Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials

Objective: We examine the reliability and validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)—which combines the nine-item Patient Health Questionnaire depression scale and seven-item Generalized Anxiety Disorder scale—as a composite measure of depression and anxiety. Methods: Baseline data from 896 patients enrolled in two primary-care based trials of chronic pain and one oncology-practice–based trial of depression and pain were analyzed. The internal reliability, standard error of measurement, and convergent, construct, and factor structure validity, as well as sensitivity to change of the PHQ-ADS were examined. Results: The PHQ-ADS demonstrated high internal reliability (Cronbach α values of .8 to .9) in all three trials. PHQ-ADS scores can range from 0 to 48 (with higher scores indicating more severe depression/anxiety), and the estimated standard error of measurement was approximately 3 to 4 points. The PHQ-ADS showed strong convergent (most correlations, 0.7–0.8 range) and construct (most correlations, 0.4–0.6 range) validity when examining its association with other mental health, quality of life, and disability measures. PHQ-ADS cutpoints of 10, 20, and 30 indicated mild, moderate, and severe levels of depression/anxiety, respectively. Bifactor analysis showed sufficient unidimensionality of the PHQ-ADS score. PHQ-ADS change scores at 3 months differentiated (p < .0001) between individuals classified as worse, stable, or improved by a reference measure, providing preliminary evidence for sensitivity to change. Conclusions: The PHQ-ADS may be a reliable and valid composite measure of depression and anxiety which, if validated in other populations, could be useful as a single measure for jointly assessing two of the most common psychological conditions in clinical practice and research. Trial Registration: Clinicaltrials.gov Identifier: NCT00926588 (SCOPE); NCT00386243 (ESCAPE); NCT00313573 (INCPAD).

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[World Report] US law agencies target “high prescribers” of pain relief

Heavy-handed legal measures have been taken against some US doctors for alleged prescription drug malpractices. But for whose benefit? Hannah Roberts investigates.

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Nurofen advertisement was misleading, says watchdog

The UK advertising watchdog has banned a TV advertisement because it misled consumers by suggesting that Reckitt Benckiser’s branded ibuprofen product, Nurofen Joint and Back Pain Relief, could...

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The Association between Clinical Characteristics of Migraine and Brain GABA Levels: an Exploratory Study

Migraine is prevalent and disabling yet is poorly understood. One way to better understand migraine is to examine its clinical characteristics and potential biomarkers such as gamma-aminobutyric acid (GABA). The primary objective of this study was to explore whether relevant disease characteristics of migraine are associated with brain GABA levels. Twenty adults fulfilling the established diagnostic criteria for migraine and 20 age- and gender-matched controls completed this cross-sectional study.

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Muscular mechanical hyperalgesia after lengthening contractions in rats depends on stretch velocity and range of motion

Abstract

Background

The current study investigated stretch variables and mechanical factors of lengthening contractions (LC) in the processes leading to muscular mechanical hyperalgesia in rats to understand mechanisms underpinning delayed onset muscle soreness (DOMS).

Methods

Under isoflurane anaesthesia, ankle extensor muscles were loaded with repetitive LC with angular stretch velocities (50°, 100°, 200° and 400°/s) at a fixed range of motion (ROM) of 90°, and with ROMs (30°, 60°, 90° and 120°) at a fixed velocity of 200°/s.

Results

Mechanical hyperalgesia was observed in a velocity- and ROM-dependent manner. Under the fixed ROM, integrated torque generated during LC (iTq_[max]) was inversely correlated with the velocity, but the rate of torque increase during LC (rTq_[max]) was positively and significantly correlated with the velocity, and the magnitude of hyperalgesia was correlated with rTq_[max] (p < 0.001). When the velocity was fixed, iTq_[max] was significantly correlated with ROM, and the magnitude of hyperalgesia was correlated with iTq_[max] (p < 0.01). Necrotic myofibres were observed only sparsely (<0.8%) after any of the LC protocols tested. Up-regulation of nerve growth factor and glial cell line-derived neurotrophic factor mRNA in the muscle was positively correlated with the increases in the LC velocity and ROM (p < 0.05~0.001).

Conclusions

Both velocity and ROM are pivotal variables determining the initiation of mechanical hyperalgesia. Neurotrophic factor-mediated peripheral mechanisms, but apparently not inflammatory changes caused by myofibre damage, are responsible for the mechanical hyperalgesia.

Significance

Mechanical hyperalgesia appears after LC in a stretch velocity- and range of motion-dependent manner. The rate of torque increase and integrated torque are the crucial factors. Neurotrophic factor-mediated peripheral pain mechanisms without robust inflammatory changes caused by myofibre damage were required for this mechanical hyperalgesia.

