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De la Corte-Rodriguez H, Roman-Belmonte JM, Resino-Luis C, Madrid-Gonzalez J, Rodriguez-Merchan EC. The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review. Healthcare (Basel) 2024; 12:242. [PMID: 38255129 PMCID: PMC10815384 DOI: 10.3390/healthcare12020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.
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Affiliation(s)
- Hortensia De la Corte-Rodriguez
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital, 28046 Madrid, Spain;
- IdiPAZ Institute for Health Research, 28046 Madrid, Spain
| | - Juan M. Roman-Belmonte
- Department of Physical Medicine and Rehabilitation, Cruz Roja San José y Santa Adela University Hospital, 28003 Madrid, Spain; (J.M.R.-B.); (C.R.-L.)
- Medical School, Universidad Alfonso X El Sabio (UAX), 28691 Madrid, Spain
| | - Cristina Resino-Luis
- Department of Physical Medicine and Rehabilitation, Cruz Roja San José y Santa Adela University Hospital, 28003 Madrid, Spain; (J.M.R.-B.); (C.R.-L.)
| | - Jorge Madrid-Gonzalez
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital, 28046 Madrid, Spain;
| | - Emerito Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, 28046 Madrid, Spain;
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research—IdiPAZ (La Paz University Hospital—Autonomous University of Madrid), 28046 Madrid, Spain
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Araújo Almeida L, Bilterys T, Van Looveren E, Mairesse O, Cagnie B, Meeus M, Moens M, Goubert D, Munneke W, Danneels L, Ickmans K, Rezende Camargo P, Nijs J, Malfliet A, De Baets L. Do Patients with Chronic Spinal Pain and Comorbid Insomnia Have More Features of Central Sensitization? A Case-Control Study. Healthcare (Basel) 2023; 11:3152. [PMID: 38132043 PMCID: PMC10742599 DOI: 10.3390/healthcare11243152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/26/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Chronic spinal pain (CSP) is a major public health problem worldwide, frequently related to sleep problems. Central sensitization (CS) may worsen the clinical picture of CSP patients with insomnia. The aim of this study was to compare self-reported and objectively measured clinical outcomes between insomniac CSP patients with comorbid insomnia with and without symptoms of CS. METHODS A case-control study on baseline self-reported sleep, functioning, and psychological distress through online questionnaires. Objective sleep and physical activity parameters and pressure pain thresholds (PPTs) were assessed through polysomnography, actigraphy, and digital algometry, respectively. Independent sample t-test and Mann-Whitney U tests were used to examine possible differences in the outcome measures between the groups. RESULTS Data from 123 participants were included and revealed no statistically significant group for objective sleep and physical activity parameters. The CS group, however, presented with worse self-reported sleep (quality sleep, insomnia severity, and dysfunctional beliefs about sleep), increased mental and physical fatigue, and higher psychological distress (anxiety and depressive symptoms), and reported lower PPTs. CONCLUSIONS symptoms of CS may influence perceived sleep and affect functional health and well-being perception but do not seem to affect objective sleep and physical activity.
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Affiliation(s)
- Lucas Araújo Almeida
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos 13565-905, SP, Brazil;
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA
| | - Thomas Bilterys
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
- Institute of Advanced Study, University of Warwick, Coventry CV4 7AL, UK
| | - Eveline Van Looveren
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
| | - Olivier Mairesse
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
| | - Mira Meeus
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Maarten Moens
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Neurosurgery and Radiology, University Hospital Brussels, 1090 Brussels, Belgium
- Stimulus Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Center of Neurosciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Dorien Goubert
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
| | - Wouter Munneke
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Department of Sport and Rehabilitation Sciences, University of Liège, 4000 Liege, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans—Building B3, De Pintelaan 185, 9000 Ghent, Belgium; (B.C.); (L.D.)
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Movement & Nutrition for Health & Performance Research Group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos 13565-905, SP, Brazil;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 41390 Göterbog, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103—Building F, 1090 Brussel, Belgium; (L.A.A.); (T.B.); (E.V.L.); (W.M.); (K.I.); (J.N.); (A.M.)
- Pain in Motion International Research Group, 1090 Brussel, Belgium; (M.M.); (M.M.); (D.G.)
