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Zingg S, de Graaf M, Hilfiker R. Empowering patients with persistent pain: The potential of cognitive functional therapy in interdisciplinary care: A single-case experimental design. J Bodyw Mov Ther 2024; 38:211-253. [PMID: 38763565 DOI: 10.1016/j.jbmt.2023.11.063] [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: 07/07/2022] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION AND PURPOSE Persistent musculoskeletal pain (PMP) is multifactorial and causes both societal and financial burdens. Integration of multifactorial management in patients with PMP remains challenging. A single-case experimental design was performed on three patients suffering from high impact PMP (lumbar spine, shoulder and knee) to i) assess the potential for Cognitive Functional Therapy (CFT) in interdisciplinary care, ii) describe in detail the clinical journey patients experienced during the intervention, and iii) evaluate the changes and associations in relation to the outcome measures of pain, disability, maladaptive movement behavior, subjective overall improvement, health related quality of life and work status. These were monitored over one year, at the end of each of the six intervention modules. RESULTS After introducing the intervention systematic changes were seen, with medium to large changes (Non-overlap of All Pairs 0.67-1) for all outcome measures. Associations between changes of the outcome measures were large (r ≥ 0.50) and changes occurred concurrently. Minimally clinically important difference thresholds were exceeded for all outcome measures and two patients achieved relevant improvements related to work reintegration. DISCUSSION The positive results of this study are comparable with recent CFT studies. However, the difference regarding the number of sessions and duration of the intervention is evident. The length of the intervention in this study seemed to enable continuous significant improvements up until 12 months post onset and follow-up. CONCLUSION CFT in interdisciplinary care was effective for all measures. The detailed descriptions of the clinical processes aim to improve clinical care.
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Affiliation(s)
- Simone Zingg
- School of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland.
| | | | - Roger Hilfiker
- Research and Independent Studies in Private Physiotherapy (RISE), Valais, Glis, Switzerland
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Lang-Illievich K, Lang J, Rumpold-Seitlinger G, Dorn C, Brenna CTA, Klivinyi C, Bornemann-Cimenti H. The Dose-Response Relationship between Opioid Agonist Therapy and Alterations in Pain Pathways in Patients with Opioid Use Disorders: A Cross-Sectional Study. CNS Drugs 2024; 38:281-290. [PMID: 38421579 PMCID: PMC10980620 DOI: 10.1007/s40263-024-01069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The administration of opioids can be followed by enduring neuroplastic changes in the peripheral and central nervous systems. This remodeling can lead to opioid-induced hyperalgesia, causing an increased sensitivity to painful stimuli. The description of opioid-induced changes in the somatosensory system has seldom been described in the setting of opioid agonist therapy in the treatment of opioid use disorders, and the few existing reports provide no guidance with respect to the effect of varied doses or substances. OBJECTIVE The aim of the present study was to assess alterations of pain pathways among patients receiving opioid agonist therapy and to elucidate the dose-response relationship. METHODS This study was planned as cross-sectional in an outpatient clinic in Graz, Austria. Patients receiving opioid agonist therapy for opioid use disorders (including methadone, levomethadone, buprenorphine, and extended-release morphine) were asked to fill out a questionnaire, including the central sensitization inventory. A battery of somatosensory system assessments was then performed. RESULTS A total of 120 patients participated (85 men/35 women). The mean oral morphine milligram equivalent (MME) was 694 ± 249 mg/day. Our study found significant alterations in pain perception, conditioned pain modulation, and wind-up. We demonstrated a moderate dose-response relationship between high-dose opioids and markers of central sensitization. CONCLUSION The present trial demonstrates the clear effects of opioid agonist therapy on the somatosensory system. Both central sensitization and descending pain modulation are negatively affected by high doses of opioids and our data elucidate a moderate dose-response relationship for these phenomena.
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Affiliation(s)
- Kordula Lang-Illievich
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036, Graz, Austria
- Department of Anesthesia and Intensive Care Medicine, Klinik Güssing, Güssing, Austria
| | - Johanna Lang
- Comenius University Bratislava, Bratislava, Slovakia
| | - Gudrun Rumpold-Seitlinger
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036, Graz, Austria
| | - Christian Dorn
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036, Graz, Austria
| | - Connor T A Brenna
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Christoph Klivinyi
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036, Graz, Austria
| | - Helmar Bornemann-Cimenti
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036, Graz, Austria.