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Brain structural changes in patients with chronic myofascial pain

Abstract

Background

Myofascial trigger points (MTrPs) are a highly prevalent source of musculoskeletal pain. Prolonged ongoing nociceptive input from MTrPs may lead to maladaptive changes in the central nervous system. It remains, however, unknown whether pain from MTrPs is associated with brain atrophy. In addition, stress, which may contribute to the formation of MTrPs, is also known to affect brain structures. Here, we address whether structural brain changes occur in patients with chronic pain originating from MTrPs and whether such changes are related to pain or stress.

Methods

Voxel-based morphometry was used to compare grey-matter (GM) volumes in 21 chronic pain patients, with MTrPs in the bilateral upper trapezius muscles, with 21 healthy controls. Hyperalgesia was assessed by pressure pain thresholds, and stress was assessed by cortisol levels and anxiety questionnaires.

Results

Patients exhibited normal stress levels but lowered pain thresholds. GM atrophy was found in dorsal and ventral prefrontal regions in patients. The GM density of the right dorsolateral prefrontal cortex correlated with pain thresholds in patients, i.e. the more atrophy, the lower pain threshold. GM atrophy was also found in the anterior hippocampus, but the atrophy was neither related to pain nor stress.

Conclusions

Patients with chronic myofascial pain exhibit GM atrophy in regions involved in top-down pain modulation and in processing of negative affect. The relationship between the dorsolateral prefrontal cortex and pain thresholds suggests the presence of pain disinhibition. No evidence was found for the involvement of stress. It remains unclear whether the observed atrophy contributes to the development of the chronic pain state or is caused by the ongoing nociceptive input.

Significance

Chronic myofascial pain, caused by myofascial trigger points, is associated with localized brain atrophy in areas involved in pain processing and modulation, among others. These findings extend previous knowledge about peripheral and spinal changes to the supraspinal level.

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Attentional bias modification for acute experimental pain: A randomized controlled trial of retraining early versus later attention on pain severity, threshold and tolerance

Abstract

Background

Noxious attentional bias is thought to confer vulnerability to pain, suggesting that modifying the bias could reduce pain outcomes. Herein is presented a randomized controlled trial to test the effects of retraining the dot probe attentional bias at short versus long stimulus durations towards neutral stimuli, and away from threat stimuli, on acute pain experience, in comparison with a placebo control group.

Methods

Eighty-one pain-free volunteers, blinded to condition, were randomized to complete either one of two neutral bias modification programs in which words were presented for 500 ms (ABM-500; n = 28) or 1250 ms (ABM-1250; n = 26), or to a sham training program that included both stimulus durations (ABM-Placebo; n = 27). Testing took place in a university laboratory. At post-training, participants completed the pain-inducing ‘cold pressor task’, and measures of pain severity, threshold and tolerance were taken. Attentional bias was also measured at pre- and post-training.

Results

Findings indicated that ABM-500 reliably increased pain threshold and tolerance, in comparison with the control group. In contrast, ABM-1250 did not affect any of the pain outcomes. Expected ABM effects on attentional bias were not evident at the group level, but nevertheless ABM-500 bias reduction was significantly associated with increased pain tolerance.

Conclusions

These findings suggest that retraining attention at short stimulus exposure durations is relatively more efficacious in promoting transfer of attentional retraining effects to real-world acute pain stressors, in comparison with both the longer stimulus duration and ABM-Placebo.

Significance

Testing of the impact of modifying maintained attentional bias on vulnerability to an acute pain stressor.

Findings suggested that retraining rapid attentional bias using short exposure durations conferred greater analgesic benefit, in comparison with both the slower bias and sham-training.

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Empathy predicts an experimental pain reduction during touch

Previous studies have provided evidence for pain alleviating effects of segmental tactile stimulation, yet the effect of social touch and its underlying mechanism is still unexplored. Considering that the soma affects the way we think, feel and interact with others, it has been proposed that touch may communicate emotions, including empathy, interacting with the identity of the toucher. Thus, the goal of the current study was to examine the analgesic effects of social touch, and to test the moderating role of the toucher’s empathy in analgesia using an ecological paradigm.

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Pediatric Pain Beliefs Questionnaire: Psychometric Properties of the Short Form

Cognitive appraisals inform and shape individuals’ pain experiences. As researchers examine mechanisms of cognitive behavioral interventions for chronic pain, psychometrically sound measures based in cognitive theory are needed to directly assess pain beliefs. The Pain Beliefs Questionnaire (PBQ), a 32 item self-report measure informed by coping and appraisal theory, was designed to assess children’s pain threat appraisals, problem-focused pain coping efficacy, and emotion-focused pain coping efficacy.