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de Zoete RMJ. Exercise Therapy for Chronic Neck Pain: Tailoring Person-Centred Approaches within Contemporary Management. J Clin Med 2023; 12:7108. [PMID: 38002720 PMCID: PMC10671970 DOI: 10.3390/jcm12227108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Exercise therapy is considered the best evidence-based approach for managing chronic neck pain. However, the implementation of exercise therapy presents several challenges. Systematic reviews indicate that it has modest effectiveness, while clinical practice guidelines offer limited guidance on the exercise parameters required to optimise clinical outcomes. Moreover, recommendations often fail to differentiate between different types of neck pain. This article addresses the challenges associated with the prescription of exercise for chronic neck pain and provides recommendations for exercise therapy specific to chronic nociceptive, neuropathic, and nociplastic neck pain. The goal of this article is to facilitate the implementation of high-value evidence-based exercise therapy for these distinct types of chronic neck pain with the aim to improve its outcomes and to reduce the related individual and societal burdens.
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Affiliation(s)
- Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA 5005, Australia
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Zi‐Han X, Nan A, Rui CJ, Yong‐Long Y. Modulation of pain perceptions following treadmill running with different intensities in females. Physiol Rep 2023; 11:e15831. [PMID: 37749050 PMCID: PMC10519819 DOI: 10.14814/phy2.15831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
We aimed to compare the effects of three intensities of treadmill running on exercise-induced hypoalgesia (EIH) in healthy individuals. We anticipated that the primary and secondary changes in pain perception and modulation may differ between running intensities. Sixty-six women were randomly assigned to one of three treadmill running intensities for 35 min: 40% reserved heart rate (HRR), 55% HRR, or 70% HRR. The effects of EIH were assessed using pressure pain thresholds (PPT) and tolerance thresholds (PPTol). We measured conditional pain modulation (CPM). Compared with baseline, PPT and PPTol significantly increased in all groups during running and at the 5-10-min follow-up. The PPT and PPTol changes in the moderate- and low-intensity groups were significantly higher than those in the high-intensity group during running and 24 h after running, while the CPM responses of the high-intensity group were significantly reduced at the 24-h follow-up. Moderate- and low-intensity running may elicit significant primary and secondary (persisting over 24 h) EIH effects and increase CPM responses in females. However, high-intensity running induced only limited analgesic effects and reduced CPM responses, which may be attributed to the activation of endogenous pain modulation.
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Affiliation(s)
- Xu Zi‐Han
- School of Sport Medicine and RehabilitationBeijing Sport UniversityBeijingChina
| | - An Nan
- School of Sport Medicine and RehabilitationBeijing Sport UniversityBeijingChina
| | - Chang Jeremy Rui
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong KongChina
| | - Yang Yong‐Long
- School of Sport Medicine and RehabilitationBeijing Sport UniversityBeijingChina
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de Zoete RMJ, McMahon KL, Coombes JS, Sterling M. The effects of physical exercise on structural, functional, and biochemical brain characteristics in individuals with chronic whiplash-associated disorder: A pilot randomized clinical trial. Pain Pract 2023; 23:759-775. [PMID: 37157897 DOI: 10.1111/papr.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/01/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Exercise for people with whiplash associated disorder (WAD) induces hypoalgesic effects in some, but hyperalgesic effects in others. We investigated the exercise-induced neurobiological effects of aerobic and strengthening exercise in individuals with chronic WAD. METHODS Sixteen participants (8 WAD, 8 pain-free [CON]) were randomised to either aerobic or strengthening exercise. MRI for brain morphometry, functional MRI for brain connectivity, and magnetic resonance spectroscopy for brain biochemistry, were used at baseline and after the 8-week intervention. RESULTS There were no differences in brain changes between exercise groups in either the WAD or CON group, therefore aerobic and strengthening data were combined to optimise sample size. After the exercise intervention, the CON group demonstrated increased cortical thickness (left parahippocampus: mean difference = 0.04, 95% CI = 0.07-0.00, p = 0.032; and left lateral orbital frontal cortex: mean difference = 0.03, 95% CI = 0.00-0.06, p = 0.048). The WAD group demonstrated an increase in prefrontal cortex (right medial orbital frontal) volume (mean difference = 95.57, 95% CI = 2.30-192.84, p = 0.046). Functional changes from baseline to follow-up between the default mode network and the insula, cingulate cortex, temporal lobe, and somatosensory and motor cortices, were found in the CON group, but not in the WAD group. There were no changes post-exercise in brain biochemistry. CONCLUSION Aerobic and strengthening exercises did not exert differential effects on brain characteristics, however differences in structural and functional changes were found between WAD and CON groups. This suggests that an altered central pain modulatory response may be responsible for differential effects of exercise in individuals with chronic WAD.
