated with a complex interaction of biopsychosocial factors. Cognitive functional therapy (CFT) is a promising new intervention that deals with potentially modifiable multidimensional aspects of pain (e.g., provocative cognitive, movement, and lifestyle behaviors).

Methods

To investigate the efficacy of CFT compared with a sham intervention for pain intensity and disability post-intervention (immediately after the last session) in patients with non-specific chronic low back pain (CLBP). This study is a randomized controlled trial in which 152 (18–60 years old) patients with CLBP will be enrolled. The patients will be randomly allocated to receive (1) CFT intervention or (2) sham intervention. The experimental group will receive individualized CFT in a pragmatic manner (5 to 7 sessions) based on the clinical progression of the participants. The sham group will attend six sessions: consisting of 30 min of photobiomodulation using a detuned device and more than 15 min of talking about neutral topics. Patients from both groups also will receive an educational booklet (for ethical reasons). Participants will be assessed pre and post-intervention, 3 months, and 6 months after randomization. The primary outcomes will be pain intensity and disability post-intervention. The secondary outcomes will be: pain intensity and disability at 3- and 6-month follow-up, as well as self-efficacy, global perceived effect of improvement, and functioning post-intervention, 3-, and 6-month follow-up. The patients and the assessor will be blinded to the treatment administered (active vs. sham).

Statistical analysis

The between-group differences (effects of treatment), as well as the treatment effect for the primary and secondary outcomes, and their respective 95% confidence intervals will be calculated by constructing linear mixed models.

Discussion

To the best of our knowledge, the current study will be the first to compare CFT vs. sham intervention. Sham-controlled RCTs may help to understand the influence of non-specific factors on treatment outcomes. Considering complex interventions as CFT, it is imperative to understand the impact of contextual factors on outcomes.

Trial registration

ClinicalTrials.gov NCT04518891. First Posted: August 19, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06466-8.

Motor control exercises versus general exercises for greater trochanteric pain syndrome: A protocol of a randomized controlled trial

Introduction

Greater trochanteric pain syndrome is an overarching term used to define pain and tenderness in the greater trochanteric region of the femur, which is more common in women. Abnormal control of lower limb movements and deficient neuromuscular parameters may lead to greater trochanteric pain syndrome; however, no studies have used neuromuscular training as a treatment strategy. Thus, this study aims to compare the effect of a protocol of general exercises versus a program of motor control training on pain at baseline and after treatment in women with greater trochanteric pain syndrome.

Methods

The study was approved by the Research Ethics Committee (CAAE: 87372318.1.0000.5406) and has been prospectively registered on the Brazilian Registry of Clinical Trials (RBR-37gw2x). Sixty participants will be randomized to receive motor control exercises or general exercises. The application will be performed twice a week for 8 weeks. The participants will be evaluated before the treatment (T0), after 8 weeks of intervention (T8) and after 60 weeks of intervention (T60). The primary outcome measures will be the hip pain intensity, and secondary outcomes will be muscle strength, kinesiophobia, global perceived effect, pain catastrophization, central sensitization and quality of life.

Conclusions

Studies have suggested that greater trochanteric pain syndrome may be related to poor hip and pelvic control, however, no study has investigated an exercise protocol focused on increasing the strength of the abductor and extensor muscles of the hip associated with pelvic control training, especially in positions of unilateral support, such as gait. This study will help determine whether greater trochanteric pain syndrome is related to abnormal control of lower limb movements.

Hyper-connectivity between the left motor cortex and prefrontal cortex is associated with the severity of dysfunction of the descending pain modulatory system in fibromyalgia

Introduction

The association between descending pain modulatory system (DPMS) dysfunction and fibromyalgia has been previously described, but more studies are required on its relationship with aberrant functional connectivity (FC) between the motor and prefrontal cortices.

Objectives

The objective of this cross-sectional observational study was to compare the intra- and interhemispheric FC between the bilateral motor and prefrontal cortices in women with fibromyalgia, comparing responders and nonresponders to the conditioned pain modulation (CPM) test.