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Upright Magnetic Resonance Imaging Tasks in the Knee Osteoarthritis Population: Relationships Between Knee Flexion Angle, Self-Reported Pain, and Performance

Lower Amplitude of the Hoffmann Reflex in Women With Patellofemoral Pain: Thinking Beyond Proximal, Local, and Distal Factors

Musculoskeletal Complaints in Transverse Upper Limb Reduction Deficiency and Amputation in The Netherlands: Prevalence, Predictors, and Effect on Health

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic Arthritis

Improving Power and Sample Size Calculation in Rehabilitation Trial Reports: A Methodological Assessment

Clinical encounters in the post-guidelines era

Jan is a 42-year-old plumber, originally from Poland. He tells his family doctor that he’s had low back pain, going down the back of his leg and making it painful to walk. He takes drugs for...

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Patients are socially excluded when their pain has no medical explanation

This study investigated whether observers socially exclude patients who experience pain that is not medically explained by means of an experimental design. Fifty-nine participants (individuals from the general population) viewed videos of 4 patients, each accompanied by a vignette describing the presence or absence of a medical explanation for their pain. Participants estimated patient’s pain, and rated the sympathy felt for and the inclination to help the patient. In order to measure social exclusion, participants indicated their willingness to interact with the patients in several situations (Social Distance Scale).

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Neuropathic pain prevalence following spinal cord injury: A systematic review and meta-analysis

Abstract

Following spinal cord injury (SCI), chronic pain is a common secondary complication with neuropathic pain (NP) cited as one of the most distressing and debilitating conditions leading to poor quality of life, depression and sleep disturbances. Neuropathic pain presenting at or below the level of injury is largely refractory to current pharmacological and physical treatments. No consensus on the prevalence of NP post SCI currently exists, hence this systematic review was undertaken. The review comprised three phases: a methodological assessment of databases [PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and Physiotherapy Evidence Database (PEDro)] identifying potential papers and screening for inclusion criteria by two independent reviewers; data extraction; and finally rating of internal validity and strength of the evidence, using a published valid and reliable scale. Meta-analysis estimated pooled point prevalence rates using a random effects model. In total, 17 studies involving 2529 patients were included in the review. Overall point prevalence rates for NP were established at 53% (38.58–67.47); 19% (13.26–26.39) for at-level NP and 27% (19.89–34.61) for below-level NP, with high heterogeneity noted (I² = 84–93%). Prevalence rates for NP following SCI are high. Future studies should include established definitions, classification systems and assessment tools for NP at defined time points post SCI to follow the trajectory of this problem across the lifespan and include indices of sleep, mood and interference to allow for appropriate, optimal and timely NP management for each patient.

What does this review add?

This is the first systematic review and meta-analysis to record pooled point prevalence of neuropathic pain post spinal cord injury at 53%. Additional pooled analysis shows that neuropathic pain is more common below the level of lesion, in patients with tetraplegia, older patients and at 1 year post injury.

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Blockade of sigma 1 receptors alleviates sensory signs of diabetic neuropathy in rats

Abstract

Background

E-52862 (S1RA, 4-[2-[[5-methyl-1-(2-naphthalenyl)-1H-pyrazol-3-yl]oxy]ethyl]-morpholine), a novel selective sigma 1 receptor (σ1R) antagonist, has demonstrated efficacy in nociceptive and neuropathic pain models. Our aim was to test if σ1R blockade with E-52862 may modify the signs of neuropathy in Zucker diabetic fatty (ZDF) rats, a type 2 diabetes model.

Methods

Mechanical and thermal response thresholds were tested on 7-, 13-, 14- and 15-week-old ZDF rats treated with saline or with E-52862 acutely administered on week 13, followed by sub-chronic administration (14 days). Axonal peripheral activity (skin–saphenous nerve preparation) and isolated aorta or mesenteric bed reactivity were analysed in 15-week-old ZDF rats treated with saline or E-52862 and in LEAN rats.