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Fuentes C, Castañón S, Roldán L. Differences between the Perilaryngeal Pressure Pain Thresholds in Asymptomatic Women, Women With Bruxism, and Women With Odynophonia. J Voice 2023:S0892-1997(23)00219-9. [PMID: 37661520 DOI: 10.1016/j.jvoice.2023.07.011] [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: 05/28/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE This study was aimed at comparing perilaryngeal pressure pain thresholds (PPT) among asymptomatic women, women with bruxism, and women with odynophonia. DESIGN Observational cross-sectional study. METHODS Eighty-four women whose age mean was 23.75 (SD, 3.02) years were grouped according to inclusion and exclusion criteria into a group of asymptomatic women (G1), another group of women with bruxism (G2), and another of women with odynophonia (G3). Palpation was used to identify regions of interest for this study, and an analog algometer was used to evaluate perilaryngeal PPT in the previously localized regions. Each PPT evaluation was done twice. RESULTS G1 PPT mean were between 1.35 (SD, 0.20) and 2.29 (SD, 0.28) kg/cm2, G2 PPT mean were found between 0.85 (SD, 0.12) and 1.78 (SD, 0.23) kg/cm2, and G3 PPT mean were located between 0.71 (SD, 0.11) and 1.45 (SD, 0.19) kg/cm2. Differences were observed between PPT in the three groups evaluated (P < 0.05). The intra-evaluator agreement between the evaluations performed fluctuated between 60.71% (κ = 0.51) and 92.86% (κ = 0.91). CONCLUSIONS There are significant differences between the perilaryngeal PPT of asymptomatic women, women with bruxism, and women with odynophonia. Asymptomatic women had the highest PPT, while odynophonia sufferers had the lowest.
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Affiliation(s)
- Christopher Fuentes
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Región Metropolitana, Chile.
| | - Sebastián Castañón
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Región Metropolitana, Chile
| | - Lylia Roldán
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Región Metropolitana, Chile
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Patel N, B Urolagin S, Haq MA, Patel C, Bhatt R, Girdhar G, Sinha S, Haque M, Kumar S. Anesthetic Effect of 2% Amitriptyline Versus 2% Lidocaine: A Comparative Evaluation. Cureus 2023; 15:e43405. [PMID: 37581201 PMCID: PMC10423460 DOI: 10.7759/cureus.43405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 08/16/2023] Open
Abstract
Introduction A common dental problem is the fear of pain during needle prick for giving local anesthesia (LA). The needle prick pain during dental procedures often varies with sex and age. Perception of pain depends on various factors, which can be psychological and biological. This perception of pain may change the behavior of patients toward dental treatments. Traditionally, lidocaine gel formulation was utilized before the parenteral dosage form. The lidocaine gel formulation is considered the drug of choice for LA in dental surgery. Currently, amitriptyline has been utilized in dental practice because of its beneficial pharmacology. Hence, the present study has been undertaken to compare the anesthetic ability of amitriptyline as an intraoral topical anesthetic agent with lidocaine gel. Methods This study was a comparative clinical study between two medications' anesthetic properties. This study included 120 patients indicated for bilateral orthodontics (the subdivision of dentistry that emphasizes identifying necessary interventions for the malocclusion of teeth) procedures. All the subjects were divided into amitriptyline and lidocaine groups. Both anesthetic gels were applied at separate sites before the injection of LA. The time of the onset of anesthesia was noted and analyzed. Patients were selected on the basis of inclusion and exclusion criteria. Individuals aged 18 to 30 years who were systemically healthy and orthodontically indicated for bilateral premolar extraction were included in this study. Again, patients with a history of neurological disorders and allergies to amitriptyline and lidocaine were excluded from the current study. Results Significant differences emerged between groups at five and 10 minutes, with amitriptyline-induced partial numbness (36.7% and 6.7%). At 40 and 45 minutes, both groups showed varied partial and complete numbness, with amitriptyline leading to partial recovery (23.3% and 73.3% complete numbness, 23.3% partial recovery) and lidocaine resulting in partial recovery (81.7%). When comparing the visual analog scale (VAS) scores, both groups exhibited a similar simultaneous effect at 15 minutes. Nonetheless, amitriptyline displayed significantly lower scores at 25 and 35 minutes (p < 0.001) in comparison to lidocaine. Similar observations were made when controlling for pain intensity. Conclusion It was concluded that amitriptyline holds both anesthetic and analgesic properties. Nevertheless, this study was unable to generalize the study findings because of the small sample size and being a single-center study. However, the VAS scores of anesthetic and analgesic pharmacodynamics properties of amitriptyline were statistically significantly lower than lidocaine, particularly at 25 and 35 minutes. Additionally, amitriptyline-induced anesthetic and analgesic pharmacology, especially pharmacokinetics properties, depends on the location and pattern of pain.
