Greater response interference to pain faces under low perceptual load conditions in adolescents with impairing pain: A role for poor attention control mechanisms in pain disability?

Chronic pain is common in young people.16 Some adolescents with pain experience significant interruptions to functioning.9,19,28 Yet, there are few interventions that effectively reduce pain-linked disability.8 Better understanding of factors influencing disability within adolescent chronic pain could inform treatment innovation.7 Information-processing accounts of chronic pain, which attribute fear and avoidance and disability to biases in early threat classification could provide this understanding.

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Endogenous pain modulation profiles among individuals with chronic pain: Relation to opioid use

It is well known that nociceptive signals can be modulated by central pain inhibitory and facilitatory processes 1,8,82. These pain-modulatory processes operate at various levels of the central nervous system and are assumed to play a determining role in the manifestations of chronic pain and in shaping inter-individual variability in the trajectory of many persistent pain conditions 6,25,51,83. Considerable studies have been conducted using quantitative sensory testing (QST) to assess pain inhibition and pain facilitation 9,19,71.

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Clostridium difficile associated disease

What you need to knowPatients usually present with diarrhoea, abdominal pain, leucocytosis, and a history of recent antibiotic useClinical manifestations usually occur on days 4 to 9 of antibiotic...

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Contextual influences in decoding pain expressions: effects of patient age, informational priming, and observer characteristics

We aimed to examine the effects of contextual factors (ie, observers' training background and priming texts) on decoding facial pain expressions of younger and older adults. A total of 165 participants (82 nursing students and 83 nonhealth professionals) were randomly assigned to one of 3 priming conditions: (1) information about the possibility of secondary gain (misuse); (2) information about the frequency and undertreatment of pain in the older adult (undertreatment); or (3) neutral information (control). Subsequently, participants viewed 8 videos of older adults and 8 videos of younger adults undergoing a discomforting physical therapy examination. Participants rated their perception of each patient's pain intensity, unpleasantness, and condition severity. They also rated their willingness to help, sympathy level, patient deservingness of financial compensation, and how negatively/positively they feel towards the patient (ie, valence). Results demonstrated that observers ascribed greater levels of pain and other indicators (eg, sympathy and help) to older compared with younger patients. An interaction between observer type and patient age demonstrated that nursing students endorsed higher ratings of younger adults' pain compared with other students. In addition, observers in the undertreatment priming condition reported more positive valence towards older patients. By contrast, priming observers with the misuse text attenuated their valence ratings towards younger patients. Finally, the undertreatment prime influenced observers' pain estimates indirectly through observers' valence towards patients. In summary, results add specificity to the theoretical formulations of pain by demonstrating the influence of patient and observer characteristics, as well as informational primes, on decoding pain expressions.

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Quantifying visual allodynia across migraine subtypes: the Leiden Visual Sensitivity Scale

Enhanced sensitivity to light (photophobia) and patterns is common in migraine and can be regarded as visual allodynia. We aimed to develop and validate a questionnaire to easily quantify sensitivity to light and patterns in large populations, and to assess and compare visual allodynia across different migraine subtypes and states. We developed the Leiden Visual Sensitivity Scale (L-VISS), a 9-item scale (score range 0-36 points), based on literature and patient interviews, and examined its construct validity. Furthermore, we assessed ictal and interictal visual sensitivity in episodic migraine with (n = 67) and without (n = 66) aura and chronic migraine with (n = 20) and without (n = 19) aura, and in healthy controls (n = 86). Differences between migraine subtypes and states were tested using a linear mixed model with 3 fixed factors (episodic/chronic, with/without aura, and ictal/interictal). Test–retest reliability and construct validity of L-VISS were good. Leiden Visual Sensitivity Scale scores correlated in the expected direction with light discomfort (Kendall's τ = −0.25) and pattern glare tests (τ = 0.35). Known-group comparisons confirmed its construct validity. Within migraine subtypes, L-VISS scores were higher in migraine with aura versus without aura and in chronic versus episodic migraine. The linear mixed model showed all factors affected the outcome (P < 0.001). The L-VISS is an easy-to-use scale to quantify and monitor the burden of bothersome visual sensitivity to light and patterns in large populations. There are remarkable ictal and interictal differences in visual allodynia across migraine subtypes, possibly reflecting dynamic differences in cortical excitability.