Results

Zucker diabetic fatty rats showed significantly decreased thermal withdrawal latency and threshold to mechanical stimulation on week 13 compared to week 7 (prediabetes) and with LEAN animals; single-dose and sub-chronic E-52862 administration restored both parameters to those recorded on week 7. Regarding axonal peripheral activity, E-52862 treatment increased the mean mechanical threshold (77.3 ± 21 mN vs. 19.6 ± 1.5 mN, saline group) and reduced the response evoked by mechanical increasing stimulation (86.4 ± 36.5 vs. 352.8 ± 41.4 spikes) or by repeated mechanical supra-threshold steps (39.4 ± 1.4 vs. 83.5 ± 0.9). E-52862 treatment also restored contractile response to phenylephrine in aorta and mesenteric bed.

Conclusions

E-52862 administration reverses neuropathic (behavioural and electrophysiological) and vascular signs in the ZDF rat.

Significance

Blockade of σ1R avoids the development of diabetic neuropathy in rats, and may represent a potentially useful therapeutic approach to peripheral neuropathies in diabetic patients.

What does this study add?

• This study presents evidences for the potential usefulness of sigma receptor blockade on diabetic neuropathy in rats.
• The methodology includes behavioural evidences, electrophysiological data and vascular-isolated models.

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Table of Contents

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Editorial Board

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Masthead

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Can a professional development workshop with follow-up alter practitioner behaviour and outcomes for neck pain patients? A randomised controlled trial

Continuing professional development (CPD) is a fundamental component of physiotherapy practice. Follow-up sessions provide opportunity for the refinement of skills developed during CPD workshops. However, it is necessary to identify if such opportunity translates to improved physiotherapist performance and patient outcomes.

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The effects of Tai Chi and neck exercises in the treatment of chronic non-specific neck pain: A randomized controlled trial

This study aimed to test the efficacy of Tai Chi for treating chronic neck pain.Subjects with chronic non-specific neck pain were randomly assigned to 12 weeks of group Tai Chi or conventional neck exercises with weekly sessions of 75-90 minutes, or a wait-list control. The primary outcome measure was pain intensity (visual analog scale, VAS). Secondary outcomes included pain on movement, functional disability, quality of life, well-being and perceived stress, postural and interoceptive awareness, satisfaction and safety.

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Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis

Abstract

Muscle relaxants are commonly prescribed for low back pain (LBP); however, there is limited evidence of their clinical efficacy and tolerability. This review evaluated the efficacy and tolerability of muscle relaxants in people with LBP. We searched online databases including Medline, EMBASE, CENTRAL and PsycINFO (inception to end October 2015) and performed citation tracking for eligible randomized controlled trials (RCTs). Two authors independently extracted data and assessed risk of bias of randomized controlled trials of muscle relaxants. Pain outcomes were converted to a common 0–100 scale. Data were pooled using a random effects model with strength of evidence assessed using GRADE. Fifteen trials (3362 participants) were evaluated in this review. A total of five trials (496 participants) provide high quality evidence that muscle relaxants provide clinically significant pain relief in the short term for acute LBP; MD −21.3, [−29.0, −13.5]. There was no information on long-term outcomes. The median adverse event rate in clinical trials for muscle relaxants was similar to placebo 14.1% IQR (7.0–28.7%) and 16.0% (4.1–31.2%); p = 0.5, respectively. There is no evidence for the efficacy of benzodiazepines in LBP. For people with acute LBP, muscle relaxants provide clinically significant short-term pain relief. For chronic LBP, the efficacy of muscle relaxants is largely unknown. There was no eligible RCT evidence to support the efficacy of benzodiazepines in LBP. Prolonged use of these medicines in LBP cannot be guided by trial evidence.

What does this review add?

Muscle relaxants provide clinically significant pain relief for acute low back pain. Caution must be taken with the interpretation of the findings as the evidence comes from specific muscle relaxant medicines.

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Similar Effects of Thrust and Nonthrust Spinal Manipulation Found in Adults With Subacute and Chronic Low Back Pain: A Controlled Trial With Adaptive Allocation