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Affiliation(s)
- Rutger M J de Zoete
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Katie L McMahon
- Herston Imaging Research Facility, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
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de Zoete RMJ, Berryman CF, Nijs J, Walls A, Jenkinson M. Differential Structural Brain Changes Between Responders and Nonresponders After Physical Exercise Therapy for Chronic Nonspecific Neck Pain. Clin J Pain 2023; 39:270-277. [PMID: 37220328 DOI: 10.1097/ajp.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/23/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Physical exercise therapy is effective for some people with chronic nonspecific neck pain but not for others. Differences in exercise-induced pain-modulatory responses are likely driven by brain changes. We investigated structural brain differences at baseline and changes after an exercise intervention. The primary aim was to investigate changes in structural brain characteristics after physical exercise therapy for people with chronic nonspecific neck pain. The secondary aims were to investigate (1) baseline differences in structural brain characteristics between responders and nonresponders to exercise therapy, and (2) differential brain changes after exercise therapy between responders and nonresponders. MATERIALS AND METHODS This was a prospective longitudinal cohort study. Twenty-four participants (18 females, mean age 39.7 y) with chronic nonspecific neck pain were included. Responders were selected as those with ≥20% improvement in Neck Disability Index. Structural magnetic resonance imaging was obtained before and after an 8-week physical exercise intervention delivered by a physiotherapist. Freesurfer cluster-wise analyses were performed and supplemented with an analysis of pain-specific brain regions of interest. RESULTS Various changes in grey matter volume and thickness were found after the intervention, for example, frontal cortex volume decreased (cluster-weighted P value = 0.0002, 95% CI: 0.0000-0.0004). We found numerous differences between responders and nonresponders, most notably, after the exercise intervention bilateral insular volume decreased in responders, but increased in nonresponders (cluster-weighted P value ≤ 0.0002). DISCUSSION The brain changes found in this study may underpin clinically observed differential effects between responders and nonresponders to exercise therapy for people with chronic neck pain. Identification of these changes is an important step toward personalized treatment approaches.
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Affiliation(s)
| | - Carolyn F Berryman
- Brain Stimulation, Imaging and Cognition Group, School of Medicine
- IIMPACT in Health, The University of South Australia
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel
- Chronic pain rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Angela Walls
- Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute
| | - Mark Jenkinson
- Australian Institute for Machine Learning (AIML), School of Computer Science, University of Adelaide
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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Chen KK, Hutchinson MR, Rolan P, de Zoete RMJ. Effect of exercise on chronic neck pain and central sensitization: A protocol for a randomized crossover trial. Exp Physiol 2023; 108:672-682. [PMID: 36989062 PMCID: PMC10988480 DOI: 10.1113/ep091065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
Exercise-induced hypoalgesia (EIH) has been found to vary widely within individuals with chronic neck pain (NP). Research has suggested that the presence of central sensitization within a subgroup of individuals with chronic NP might be a mediating factor to explain the relationship between exercise and improvements in patient-reported outcomes. Furthermore, recent work has found that lactate might play a role in the development and maintenance of chronic pain. The immediate effect of a single bout of physical exercise on central sensitization in individuals with chronic NP and the relationship between lactate concentration, central sensitization and pain sensitivity are to be investigated. Eighty adult participants with chronic NP will be recruited for this randomized crossover trial. Outcome measures, including temporal summation, conditioned pain modulation, EIH and lactate concentration, will be assessed before and after low- and high-intensity bicycling exercise. The outcomes of this study will provide new insights into the mechanistic effect of exercise on central sensitization in individuals with chronic NP and have the potential to add important information to the current exercise prescription guidelines for individuals with chronic NP. This study has been approved by the Human Research Ethics Committee, The University of Adelaide (H-2022-082) and registered in the Australian New Zealand Clinical Trials Registry (ACTRN12622000642785p).