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Fulranumab as Adjunctive Therapy for Cancer-Related Pain: A Phase 2, Randomized, Double-Blind, Placebo-Controlled, Multicenter Study

Pain resulting directly or indirectly from the growth of malignant cells is one of the most common and distressing symptoms associated with cancer.62 Cancer-related pain occurs in approximately one-quarter of the patients at the time of diagnosis and early in the course of disease, in three-quarters of the patients with advanced disease, and in almost one-third of the patients on active therapy.10,15,62 It is estimated that almost one in two patients with cancer pain are sub-optimally treated.10

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Pharmacological modulation of endogenous opioid activity to attenuate neuropathic pain in rats

Endomorphins (EMs) are widely considered to be the endogenous ligands for the mu-opioid receptor (MOR), the predominant opioid receptor mediating antinociception. Central administration of EM1 (Tyr-Pro-Trp-Phe-NH2) and EM2 (Tyr-Pro-Phe-Phe-NH2) produce potent MOR-mediated antinociception.57,60,70 We previously reported that the magnitude of antinociception elicited by the spinal application of EM2, varies across the rat estrous cycle, minimal during diestrus but robust, comparable to that of male rats, during proestrus.

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No PhDs needed: how citizen science is transforming research

No PhDs needed: how citizen science is transforming research

No PhDs needed: how citizen science is transforming research, Published online: 23 October 2018; doi:10.1038/d41586-018-07106-5

Projects that recruit the public are getting more ambitious and diverse, but the field faces some growing pains.

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When Environment Meets Genetics: A Clinical Review On The Epigenetics Of Pain, Psychological Factors, And Physical Activity

Publication date: Available online 22 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Andrea Polli, Kelly Ickmans, Lode Godderis, Jo Nijs

Abstract

Epigenetic mechanisms represent a link between the environment and gene function. Recent evidence shows how early-life stress, inflammation, and physical activity can influence gene expression through epigenetic mechanisms. Epigenetic changes – such as DNA methylation and microRNA interference – can be measured in humans and might soon become important biological markers. Epigenetic marks can accompany clinical assessment to measure the effectiveness of various interventions, such as exercise therapy.

In addition, epigenetics is improving the understanding of important underlying mechanisms related to the central nervous system, the opioidergic system, and stress responses. Epigenetics is covering a gap in our explanatory abilities and should be implemented to broaden the field of rehabilitation sciences, promote a mechanism-based clinical reasoning, and develop new treatments.

In the present review, we focused on epigenetic mechanisms related to pain, psychological factors such as fear and anxiety, and physical activity, translating relevant findings from these three different – yet related – areas of cardinal importance for clinicians.

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Taking rejection to heart: Associations between blood pressure and sensitivity to social pain

Publication date: Available online 21 October 2018

Source: Biological Psychology

Author(s): Tristen K. Inagaki, J. Richard Jennings, Naomi I. Eisenberger, Peter J. Gianaros

Abstract

A reliable finding from the physical pain literature is that individuals with higher resting (i.e., tonic) blood pressure experience relatively less pain in response to nociceptive stimuli. Converging lines of evidence suggest that biological factors that influence the experience of physical pain may also relate to social pain. An open question, however, is whether higher blood pressure per se is a biological factor associated with lower sensitivity to social pain. This possible association was tested in three studies. Consistent with prior findings on physical pain, higher resting blood pressure was associated with lower self-reported sensitivity to social pain across individuals (Study 1 r = ­.303, Study 2 r = -.262, -.246), even after adjusting for confounding factors related to blood pressure (Study 3 r = -.222). Findings suggest a previously unknown biological correlate of sensitivity to social pain, providing further evidence for possible shared substrates for physical and social pain.

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[Comment] Steroid injection or wrist splint for first-time carpal tunnel syndrome?

Carpal tunnel syndrome is a common cause of hand pain, sensory disturbance, and weakness affecting daily activities and quality of life.1 It is a frequent reason for medical consultation and up to 40% of patients are managed exclusively in primary care.2 Treatment goals are to relieve symptoms, improve function, and prevent disease progression to nerve damage. The two treatments that constitute standard care for most patients with first-time carpal tunnel syndrome are night splinting and local steroid injections.