Study Design. A three-arm controlled trial with adaptive allocation. Objectives. The aim of this study was to compare short-term effects of a side-lying, thrust spinal manipulation (SM) procedure and a nonthrust, flexion-distraction SM procedure in adults with subacute or chronic low back pain (LBP) over 2 weeks. Summary of Background Data. SM has been recommended in recently published clinical guidelines for LBP management. Previous studies suggest that thrust and nonthrust SM procedures, though distinctly different in joint loading characteristics, have similar effects on patients with LBP. Methods. Participants were eligible if they were 21 to 54 years old, had LBP for at least 4 weeks, scored 6 or above on the Roland-Morris disability questionnaire, and met the diagnostic classification of 1, 2, or 3 according to the Quebec Task Force Classification for Spinal Disorders. Participants were allocated in a 3:3:2 ratio to four sessions of thrust or nonthrust SM procedures directed at the lower lumbar and pelvic regions, or to a 2-week wait list control. The primary outcome was LBP-related disability using Roland-Morris Disability Questionnaire and the secondary outcomes were LBP intensity using visual analog scale, Fear-Avoidance Beliefs Questionnaire, and the 36-Item Short Form Health Survey. The study was conducted at the Palmer Center for Chiropractic Research with care provided by experienced doctors of chiropractic. Clinicians and patients were not blinded to treatment group. Results. Of 192 participants enrolled, the mean age was 40 years and 54% were male. Improvement in disability, LBP intensity, Fear-Avoidance Beliefs Questionnaire—work subscale, and 36-Item Short Form Health Survey—physical health summary measure for the two SM groups were significantly greater than the control group. No difference in any outcomes was observed between the two SM groups. Conclusion. Thrust and nonthrust SM procedures with distinctly different joint loading characteristics demonstrated similar effects in short-term LBP improvement and both were superior to a wait list control. Level of Evidence: 2

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PGE1 Attenuates IL-1β-induced NGF Expression in Human Intervertebral Disc Cells

Study Design. In vitro study using isolated human intervertebral disc (IVD) cells. Objective. To investigate the effects of prostaglandin (PG)E1 and its orally available derivative limaprost on the regulation of nerve growth factor (NGF) expression and to compare their actions with other prostanoids using interleukin (IL)-1-stimulated human IVD cells. Summary of Background Data. We previously reported that a selective COX-2 inhibitor enhanced, whereas PGE2 suppressed the induction of NGF by IL-1 in human IVD cells, and proposed that PGE2 can suppress NGF expression by a negative feedback mechanism. Methods. Isolated human IVD cells were stimulated with IL-1 in the presence or absence of increasing concentrations of PGE2, PGE1, limaprost, PGI2, PGD2, or PGF2α (10–10,000 nM). For some experiments, an E-series prostanoid receptor (EP)4 antagonist (L-161,982) was added prior to the stimulation. NGF expression was determined by real-time polymerase chain reaction and its protein level was quantified by enzyme-linked immunosorbent assay. Results. PGE2, PGE1, and limaprost inhibited the IL-1-mediated induction of NGF in a concentration-dependent manner, with IC50 values of 9.9, 10.6, and 70.9 nM, respectively. PGI2 also suppressed NGF expression but to a much less extent. PGD2, on the other hand, significantly enhanced NGF expression, whereas PGF2α had no effect. Protein expression levels of NGF mirrored its mRNA levels. The suppression of NGF expression by PGE2 and PGE1 was partly reversed by L-161,982. Conclusion. PGE1 and limaprost exhibited a novel pharmacological action that suppresses NGF expression in human IVD cells, and other prostanoids differentially regulated NGF expression. Limaprost has been used to treat patients with lumbar spinal stenosis in Japan and was proved to be effective in relieving symptoms. Our in vitro results may explain, in part, the mechanism of action of limaprost for low back pain. Level of Evidence: N/A

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Multimodal Versus Patient-Controlled Analgesia After an Anterior Cervical Decompression and Fusion

Study Design. Retrospective analysis of a prospectively maintained surgical registry. Objective. To compare postoperative narcotic consumption between multimodal analgesia (MMA) and patient-controlled analgesia (PCA) after an anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Studies suggest that a multimodal approach to pain management leads to decreased pain and morphine consumption after total joint arthroplasty and lumbar spinal procedures. Patients and surgeons would benefit from knowing whether a multimodal approach to pain management is superior to PCA for ACDF. Methods. A retrospective cohort study of ACDF patients receiving either MMA or PCA was conducted. Inpatient narcotic consumption, pain scores, nausea/vomiting, hospital length of stay, and narcotic dependence during the months after surgery were compared between MMA and PCA. Results. A total of 239 patients met inclusion criteria. Of these, 55 (23.0%) received MMA and 184 (77.0%) received PCA. Patients who received MMA had a lower rate of inpatient narcotic consumption (2.5 OME/h vs. 5.8 OME/h, P < 0.001) were less likely to experience nausea/vomiting during the hospitalization (5.5% vs. 37.5%, P < 0.001), and had a shorter hospital length of stay (27.3 vs. 40.1 h, P < 0.001). However, there was no difference between groups in mean visual analogue pain scale during postoperative day zero (4.7 for MMA vs. 5.2 for PCA, P = 0.126) or during postoperative day one (4.1 for MMA vs. 4.1 for PCA, P = 0.937). In addition, there was no difference in the rate of narcotic dependence at the first (P = 0.626) or second (P = 0.480) postoperative visits. Conclusion. These data suggest that MMA results in lower narcotic consumption than PCA after an ACDF. This difference is associated with a shorter inpatient stay and a decrease in postoperative nausea/vomiting. Critically, MMA and PCA appear to provide similar postoperative analgesia. Level of Evidence: 3