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Affiliation(s)
- Kexun Kenneth Chen
- School of Allied Health Science and Practice, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Mark Rowland Hutchinson
- Adelaide Medical School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- Australian Research Council Centre of Excellence for Nanoscale BiophotonicsThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Paul Rolan
- Adelaide Medical School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Rutger Marinus Johannes de Zoete
- School of Allied Health Science and Practice, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
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Chaikla R, Sremakaew M, Kothan S, Saekho S, Wantanajittikul K, Uthaikhup S. Effects of manual therapy combined with therapeutic exercise versus routine physical therapy on brain biomarkers in patients with chronic non-specific neck pain in Thailand: a study protocol for a single-blinded randomised controlled trial. BMJ Open 2023; 13:e072624. [PMID: 37094892 PMCID: PMC10151953 DOI: 10.1136/bmjopen-2023-072624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Structural brain alterations in pain-related areas have been demonstrated in patients with non-specific neck pain. While manual therapy combined with therapeutic exercise is an effective management for neck pain, its underlying mechanisms are poorly understood. The primary objective of this trial is to investigate the effects of manual therapy combined with therapeutic exercise on grey matter volume and thickness in patients with chronic non-specific neck pain. The secondary objectives are to assess changes in white matter integrity, neurochemical biomarkers, clinical features of neck pain, cervical range of motion and cervical muscle strength. METHODS AND ANALYSIS This study is a single-blinded, randomised controlled trial. Fifty-two participants with chronic non-specific neck pain will be recruited into the study. Participants will be randomly allocated to either an intervention or control group (1:1 ratio). Participants in the intervention group will receive manual therapy combined with therapeutic exercise for 10 weeks (two visits per week). The control group will receive routine physical therapy. Primary outcomes are whole-brain and regional grey matter volume and thickness. Secondary outcomes are white matter integrity (fractional anisotropy and mean diffusivity), neurochemical biomarkers (N-acetylaspartate, creatine, glutamate/glutamine, myoinositol and choline), clinical features (neck pain intensity, duration, neck disability and psychological symptoms), cervical range of motion and cervical muscle strength. All outcome measures will be taken at baseline and postintervention. ETHICS AND DISSEMINATION Ethical approval of this study has been granted by Faculty of Associated Medical Science, Chiang Mai University. The results of this trial will be disseminated through a peer-reviewed publication. TRIAL REGISTRATION NUMBER NCT05568394.
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Affiliation(s)
- Rungtawan Chaikla
- Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Munlika Sremakaew
- Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Suchart Kothan
- Department of Radiologic Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Suwit Saekho
- Department of Radiologic Technology, Chiang Mai University, Chiang Mai, Thailand
| | | | - S Uthaikhup
- Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
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The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:91-105. [PMID: 36650605 DOI: 10.1097/ajp.0000000000001089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/22/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To summarize and critically appraise the body of evidence on conservative management of complex regional pain syndrome (CRPS), we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We conducted a literature search from inception to November 2021 in the following databases: Embase, Medline, CINAHL, Google Scholar, PEDRO, and Psychinfo. Two independent reviewers conducted risk of bias and quality assessment. Qualitative synthesis and meta-analysis were the methods for summarizing the findings of the RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the overall quality and certainty of the evidence on each treatment outcome. RESULT Through a database search, 751 records were found, and 33 RCTs were eligible for inclusion. Studies were published between 1995 and 2021. The overall risk of bias for 2 studies was low, 8 studies were unclear, and 23 studies were high.Low-quality evidence suggests that mirror therapy (as an addition to conventional stroke rehabilitation interventions) and graded motor imagery program (compared with routine rehabilitation interventions) may result in a large improvement in pain and disability up to 6-month follow-up in poststroke CRPS-1 patients. Low-quality evidence suggests that pain exposure therapy and aerobic exercises as an additive treatment to physical therapy interventions may result in a large improvement in pain up to a 6-month follow-up. The evidence is very uncertain about the effect of all other targeted interventions over conventional physical therapy or sham treatments on pain and disability. DISCUSSION There is an ongoing need for high-quality studies to inform conservative management choices in CRPS.