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Imagining My Painful Hand Is Not Mine: Self-distancing Relieves Experimental Acute Pain Induced by a Cold Pressor Task

Pain, whether emotional or physical, has broad adverse effects on well-being. Over the past decades, various psychological interventions, such as cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT), that focus on changing either cognitive content or cognitive processes have been developed to cope with pain. ACT is regarded as a ‘‘third-wave’’ cognitive-behavioral therapy to cope with pain and is distinguished by its primary focus on psychological flexibility (PF). PF is defined as the capacity to be directly, consciously, and fully in contact with the present moment without needless defense.

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Operant learning versus energy conservation activity pacing treatments in a sample of patients with fibromyalgia syndrome: A pilot randomized controlled trial

Fibromyalgia syndrome (FMS) is a clinical condition characterized by chronic widespread pain, fatigue, and non-refreshing sleep, and is frequently associated with cognitive impairment 13. FMS prevalence in the general adult population ranges between 2% and 6% 13. Exercise and cognitive behavioral therapy (CBT) are strongly recommended, in addition to pharmacologic therapy, as essential parts of its treatment 3,13. However, one of the challenges in assessing the effectiveness of CBT is that it involves various interventions 53.

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Predicting outcome after hand orthosis and hand therapy for thumb carpometacarpal osteoarthritis; a prospective study

Publication date: Available online 12 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Jonathan Tsehaie, Kim R. Spekreijse, Robbert M. Wouters, Reinier Feitz, Steven Hovius, Harm Slijper, Ruud W. Selles, Hand-Wrist Study Group

Abstract

Objective

1 to identify predictive factors for outcome after splinting and hand therapy for CMC OA and to identify predictive factors for conversion to surgical treatment, and 2) to determine how many patients that have not improved in outcome within six weeks after start of treatment will eventually improve after three months.

Design

Observational prospective multi-center cohort study.

Setting

& participants: Between 2011 and 2014, 809 patients with CMC OA received splinting and weekly hand therapy for three months.

Intervention

Not applicable

Main outcome measures

Satisfaction and pain were measured with a visual analog

scale and function with the Michigan Hand Questionnaire at baseline, six weeks and three months posttreatment. Using regression analysis, patient demographics and pretreatment baseline scores were considered as predictors for the outcome of conservative treatment after three months and for conversion to surgery.

Results

Multivariable regression model explained 34-42% of the variance in outcome (p<0.001) with baseline satisfaction, pain and function as significant predictors. Cox regression analysis showed that baseline pain and function were significant predictors for receiving surgery. Of patients with no clinically-relevant improvement in pain and function after six weeks, 73-83% also had no clinically-relevant improvement after three months.

Conclusion

This study showed that patients with either high pain or low function may benefit most from conservative treatment. We therefore recommend to always start with conservative treatment, regardless of symptom severity of functional loss at start of treatment. Furthermore, it seems valuable to discuss the possibility of surgery with patients after six weeks of therapy, when levels of improvement are still mainly unsatisfactory.

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Muscle activity pattern dysfunction during sit to stand and stand to sit in the movement system impairment subgroups of low back pain

Publication date: Available online 11 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Neda orakifar, Mohammad Jafar Shaterzadeh-Yazdi, Reza Salehi, Mohammad Mehravar, Neda Namnik

Abstract

Objective

To investigate impairment in the activity pattern of some muscles involved in sit to stand (STD) and stand to sit (STS) among two low back pain (LBP) subgroups of the Movement System Impairment (MSI) model.

Design

Case-control study

Setting

A university medical center

Participants

Fifteen healthy women and twenty-two women with chronic LBP in two subgroups (fifteen into the lumbar extension rotation (LER) and seven into lumbar flexion rotation (LFR)) voluntarily participated in this study.

Interventions

Participants were asked to perform STD and STS at a preferred speed. Surface electromyography (EMG) were measured bilaterally from the internal oblique (IO), lumbar erector spine (ES), medial hamstring (MH) and lateral hamstring (LH) muscles.

Main Outcome Measures

Changes in mean and maximum amplitude, time to peak amplitude, duration of muscle activity and bilateral asymmetry of these variables.