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Fusion of Multiple Segments Can Increase the Incidence of Sacroiliac Joint Pain After Lumbar or Lumbosacral Fusion

Study Design. A retrospective study. Objective. To determine the risk factors for sacroiliac joint pain (SIJP) after lumbar or lumbosacral fusion. Summary of Background Data. Recently, the sacroiliac joint has gained increased attention as a source of pain after lumbar or lumbosacral fusion. We examined the factors related to the development of SIJP after lumbar or lumbosacral fusion. Methods. In total, 262 patients who underwent lumbar or lumbosacral fusion from June 2006 to June 2009 were included in this study. All patients who did not show SIJP clinically in the preoperative screening period were considered. Of these patients, 28 newly developed SIJP. We investigated whether development of SIJP after lumbar or lumbosacral fusion is related to the presence of fusion involving the sacrum (floating fusion vs. fixed fusion) and the number of fused segments. Results. The incidence of SIJP was higher with fixed fusion (13.1%) than with floating fusion (10.0%). With regard to the number of fused segments, the incidence of SIJP was 5.8% for one fused segment, 10.0% for two segments, 20.0% for three segments, 22.5% for at least four segments. Thus, the incidence was significantly higher when at least three segments were fused. Logistic regression analysis was performed to determine if the development of SIJP was related to the presence of fusion involving the sacrum or the number of fused segments. The analysis revealed that the number of fused segments was significantly associated with the development of SIJP. Conclusion. SIJP is a potential cause of low back pain after lumbar or lumbosacral fusion surgeries. Our study indicated that fusion of multiple segments (at least three) can increase the incidence of SIJP after lumbar or lumbosacral fusion. Level of Evidence: Level 3

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Pilates for Low Back Pain: Complete Republication of a Cochrane Review

Study Design. Systematic review. Objective. To determine the effects of the Pilates method for patients with nonspecific acute, subacute, or chronic low back pain. Summary of Background Data. The Pilates method is one of the most common forms of intervention based on exercise used for treating patients with low back pain. However, its effectiveness is not well established. Methods. We conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, and SPORTDiscus up to March 2014. We included randomized controlled trials examining the effectiveness of Pilates in patients with acute, subacute, or chronic nonspecific low back pain. The outcomes evaluated were pain, disability, function, and global impression of recovery. Two independent reviewers screened for potentially eligible studies, assessed risk of bias, and extracted the data. We evaluated the overall quality of evidence using the GRADE approach and treatment effect sizes were described using mean differences and 95% confidence intervals. Results. Searches retrieved 126 trials, of which 10 were included in the review (n = 510 participants). Seven studies were considered to have low risk of bias, and three were considered at high risk of bias. When compared to minimal intervention, Pilates reduces pain at short and intermediate term with low- to moderate-quality evidence and medium effect sizes. For disability, there is also a significant difference in favor to Pilates with low- to moderate-quality evidence and small effect size for short term and medium effect size for intermediate term compared with minimal intervention. It is unclear whether Pilates is better than other exercises for short-term pain, but there is low-quality evidence that Pilates reduces pain at intermediate term. For disability, there is moderate-quality evidence that there is no significant difference between Pilates and other exercises in either the short term or the intermediate term. Conclusion. There is low- to moderate-quality evidence that Pilates is more effective than minimal intervention with most of the effect sizes being considered medium. However, there is no conclusive evidence that Pilates is superior to other forms of exercises. Level of Evidence: 1

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Translation, Validation, and Crosscultural Adaptation of the Hebrew Version of the Neck Disability Index