Methods

A cross-sectional sample of 37 women (23 responders and 14 nonresponders to the CPM test) with fibromyalgia diagnosed according to the American College of Rheumatology criteria underwent a standardized clinical assessment and an FC analysis using functional near-infrared spectroscopy. DPMS function was inferred through responses to the CPM test, which were induced by hand immersion in cold water (0–1°C). A multivariate analysis of covariance for main effects between responders and nonresponders was conducted using the diagnosis of multiple psychiatric disorders and the use of opioid and nonopioid analgesics as covariates. In addition, we analyzed the interaction between the CPM test response and the presence of multiple psychiatric diagnoses.

Results

Nonresponders showed increased FC between the left motor cortex (lMC) and the left prefrontal cortex (lPFC) (t = −2.476, p = 0.01) and right prefrontal cortex (rPFC) (t = −2.363, p = 0.02), even when both were considered as covariates in the regression analysis (lMC–lPFC: β = −0.127, t = −2.425, p = 0.021; lMC–rPFC: β = −0.122, t = −2.222, p = 0.033). Regarding main effects, a significant difference was only observed for lMC–lPFC (p = 0.035). A significant interaction was observed between the psychiatric disorders and nonresponse to the CPM test in lMC−lPFC (β = −0.222, t = −2.275, p = 0.03) and lMC−rPFC (β = −0.211, t = −2.2, p = 0.035). Additionally, a significant interaction was observed between the CPM test and FC in these two region-of-interest combinations, despite the psychiatric diagnoses (lMC−lPFC: β = −0.516, t = −2.447, p = 0.02; lMC−rPFC: β = −0.582, t = −2.805, p = 0.008).

Conclusions

Higher FC between the lMC and the bilateral PFC may be a neural marker of DPMS dysfunction in women with fibromyalgia, although its interplay with psychiatric diagnoses also seems to influence this association.

Preoperative Predictors for Acute Pain After Photorefractive Keratectomy

PURPOSE

The aim of this study was to identify preoperative predictors for the occurrence of early severe postoperative pain in patients undergoing photorefractive keratectomy (PRK). The implementation of preoperative screening methods may facilitate more specific or aggressive pain therapies specifically targeted to individuals at a high risk of experiencing severe postoperative pain.

METHODS

This was exploratory research that included patients who underwent PRK. Before PRK, patients were administered a sociodemographic questionnaire, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory and underwent corneal sensitivity and conditioned pain modulation (CPM) tests. Post-PRK pain was assessed using a pain intensity visual analog scale (VAS), and the short-form McGill Pain Questionnaire (SF-MPQ) was completed 21 days before PRK and 1, 24, 48, and 72 hours after PRK. Spearman correlations were calculated for pain scores and preoperative predictors.

RESULTS

This research included 34 eyes of 34 patients. Preoperative corneal sensitivity was positively correlated with post-PRK pain scores as assessed by VAS and SF-MPQ (rho = 0.39 and rho = 0.41, respectively, P < 0.05). No correlations were found between Pain Catastrophizing Scale, State-Trait Anxiety Inventory, and CPM scores and post-PRK pain scores (P > 0.05).

CONCLUSIONS

Abnormal presurgical corneal sensitivity was a protective marker for severe pain after PRK, while scores as assessed by VAS and SF-MPQ and CPM were not related to postoperative pain.

Psychometric properties of the Brazilian short-version of the Northwick Park Neck Pain Questionnaire

OBJECTIVE

To translate, cross-culturally adapt and assess measurement properties of the translated version of the Northwick Park Neck Pain Questionnaire into Brazilian Portuguese.

DESIGN

Cross-sectional study.

SETTINGS

University healthcare facility and online.

PARTICIPANTS

People with chronic neck pain (n = 178).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants answered the translated version of Northwick Park Neck Pain Questionnaire, the Neck Disability Index, the Numerical Rating Scale for pain, the Tampa Scale for Kinesiophobia and the Pain Catastrophizing Scale. Seven to ten days after that, a subset of 84 participants answered the Northwick Park Neck Pain Questionnaire again. The structural (exploratory and confirmatory factor analyses) and construct validities, internal consistency, reliability and concordance were assessed. Level of significance was set at 5%.

RESULTS

Participants' (35.6 ± 13.5 years old) with symptoms duration of 54.4 ± 60.4 months scored 25.5 ± 14.0 on the Brazilian Northwick Park Neck Pain Questionnaire and 11.9 ± 5.8 on the Neck Disability Index. The structural analysis showed that the short version of the Northwick Park Neck Pain Questionnaire has an adequate structure to measure disability due to neck pain. Correlations with other questionnaires were between 0.268 and 0.678, Cronbach's alfa was 0.76, intraclass correlation coefficient was 0.96, standard error of measurement was 2.74 and minimal detectable change was 7.60.