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Affiliation(s)
- Nirav Patel
- Department of Oral and Maxillofacial Surgery, Goenka Research Institute of Dental Science, Gandhinagar, IND
| | - Sarvesh B Urolagin
- Department of Oral and Maxillofacial Surgery, Subbaiah Institute of Dental Sciences, Shimoga, IND
| | - Md Ahsanul Haq
- Department of Biostatistics, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BGD
| | - Chhaya Patel
- Department of Pedodontics and Preventive Dentistry, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Gaurav Girdhar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, IND
| | - Susmita Sinha
- Department of Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Mainul Haque
- Karnavati Scientific Research Center, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
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War experiences and relationship problems predict pain sensitivity cross-sectionally among patients with chronic primary pain. J Psychosom Res 2023; 168:111209. [PMID: 36898316 DOI: 10.1016/j.jpsychores.2023.111209] [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] [Received: 10/26/2022] [Revised: 02/15/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Most patients suffering from chronic pain are more susceptible to pain and pressure due to higher pain sensitivity. Since psychosocial factors play a central role in developing and maintaining chronic pain, investigating associations between pain sensitivity and psychosocial stressors promises to advance the biopsychosocial understanding of chronic pain. OBJECTIVES We aimed to replicate Studer et al.'s (2016) findings about associations of psychosocial stressors with pain sensitivity in a new sample of patients with chronic primary pain (ICD-11, MG30.0). METHODS A pain provocation test was used on both middle fingers and earlobes to assess pain sensitivity among 460 inpatients with chronic primary pain. Potentially life-threatening accidents, war experiences, relationship problems, certified inability to work, and adverse childhood experiences were assessed as potential psychosocial stressors. Structural equation modeling was used to investigate associations between psychosocial stressors and pain sensitivity. RESULTS We partially replicated Studer et al.'s findings. Similar to the original study, patients with chronic primary pain showed enhanced pain sensitivity values. Within the investigated group, war experiences (β = 0.160, p < .001) and relationship problems (β = 0.096, p = .014) were associated with higher pain sensitivity. In addition, the control variables of age, sex, and pain intensity also showed a predictive value for higher pain sensitivity. Unlike Studer et al., we could not identify a certified inability to work as a predictor of higher pain sensitivity. CONCLUSIONS This study showed that beyond age, sex, and pain intensity, the psychosocial stressors of war experiences and relationship problems were associated with higher pain sensitivity.
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Miljković A, Pribisalić A, Gelemanović A, Lasić D, Hayward C, Polašek O, Kolčić I. The association of dispositional optimism and handedness with pressure pain: A cross-sectional study in the general population. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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da Silva W, Machado ÁS, Lemos AL, de Andrade CF, Priego-Quesada JI, Carpes FP. Relationship between exercise-induced muscle soreness, pain thresholds, and skin temperature in men and women. J Therm Biol 2021; 100:103051. [PMID: 34503798 DOI: 10.1016/j.jtherbio.2021.103051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022]
Abstract
Infrared thermography (IRT) has gained popularity in sports medicine for determining whether changes in skin temperature relate to pain and muscle damage. Such a relationship would support IRT as a non-invasive method to monitor these physiological responses. However, the literature remains controversial. Here, we determine the relationship between exercise-induced muscle soreness (DOMS), pain, and skin temperature in men and women before and after exercise. Twenty-two physically active adults (10 men and 12 women) completed a squat exercise protocol to induce muscle damage. Skin temperature, DOMS, and pressure pain threshold (PPT) were assessed in the quadriceps pre, post-exercise, and 48 h post-exercise. DOMS increased similarly in men and women post-exercise and 48 h post-exercise. PPT was lower in women compared to men. PPT decreased 48 h post-exercise for men but did not differ between the moments for women. Skin temperature responses were sex-dependent. Mean and maximum temperatures increased post-exercise for men, and maximum temperature reduced 48 h post-exercise. In women, the minimum temperature increased 48 h post-exercise. DOMS was not predicted by skin temperature but showed a direct association between pre and 48 h post-exercise variation of maximum skin temperature and PPT. We conclude that there is a sex-dependent effect in analyzing skin temperature changes in response to exercise, something that seems to not have been addressed in previous studies. To date, inferences are generally assumed as similar for both men and women, which we show may not be the case.
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Affiliation(s)
- Willian da Silva
- Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Álvaro Sosa Machado
- Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Andressa Lemes Lemos
- Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Camilla Ferreira de Andrade
- Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Jose Ignacio Priego-Quesada
- Research Group in Sport Biomechanics, Department of Physical Education and Sports and Biophysics and Medical Physics Group, Department of Physiology, University of Valencia, Valencia, Spain
| | - Felipe P Carpes
- Applied Neuromechanics Research Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, RS, Brazil.
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