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Palmer KL, Shivgulam ME, Champod AS, Wilson BC, O'Brien MW, Bray NW. Exercise training augments brain function and reduces pain perception in adults with chronic pain: A systematic review of intervention studies. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 13:100129. [PMID: 37206154 PMCID: PMC10189552 DOI: 10.1016/j.ynpai.2023.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/21/2023]
Abstract
Introduction Chronic pain (CP) is a leading cause of disability worldwide. Pain may be measured using subjective questionnaires, but understanding the underlying physiology, such as brain function, could improve prognosis. Further, there has been a shift towards cost-effective lifestyle modification for the management of CP. Methods We conducted a systematic review (Registration: #CRD42022331870) using articles retrieved from four databases (Pubmed, EMBASE, AMED, and CINAHL) to assess the effect of exercise on brain function and pain perception/quality of life in adults with CP. Results Our search yielded 1879 articles; after exclusion, ten were included in the final review. Study participants were diagnosed with either osteoarthritis or fibromyalgia. However, two studies included "fibromyalgia and low back pain" or "fibromyalgia, back, and complex regional pain." Exercise interventions that were 12 weeks or longer (n = 8/10) altered brain function and improved pain and/or quality of life outcomes. The cortico-limbic pathway, default-mode network, and dorsolateral prefrontal cortex were key regions that experienced alterations post-intervention. All studies that reported an improvement in brain function also demonstrated an improvement in pain perception and/or quality of life. Discussion Our review suggests that alterations in brain function, notably the cortico-limbic, default-mode and dorsolateral prefrontal cortex, may be responsible for the downstream improvements in the subjective experience of CP. Through appropriate programming (i.e., length of intervention), exercise may represent a viable option to manage CP via its positive influence on brain health.
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Affiliation(s)
- Kierstyn L. Palmer
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, V1V 1V7, Canada
| | - Madeline E. Shivgulam
- Division of Kinesiology, Dalhousie University, Halifax, Nova Scotia, B3H 3J5, Canada
| | - Anne Sophie Champod
- Dept. of Psychology, Acadia University, Wolfville, Nova Scotia, B4P 2R6, Canada
| | - Brian C. Wilson
- Department of Biology, Acadia University, Wolfville, Nova Scotia, B4P 2R6, Canada
| | - Myles W. O'Brien
- School of Physiotherapy (Faculty of Health) and Department of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H 3J5, Canada
| | - Nick W. Bray
- Cumming School of Medicine, Dept. of Physiology & Pharmacology, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
- Corresponding author at: Lab of Human Cerebrovascular Physiology, MR Neuroimaging Lab, Heritage Medical Research Building, Room HMRB 128, Calgary, AB N6C 0A7, Canada.
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Arroyo-Fernández R, Avendaño-Coy J, Velasco-Velasco R, Palomo-Carrión R, Bravo-Esteban E, Ferri-Morales A. Effectiveness of transcranial direct current stimulation combined with exercising in people with fibromyalgia: a randomiSed sham-controlled clinical trial. Arch Phys Med Rehabil 2022; 103:1524-1532. [PMID: 35331718 DOI: 10.1016/j.apmr.2022.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of transcranial direct current stimulation (tDCS) combined with exercising in people with fibromyalgia. DESIGN Randomised, triple-blind, sham-controlled, clinical trial. SETTING Primary healthcare center. PARTICIPANTS 120 volunteer subjects between 18 and 65 years old and diagnosed with fibromyalgia. Four subjects dropped out of the study for causes unrelated to the intervention. INTERVENTION Subjects were randomised into three groups (active tDCS+exercising, sham tDCS+exercising, and no-intervention control). The intervention was delivered in five sessions over two weeks. MAIN OUTCOME MEASURES Pain intensity and referred pain area following suprathreshold pressure stimulation. RESULTS Pain intensity further decreased in the active tDCS group versus control (mean -14.43, CI95% -25.27 to -3.58) at post-intervention, unlike the sham tDCS group. Both tDCS groups did not achieve greater reductions in referred pain versus control. In the active tDCS group, health status (mean -14.80, CI95% -23.10 to -6.50) and pain catastrophising (mean -6.68, CI95% -11.62 to -1.73) improved at post-intervention, and so did health status (mean -8.81, CI95% -17.11 to -0.51), pain catastrophising (mean -7.00, CI95% -12.13 to -1.87), and depression (mean -3.52, CI95% -6.86 to -0.19) after one month. In the sham tDCS group, improvements were recorded in health status (mean -13.21, CI95% -21.52 to -4.91) and depression (mean -3.35, CI95% -6.35 to -0.35) at post-intervention and in health status (mean -8.77, CI95% -17.06 to -0.47), pain catastrophising (mean -5.68, CI95% -10.80 to -0.55), and depression (mean -3.98, CI95% -7.31 to -0.64) after one month. No intergroup differences were observed between active and sham tDCS. CONCLUSIONS Active and sham tDCS improved health status, pain catastrophising, and depression versus control, but pain intensity decreased only in the active tDCS group.