CONCLUSION

The short version of the Northwick Park Neck Pain Questionnaire is valid and reliable to be used in patients with chronic neck pain, as it presented adequate measurement properties of structural and construct validity, reliability and concordance.

Noninvasive intracranial pressure monitoring in women with migraine

This cross-sectional study aimed to compare the waveform morphology through noninvasive intracranial pressure (ICP-NI) measurement between patients with migraine and controls, and to analyze the association with clinical variables. Twenty-nine women with migraine, age 32.4 (11.2) years and headache frequency of 12.6 (7.5) days per month and twenty-nine women without headache, age 32.1 (9.0) years, were evaluated. Pain intensity, migraine disability, allodynia, pain catastrophizing, central sensitization and depression were evaluated. The ICP-NI monitoring was performed by a valid method consisting of an extracranial deformation sensor positioned in the patients’ scalp, which allowed registration of intracranial pressure waveforms. Heart rate and blood pressure measurements were simultaneously recorded during 20 min in the supine position. The analyzed parameter was the P2/P1 ratio based on mean pulse per minute which P1 represents the percussion wave related to the arterial blood pression maximum and P2 the tidal wave, middle point between the P1 maximum and the dicrotic notch. There was no between-groups difference in the P2/P1 ratio (mean difference: 0.04, IC95%: -0.07 to 0.16, p = 0.352, F (1,1) = 0.881) adjusted by body mass index covariable. The Multiple Linear Regression showed non-statistical significance [F (5,44) = 1.104; p = 0.372; R² = 0.11)] between the P2/P1 ratio and body mass index, presence of migraine, central sensitization, pain catastrophizing and depression. We found no correlation (p > 0.05) between P2/P1 ratio and migraine frequency, migraine onset, pain intensity, pain intensity at day of examination, disability, allodynia. Migraine patients did not present alterations in the waveform morphology through ICP-NI compared to women without headache and no association with clinical variables was found.

Hypnosis As A Therapy for Chronic Lower Back Pain

PURPOSE OF REVIEW

Chronic lower back pain is a crippling condition for the individual and a significant burden on society. It is notoriously challenging to manage despite access to invasive interventions. Understanding hypnosis as a powerful therapeutic adjunct to this condition allows holistic treatment of patients in distress.

RECENT FINDINGS

In addition to classic etiologies of chronic lower back pain, hypnosis has proven to be beneficial in chronic back pain caused by pregnancy, diabetic and HIV neuropathy. Combination of hypnosis with other mind-body techniques such as olfactory stimulation, music therapy and patient education offers further promise to this treatment modality. Our review provides a run-through of the fundamental mechanisms of hypnosis in moderating chronic back pain, its quantifiable benefits, its novel areas of use and its potentials in the future based on the most recent and relevant peer-reviewed literature in order to guide clinicians to better deploy this valuable resource.

Prevalência de cinesiofobia e catastrofização em pacientes com disfunção temporomandibular

RESUMO Objetivo: identificar a frequência e os níveis de cinesiofobia e catastrofização em pacientes com Disfunção Temporomandibular que realizaram terapia fonoaudiológica. Métodos: a amostra compreendeu pacientes com Disfunção Temporomandibular muscular e mista com predominância muscular, grupo de estudo e adultos saudáveis, o grupo controle. Os instrumentos utilizados foram: Diagnostic Criteria for Temporomandibular Disorders, Escala Tampa para Cinesiofobia e Escala de Catastrofização da Dor. A análise estatística foi composta do Teste de Mann-Whitney para comparar as médias entre os grupos de cada escala e o teste de Coeficiente de Correlação de Spearman para analisar a correlação entre as escalas em cada grupo e sua significância. Resultados: foi identificado um alto índice de catastrofização da dor no grupo de estudo em comparação ao grupo controle. Quanto à cinesiofobia, houve maior índice positivo para essa variável no grupo de estudo e menor para o grupo controle. Além disso, identificou-se correlação moderada e positiva entre a cinesiofobia e catastrofização no grupo de estudo. Conclusão: Pacientes com Disfunção Temporomandibular possuem níveis de cinesiofobia e catastrofização mais altos que pacientes que não foram diagnosticados com o distúrbio.