Results

During STD, bilateral asymmetry in mean amplitude of MH in the LER subgroup (p=0.031) and bilateral asymmetry in duration of LH in the LFR subgroup(p=0.026) were exhibited. Also, in this task reduced time to peak left MH activation were found in the LFR subgroup than two other groups (control; p=0.028 / LER; p=0.004). During STS, increased left ES maximum amplitude were observed in the LFR subgroup than LER subgroup (p=0.029). Also, reduced time to peak right ES (p=0.035) and left LH (p=0.038) activation in the LER subgroup than healthy subjects and reduced time to peak left LH activation in LFR subgroup than healthy subjects (p=0.041) were observed during STS.

Conclusions

The differences between the two LBP subgroups may be a result of impairment in the activity pattern of some muscles during functional activity.

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Immediate effects of transcutaneous electrical nerve stimulation on pain and physical performance in individuals with pre-radiographic knee osteoarthritis: a randomized controlled trial

Publication date: Available online 11 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Kanako Shimoura, Hirotaka Iijima, Yusuke Suzuki, Tomoki Aoyama

Abstract

Objective

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and comprehensive physical function in pre-radiographic knee osteoarthritis.

Design

A single, participant-blinded, randomized controlled trial with pre-post design

Setting

University research laboratory

Participants

Patients with knee pain belonging to Kellgren–Lawrence grade 0 or 1 (n = 50; aged 50–69 years) were randomly assigned to the TENS (n = 25) and sham-TENS groups (n = 25).

Interventions

All participants wore the TENS device under the patella of the symptomatic knee. After measurement, the TENS devices in the TENS group were turned on, and those in the sham-TENS group were not connected.

Main Outcome Measures

The primary outcome measures included the stair climb test, timed up and go (TUG) test, 6-minute walk test (6MWT), and knee pain evaluated using the visual analog scale (VAS) for stair climb test, TUG test, and 6MWT. Secondary outcomes included knee extensor strengths and the two-step test and stand-up test from the locomotive syndrome risk test.

Results

Multiple regression analysis revealed that TENS intervention significantly improved the walk distance and VAS score of the 6MWT, after adjusting for pre-measurement data (distance; p = 0.015, VAS; p = 0.030).ain and the distance walked in

Conclusions

Use of TENS improved the VAS score for p the 6MWT for individuals with Kellgren–Lawrence grade 0 or 1 of the knee. Thus, TENS may be effective for long-distance walking in patients with pre-radiographic knee osteoarthritis.

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Effects of a patient-centered graded exposure intervention added to manual therapy for women with chronic pelvic pain: a randomized controlled trial

Publication date: Available online 9 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): M José Ariza-Mateos, Irene Cabrera-Martos, Araceli Ortiz-Rubio, Irene Torres-Sánchez, Janet Rodríguez-Torres, Marie Carmen Valenza

Abstract

Objective

To explore the effects of a 6-week patient-centered graded exposure intervention added to manual therapy in women with chronic pelvic pain (CPP) and fear of movement/(re)injury.

Design

Prospective three-armed randomized controlled trial.

Setting

Faculty of Health Sciences.

Participants

A total of forty-nine women with CPP and substantial fear of movement were randomly allocated to one of three groups: 1) patient-centered graded exposure intervention added to manual therapy, 2) manual therapy or 3) control group.

Interventions

The 6-week intervention consisted of 12 sessions in the group receiving manual therapy and 6 additional sessions of graded exposure therapy in the group receiving both interventions.

Main Measures

Primary outcomes were fear-avoidance behavior assessed using the Fear-Avoidance Behavior Questionaire and pain interference and severity evaluated with the Brief Pain Inventory. The secondary outcome was disability evaluated with the Oswestry Disability Index. All the variables were assessed in a blinded manner at baseline, after the treatment, and at 3-month follow-up.

Results

Our results show interaction effects (p<0.05) for all the outcomes. Graded exposure added to manual therapy is distinctly superior to manual therapy alone in maintaining improvements for long-term fear-avoidance behavior and physical functioning.

Conclusions

Graded exposure added to manual therapy is a promising approach with long-term effects for women with CPP and fear of movement/(re)injury.

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Coeliac disease in children

What you need to knowConsider coeliac disease in children with both classic gastrointestinal symptoms (variable bowel habit, abdominal pain) and non-classic presentations (such as impaired growth,...