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Affiliation(s)
- Rubén Arroyo-Fernández
- Physiotherapy unit, Nª Sª del Prado Hospital, Talavera de la Reina, Spain.; Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain.; Research Group on Water and Health (GIAS), University of Castilla-La Mancha, Toledo, Spain
| | - Juan Avendaño-Coy
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain.; Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo, Spain
| | | | - Rocío Palomo-Carrión
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain.; Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo, Spain
| | - Elisabeth Bravo-Esteban
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain.; Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo, Spain
| | - Asunción Ferri-Morales
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain.; Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
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de Zoete RMJ, Stanwell P, Weber KA, Snodgrass SJ. Differences in Structural Brain Characteristics Between Individuals with Chronic Nonspecific Neck Pain and Asymptomatic Controls: A Case–Control Study. J Pain Res 2022; 15:521-531. [PMID: 35210851 PMCID: PMC8863323 DOI: 10.2147/jpr.s345365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Neck pain is a prevalent and costly problem, but its underlying mechanisms are poorly understood. Neuroimaging studies show alterations in brain morphometry in chronic musculoskeletal pain, but reports on neck pain are scarce. Objective This study investigates (1) differences in brain morphometry between individuals with chronic nonspecific neck pain and asymptomatic individuals and (2) associations between brain morphometry and patient-reported outcomes. Methods Sixty-three participants (33 pain, 11 female, mean [SD] age 35 [10] years; 30 control, 12 female, age 35 [11] years) underwent magnetic resonance imaging. Brain regions of interest (ROIs) were determined a priori, outcomes included cortical thickness and volume. Between-group differences were determined using cluster-wise correction for multiple comparisons and analyses of pain-related ROIs. Results Between-group differences in volume were identified in the precentral, frontal, occipital, parietal, temporal, and paracentral cortices. ROI analyses showed that parahippocampal cortical thickness was larger in the neck pain group (p=0.015, 95% CI: −0.27 to −0.03). Moderate to strong associations between volume and thickness of the cingulate cortex, prefrontal cortex, and temporal lobe and neck pain duration, pain intensity, and neck disability were identified (p-values 0.006 to 0.048). Conclusion Alterations in brain morphology that are associated with clinical characteristics inform the mechanisms underlying chronic nonspecific neck pain and may guide the development of more effective treatment approaches.
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Affiliation(s)
- Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Correspondence: Rutger MJ de Zoete, School of Allied Health Science and Practice, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia, Email
| | - Peter Stanwell
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - Suzanne J Snodgrass
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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Rodriguez-Merchan EC, De la Corte-Rodriguez H. Pain management in people with hemophilia in childhood and young adulthood. Expert Rev Hematol 2021; 14:525-535. [PMID: 34042011 DOI: 10.1080/17474086.2021.1935852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: People with hemophilia (PWH) commonly experience acute and chronic musculoskeletal pain during childhood and young adulthood, but their treatment is often inadequate.Areas covered: From 1 September 2020 to 15 April 2021, authors performed a literature search in PubMed and the Cochrane Library using 'hemophilia AND pain' as keywords. Authors found 1082 articles, 51 of which were chosen because we considered them to be intimately connected with the topic of this report. Multimodal pain treatment, including multimodal analgesia, physical and rehabilitation medicine (PRM), and psychological therapies (imagery or relaxation, hypnosis), is currently the most recommended treatment for PWH. In acute hemarthrosis, in addition to hematologic treatment and joint aspiration, paracetamol/acetaminophen should be prescribed if the pain is mild, metamizole if the pain is moderate, and soft opioids (codeine or tramadol) if the pain is severe. In cases of chronic musculoskeletal pain due to hemophilic arthropathy, paracetamol/acetaminophen, COX-2 inhibitors, PRM, intra-articular injections of some drugs (corticosteroids, hyaluronic acid, platelet-rich plasma, mesenchymal stem cells), radiosynovectomy and behavioral therapies are advised.Expert opinion: Management of musculoskeletal pain in children and young adults with hemophilia should employ multimodal pain treatment (multimodal analgesia, PRM, and psychological strategies).
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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