Prevalence of kinesiophobia and catastrophizing in patients with temporomandibular disorders

ABSTRACT Purpose: to identify the frequency and levels of kinesiophobia and catastrophizing in patients with temporomandibular disorders who had been submitted to speech-language-hearing therapy. Methods: the sample comprised patients with myogenous (predominantly) and mixed temporomandibular disorders in the study group and healthy individuals in the control group. The instruments used were the Diagnostic Criteria for Temporomandibular Disorders, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale. Statistical analyses were performed with the Mann-Whitney test (to compare the means on each scale between the groups) and the Spearman’s correlation coefficient test (to analyze the correlation between the scales in each group and its significance). Results: the study group had a higher pain catastrophizing index than the control group. Likewise, the study group had greater kinesiophobia positive indices, whereas the control group had lower ones. A moderate positive correlation was also identified between kinesiophobia and catastrophizing in the study group. Conclusion: patients presented with temporomandibular disorders have higher levels of kinesiophobia and catastrophizing than subjects not diagnosed with the disorder.

Low back pain: biopsychosocial aspects of chronic and acute pain

Abstract: Chronic low back pain is a highly prevalent pathology, which has unclear associations with psychosocial aspects. This study investigated differences between patients with chronic low back pain (n = 25) and acute low back pain (n = 20) and verified the effect of the variables assessed on the pain mean. The design was cross-sectional, and the instruments applied were: sociodemographic interviews, Brief Pain Inventory, Beck Depression Inventory II, Hamilton Anxiety Rating Scale, Personality Factor Battery, Social Support Scale and Pain Catastrophizing Scale. The chronic pain group had significantly higher means of pain intensity, anxiety and catastrophic thoughts. In the regression analysis, the factor Depression of the Personality Factor Battery and belonging to the chronic pain group were found as predictors of the mean pain in the sample studied. It is understood that psychological factors are associated with the pain condition and require further investigation.

Three-dimensional kinematic analysis of upper limb movements between individuals with and without subacromial shoulder pain exploring the statistical parametric mapping

Subacromial shoulder pain (SSP) accounts for 44-65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0-100%, p < 0.001) and rotated scapula internally (0-20%, p < 0.001 and 75-100%, p < 0.001); rotated upwards (17-32%, p < 0.005 and 58-87%, p < 0.003) and posteriorly tilted (28-79%,p < 0.001 and 81-95%,p < 0.006) less than CG group during arm abduction-adduction. Through arm flexion-extension, the SSP group flexed (38-82% p < 0.009) less their trunk, rotated upwards (5-10% p = 0.021) less their scapula, and posteriorly tilted scapula (0-100% p < 0.001) more than CG. Combining conventional variables used to describe motion in individuals with SSP, such as minimum and maximum values, range of motion, and results provided by SPM can furnish a detailed description of the compensations and limitations of the patient, enabling a better understanding of the function of the scapular girdle as well as improvements in the evaluation process and clinical decision making.

Brazilian version of headache management self-efficacy scale

Background Headache-management self-efficacy has been associated with pain severity and headache-related disability. Objective The aim of this study was to test the cross-cultural adaptation and psychometric properties of a Brazilian version of the Headache Management Self-Efficacy Scale (HMSE) in a sample of patients coming from three tertiary headache centers in Brazil. Methods 137 migraine outpatients completed the Headache Management Self-Efficacy Scale (HMSE) and measures of psychopathological symptoms, pain catastrophizing, depression, anxiety, quality of life and headache-related disability. Results HMSE-10 showed good reliability (α = 0.84) and adequate corrected item-total correlation, ranging from 0.46 to 0.64. HMSE-10 was positively correlated with 6 of 8 domains of overall health status and negatively correlated with psychopathological symptoms, depression, anxiety, pain catastrophizing, headache-related disability, headache frequency and headache intensity. The difference between the means of the episodic and chronic headache patients had a magnitude of moderate effect in all the study measures, being headache-related disability the largest one found (d = 0.68). Along with headache intensity and depression, Efficacy Scale beliefs were predictors of headache-related disability. Conclusions The Brazilian short version of Headache Management Self-Efficacy Scale (HMSE-10) was revealed as a valid and reliable measure of headache-specific Efficacy Scale beliefs.