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Deep tissue incision enhances spinal dorsal horn neuron activity during static isometric muscle contraction in rats

Severe acute postoperative pain often complicates the recovery process after surgery,15,27 resulting in prolonged hospitalization associated with respiratory and cardiovascular complications.5,8,15,33

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Does sensorimotor incongruence trigger pain and sensory disturbances in people with chronic low back pain? A randomised cross-over experiment

Chronic low back pain (CLBP) is a common, complex and hard to treat disorder [20; 21; 40; 42]. The global point prevalence of low back pain (LBP) was estimated at 9.4% in 2010, with the highest prevalence of 15% in Western Europe [21]. When pain persists and becomes chronic, it has a vast socioeconomic impact [42]. Overall, unravelling the underlying mechanisms of CLBP is important to improve the effectiveness of care.

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Generalization and extinction of concept-based pain-related fear

Fear can be acquired through associative learning. The ability to learn that certain stimuli predict aversive outcomes facilitates the employment of appropriate defensive responses. Since threat can present itself in many forms, generalizing a once-learned stimulus-outcome association beyond a specific instance benefits survival. Fear generalization is the adaptive ability to extrapolate information from an aversive learning experience and apply it to novel, similar threatening encounters.18,21,25,26 However, when these defensive responses spread to safe stimuli, fear and avoidance may become maladaptive.

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Waiting for a pediatric chronic pain clinic evaluation: A prospective study characterizing waiting times and symptom trajectories

Epidemiological studies indicate that chronic pain is common in children and adolescents with median prevalence rates of 11% to 38% depending upon the condition.14 Chronic pain negatively affects multiple domains of functioning for children and adolescents including school attendance, social, physical, and athletic activities, and emotional functioning.16 Because longitudinal data demonstrates that childhood chronic pain places individuals at significant risk for developing or continuing with chronic pain, physical symptoms, and psychiatric complaints into adulthood,22 effective treatment of pain in childhood is critical for preventing or lessening the enormous societal impact of adult chronic pain.

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The Effects of Partners’ Helping Motivation on Chronic Pain Patients’ Functioning over Time

Because partners of individuals with chronic pain (ICP) may differ considerably in their helping responses (e.g., providing emotional, instrumental and informational support4), various attempts have been undertaken to categorize helping responses of close others in terms of its expected implications for ICP's functioning (e.g.,9). To fully understand whether partners’ helping response is truly helpful and promotes ICP's adjustment, the present research draws on Self-Determination Theory (SDT,7,34), a broad theory on human motivation.

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Characteristics associated with high-impact pain in people with TMD: a cross-sectional study

Temporomandibular disorder (TMD) is characterized by pain in the jaw joint, face, and masticatory muscles that can become chronic. Although the hallmarks of TMD, as a regional pain disorder, are pain in the temporomandibular joints and masticatory muscles, people with TMD often experience pain in many other areas of the body.44

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Effects of Combined Lower Thoracic Epidural/General Anesthesia on Pain Control in Patients Undergoing Elective Lumbar Spine Surgery: A Randomized Controlled Trial

Study Design. Randomized controlled trial. Objective. Our objective was to compare postoperative pain relief and operating field condition of single-shot, low-thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone. Summary of Background Data. Prior studies have suggested that continuous epidural analgesia provides better postoperative pain relief and less intraoperative blood loss, but with the risk of the epidural catheter contaminating the surgical field. Methods. A total of 22 patients scheduled for elective lumbar spine surgery were enrolled and randomly allocated into two groups. Group B (block) received a single-shot epidural block with 0.25% bupivacaine plus 4 mg of morphine with a total volume of 10 mL before receiving general anesthesia with desflurane, and cisatracurium. Group G (general) received general anesthesia alone with desflurane, cisatracurium, and any systemic analgesia deemed appropriate by the attending anesthesiologist. Postoperative pain score, opioid consumption, intraoperative blood loss, surgical field rating score, and other side effects were recorded at the postanesthesia care unit (PACU) and at 24 hours postoperatively. Results. Both groups were comparable for age, sex, body mass index, and American Society of Anaesthesiologists physical status. Fentanyl consumption was significantly lower (P < 0.05) for group B (block) at the PACU and 24 hours. Mean fentanyl consumption at PACU was 20 μg for group B and 85 μg for group G. At 24 hours mean fentanyl consumption was 80 μg for group B and 386 μg for group G. Pain measured with numerical rating scale, surgical field rating score, blood loss, and complications were similar in both groups. Conclusion. Single-shot low-thoracic epidural anesthesia combined with general anesthesia provides better pain control than general anesthesia alone. Level of Evidence: 2