Study Design. The present study's design was translation and crosscultural validation of the Neck Disability Index (NDI). Objective. The aim of the study was to translate and culturally adapt the NDI into Hebrew language and to evaluate the psychometric properties of this version. Summary of Background Data. As yet, no Hebrew language neck pain and disability questionnaires exist. The NDI is widely used and validated among different patient populations with neck pain. Methods. The English version of the NDI was translated into Hebrew according to the published guidelines. A total of 100 patients with neck pain participated in the study. Inclusion criteria were age 18 years and older, neck pain, and ability to read and speak Hebrew. Exclusion criteria were cancer or suspected tumor, neck pain related to vertebral fracture, or neurological disease. Participants were asked to complete the NDI-Hebrew version (NDI-H), Numeric Pain Rating Scale (NPRS), and Patient-Specific Functional Scale (PSFS). Seventy-three patients completed the NDI-H twice in an interval of 2 days. Psychometric properties included test-retest reliability (intraclass correlation coefficient), internal consistency (Cronbach α), convergent validity (Pearson correlation), and factor analysis. Results. The NDI-H demonstrated excellent test-retest reliability (intraclass correlation coefficient ranged from 0.827 to 0.929; Pv < 0.001). Cronbach α value was excellent (0.855). A very good correlation was found between the NDI-H and NPRS scores (r = 0.611, P < 0.001) and a good correlation between the NDI-H and PSFS score (r = 0.417, P < 0.001). Factor analysis revealed a two-factor solution representing daily function and pain and symptoms. Conclusion. The NDI-H is a valid and reliable instrument to measure functional limitations and disability in Hebrew-speaking patients with neck pain. Level of Evidence: NA

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Comparison of Atlantoaxial Rotation and Functional Outcomes of Two Nonfusion Techniques in the Treatment of Anderson-D’Alonzo Type II Odontoid Fractures

Study Design. A retrospective comparative study. Objective. The aim of this study was to compare the outcomes of anterior screw fixation and posterior temporary-fixation in the treatment of Anderson-D’Alonzo type II odontoid fractures. Summary of Background Data. Posterior C1-C2 temporary-fixation can spare the motion of C1-C2 in the treatment of odontoid fractures. However, it is unknown whether it can achieve the same outcomes as anterior screw fixation. Methods. Data of 20 patients who underwent posterior temporary-fixation due to Anderson-D’Alonzo type II odontoid fractures with intact transverse ligament were retrospectively reviewed. Another 20 patients undergoing anterior screw fixation were randomly selected as the control group. The range of motion (ROM) in rotation of C1-C2 measured on functional computed tomography (CT) scan and outcomes evaluated by the visual analog scale (VAS) for neck pain, neck stiffness, patient satisfaction, and neck disability index (NDI) were compared between two groups at the final follow-up. Results. At the final follow-up, 19 cases in each groups achieved facture healing. Total C1-C2 ROM in rotation on both sides in the posterior temporary-fixation group was 32.4 ± 12.5°, smaller than 40.0 ± 13.0 in the anterior fixation group. However, there was no statistical difference between two groups. And there was no significant difference between two groups in functional outcomes evaluated by VAS for neck pain, neck stiffness, patient satisfaction, and NDI. Conclusion. Posterior temporary-fixation can spare the motion of C1-C2 and achieve same good clinical outcomes as anterior screw fixation in the treatment of Anderson-D’Alonzo type II odontoid fractures. It was an ideal alternative strategy to anterior screw fixation. Level of Evidence: 3

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Effects of analgesics on olfactory function and the perception of intranasal trigeminal stimuli

Abstract

Background

There is some evidence suggesting that analgesics have an impact on human chemosensory function, especially opioids and cannabinoids are known to interfere with olfactory function. However, largely unknown is the effect of a long-term use of analgesics on the intranasal trigeminal system so far. Here, we investigated olfactory function and the perception of intranasal trigeminal stimuli in pain patients with long-term use of analgesics compared to age-matched healthy controls.

Methods

For this purpose, a psychophysical approach was chosen to measure these sensory functions in 100 chronic pain patients and 95 controls. Olfactory testing was performed using the ‘Sniffin’ Sticks’ test kit, which involves tests for odour threshold, odour discrimination and odour identification. Further, participants were asked to rate the intensity of trigeminal stimuli by using a visual analogue scale.

Results

We observed that the chronic use of pain medication was associated with significantly reduced perception of intranasal trigeminal stimuli and olfactory function compared to age-matched controls without intake of analgesics. Results indicate that non-opioid and opioid drugs, or a combination of both did not differ in their effects on chemosensory function. Further, after eliminating the effect of a co-existing depression and the use of co-analgesics, the negative influence of analgesics on olfactory function and trigeminal perception was still evident.

Conclusion

The observed effect might be mediated due to interaction with opioid receptors in trigeminal ganglia and nuclei or due to trigeminal/olfactory interaction. As a practical consequence, patients should be made aware of a possible impairment of their olfactory and trigeminal function under long-term analgesic treatment.

What does this study add?

We observed that the chronic use of pain medication was associated with significantly reduced olfactory function and perception of intranasal trigeminal stimuli compared to age-matched controls without intake of analgesics. Non-opioid and opioid drugs did not differ in their effects on chemosensory function.