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Does the Use of Electrotherapies Increase the Effectiveness of Neck Stabilization Exercises for Improving Pain, Disability, Mood, and Quality of Life in Chronic Neck Pain?: A Randomized, Controlled, Single-Blind Study

Study Design. This study was a prospective, randomized, controlled study. Objective. The aim of this study was to determine whether transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) increase the effectiveness of neck stabilization exercises (NSEs) on pain, disability, mood and quality of life for chronic neck pain (CNP). Summary of Background Data. Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Electrotherapies, such as IFC and TENS, have been applied solo or combined with exercise for management of neck pain; however, the efficacy of these combinations is unclear. Methods. A total of 81 patients with CNP were included in this study. Patients were randomly assigned into three groups regarding age and gender. First group had NSE, second group had TENS and NSE, and third group had IFC and NSE. Pain levels [visual analogue scale (VAS)], limits of cervical range of motion (ROM), quality of life (short form-36), mood (Beck depression inventory), levels of disability (Neck Pain and Disability Index), and the need for analgesics of all patients were evaluated before treatment, at 6th and 12th week follow-up. Physical therapy modalities were applied for 15 sessions in all groups. All participants had group exercise accompanied by a physiotherapist for 3 weeks and an additional 3 weeks of home exercise program. Results. According to the intragroup assessment, the study achieved its purpose of pain reduction, ROM increase, improvement of disability, quality of life, mood and reduction in drug use in all three treatment groups (P < 0.05). However, clinical outcomes at 6th and 12 th week had no significant difference among the three groups (P > 0.05). Conclusion. TENS and IFC therapies are effective in the treatment of CNP patients. However, they have no additional benefit or superiority over NSE. Level of Evidence: 2

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Dysregulation of the Inflammatory Mediators in the Multifidus Muscle After Spontaneous Intervertebral Disc Degeneration SPARC-null Mice is Ameliorated by Physical Activity

Study Design. A longitudinal case-control animal model. Objective. The aim of this study was to investigate the inflammatory pathways active in the multifidus muscle after spontaneous intervertebral disc degeneration (IDD), and whether these IDD-related muscle changes can be ameliorated by exercise. Summary of Background Data. A pro-inflammatory response is present in the multifidus muscle after an intervertebral disc lesion and has been proposed to drive the structural alterations present during low back pain. However, it is not known whether spontaneous IDD produces an inflammatory response. Furthermore, exercise/physical activity produces a strong anti-inflammatory response, but its effectiveness in ameliorating inflammation in the multifidus is unknown. We assessed the inflammatory profile of the multifidus and the effectiveness of physical activity as a treatment using an animal model of spontaneous model of IDD. Methods. Wild-type and SPARC null mice that were sedentary or housed with a running wheel were used in this study. Multifidus muscle segments were harvested from L2-L6 from the mice at 9 months of age after they had undergone a magnetic resonance imaging (MRI) scan to determine levels with IDD. The inflammatory profile of the multifidus was examined using quantitative polymerase chain reaction (PCR) assays. Results. Spontaneous IDD in the SPARC-null mice caused a dysregulation of interleukin (IL)-1β, IL6, transforming growth factor-beta (TGFβ1), and adiponectin expression. More specifically, the proximity and degree of IDD was related to levels of IL-1β expression. Physical activity reduced the pro-inflammatory response to IDD in the multifidus. IL-1β, tumor necrosis factor (TNF), IL-10, adiponectin, and leptin levels were lower in the physically active group. Conclusion. These results reveal that spontaneous IDD causes dysregulation of the inflammatory pathways active in the multifidus muscle. These alterations were related to the severity of IDD and were prevented by physical activity. Level of Evidence: N/A

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Musculoskeletal Multisite Pain and Patterns of Association After Adjusting for Sleep, Physical Activity, and Screen Time in Adolescents

Study Design. Cross-sectional. Objective. This study aims to describe how pain at multiple body sites is associated after controlling for other predictive factors such as age, sex, sleeping hours, time spent in physical activity, and time spent in screening based activities in adolescents aged 13 to 19 years. Summary of Background Data. The prevalence of multisite pain in adolescents is high, but studies investigating the patterns of association between painful body sites are scarce. Methods. Pain for the last 3 months was assessed using Nordic Musculoskeletal Questionnaire. In addition, data on time spent in moderate and vigorous physical activity, sleeping, and in screen based activities were also assessed. Results. In univariable analysis of associations, there is a significant association between most painful body sites (odds ratio [OR\ between 1.52 and 3.73, P < 0.05). After controlling for age, sex, physical activity, sleep and screen time, most of the previous associations remain significant (OR between 1.50 and 3.07, P < 0.05). Conclusion. This study's results seem to suggest that pain at one body site is more important in determining multiple painful body sites than demographic or lifestyle factors. Longitudinal studies exploring the association and chronology of multisite pain are needed. Level of Evidence: 3

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A Comparison of Isolated Lumbar Extension Strength Between Healthy Asymptomatic Participants and Chronic Low Back Pain Participants Without Previous Lumbar Spine Surgery

Study Design. Cross-sectional case-control study. Objective. To compare isolated lumbar extension strength between healthy asymptomatic participants and participants with chronic low back pain (CLBP), while controlling for previous lumbar spine surgery. Summary of Background Data. Deconditioning of the lumbar musculature is common in those with previous lumbar surgery, resulting in decreased strength and endurance. Evidence is required to support whether this is the case for participants with CLBP yet no previous surgery compared with asymptomatic participants. Methods. Forty-two healthy (25 males and 17 females) asymptomatic participants, and 53 participants with non-specific CLBP (30 males and 23 females) aged between 19 and 76 years were recruited. Maximal isometric isolated lumbar extension (ILEX) strength was examined. Results. A Mann–Whitney U test indicated that ILEX strength was significantly greater in the asymptomatic group compared with the CLBP group (Z = 1441.00, P = 0.014). Post-hoc effect size was calculated to be d = 0.56, showing a moderate effect. Conclusion. These results indicate that ILEX weakness and lumbar extensor deconditioning is present independent of surgery and may be a factor involved in CLBP. As such, lumbar extensor deconditioning would appear to be a reasonable target for interventions in CLBP. Level of Evidence: 3

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Simplified Chinese Version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: Agreement, Responsiveness, and Minimal Important Change for Patients With Chronic Low Back Pain

Study Design. Psychometric test of the cross-cultural adaptation the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in low back pain (LBP) patients. Objective. To investigate the agreement, responsiveness, and minimal important change (MIC) of the simplified Chinese version of the JOABPEQ in LBP patients. Summary of Background Data. The factor structure, internal consistency, test–retest reliability, validity, floor and ceiling effect of simplified Chinese JOABPEQ have been tested, while the agreement, responsiveness, and MIC were required. Methods. The agreement, responsiveness, and MIC of the simplified Chinese version were assessed by completing the Chinese JOABPEQ twice. Agreement was tested with Bland–Altman plot. Responsiveness was operationalized using receiver operating characteristic analyses. The anchor-based method was used to calculate MIC. Results. One hundred sixty-two of 184 patients returned to finish the booklet twice were available for analysis (response rate: 88.0%). While the responsiveness, the area under the curves of each subscale were ranged from 0.746 to 0.875, which meant a good responsiveness. While the MIC (MIC%) of simplified Chinese JOABPEQ was 19.28 (44.98%) for Q1 Low back pain, 15.20 (24.13%) for Q2 Lumbar function, 15.79 (22.76%) for Q3 Walking ability, 9.58 (19.86%) for Q4 Social life function, 7.33 (17.28%) for Q5 Mental health. While compared with the MIC, only the Q3 Walking ability had a positive rating for agreement in the Bland–Altman plot. Conclusion. The simplified Chinese JOABPEQ has positive agreement of Q3 Walk ability and acceptable to excellent responsiveness of all the subscales. The MICs for subscales of the simplified Chinese JOABPEQ ranged from 7.33 to 19.28 points. Level of Evidence: 3

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