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Disrupted self-perception in people with chronic low back pain. Further evaluation of The Fremantle Back Awareness Questionnaire

Several lines of evidence suggest that body-perception is altered in people with chronic back pain. Maladaptive perceptual awareness of the back might contribute to the pain experience as well as serve as a target for treatment. The Fremantle Back Awareness Questionnaire (FreBAQ) is a simple questionnaire recently developed to assess back-specific altered self-perception. The aims of this study were to present the outcomes of a comprehensive evaluation of the questionnaire’s psychometric properties and explore the potential relationships between body-perception, nociceptive sensitivity, distress and beliefs about back pain and the contribution these factors might play in explaining pain and disability.

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Is there a relationship between lumbar proprioception and low back pain? A systematic review with meta-analysis

Wheelchair Skills Capacity and Performance of Manual Wheelchair Users with Spinal Cord Injury

Community programme reduces depression in patients with chronic pain, study shows

A community based programme helping patients to use a cognitive behavioural approach to manage chronic pain reduced depression but not pain related disability over 12 months, a UK study has...

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Functional interaction between orexin-1 and CB1 receptors in the periaqueductal gray matter during antinociception induced by chemical stimulation of the lateral hypothalamus in rats

Abstract

Background

Chemical stimulation of the lateral hypothalamus (LH) with carbachol induces antinociception which is antagonized by blockade of orexin receptors in some pain modulatory sites in the tail-flick test. In this study, we evaluated the role of orexin-1 and CB1 receptors in the periaqueductal gray matter (PAG), a critical pain modulatory site, in mediation of antinociceptive responses induced by LH stimulation in rats.

Methods

One hundred thirty-two adult male albino Wistar rats weighing 180–250 g were unilaterally implanted with two separate cannulae into the LH and ventrolateral PAG (vlPAG). Intra-vlPAG administration of SB334867, as a selective orexin-1 receptor antagonist (0.5, 1.5, 5, 15 and 50 nM), or AM251, as a selective CB1 receptor antagonist (1, 3, 10, 30 and 100 nM), was performed just 5 min before carbachol (125 nM) microinjection into the LH.

Results

Our findings showed that SB334867 or AM251 administration dose dependently prevented the development of LH-induced antinociception in rats. Treatment with two antagonists at the same time could not intensify their effects in comparison with separate administration of antagonists.

Conclusion

It seems that antinociceptive effect of intra-LH administration of carbachol is mediated, at least partially, through the activation of orexin-1 and CB1 receptors in the vlPAG.

Significance

This work demonstrates a pain modulatory role of the orexinergic system via the PAG in hypothalamic-mediated analgesia suggesting that orexins can be advantageously targeted to achieve analgesia.

What does this study add?

OX1 receptor antagonist (SB334867) administration into the ventrolateral periaqueductal gray matter (vlPAG) dose dependently blocked the carbachol-induced antinociception. CB1 receptor antagonist (AM251) microinjection in the vlPAG prevented carbachol-induced antinociception in a dose-dependent manner. Concurrent administration of SB334867 and AM251 into the vlPAG did not reinforce the antinociceptive responses.

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Cleavage of SNAP-25 ameliorates cancer pain in a mouse model of melanoma

Abstract

Background

Cancer pain is associated with increased pain sensitivity to noxious (hyperalgesia) and normally innocuous (allodynia) stimuli due to activation of nociceptors by tumour-derived mediators or tumour infiltration of nerves. The pain sensitization is accompanied by modifications in gene expression, but specifically regulated genes are largely unknown. The 25 kDa synaptosomal-associated protein (SNAP-25) is involved in chemical neurotransmission at the synaptic cleft. Its inhibition by Botulinum neurotoxin A (BoNT/A) has been associated with antinociceptive effects in migraine, inflammatory and neuropathic pain. However, its potential to reduce tumour-associated pain remains to be clarified.

Methods

We applied a melanoma model of tumour pain in C57BL/6 mice and investigated SNAP-25 expression and regulation by qRT-PCR, Western Blot and immunofluorescence as well as tumour-associated mechanical allodynia with and without BoNT/A treatment.

Results

We found increased SNAP-25 expression in the dorsal root ganglia and the sciatic nerve. Intraplantar injection of BoNT/A induced the cleavage of SNAP-25 in these tissues and was associated with decreased mechanical allodynia after therapeutic treatment at early and late stages of tumour pain while the tumour size was not affected.

Conclusions

Our data indicate that SNAP-25 plays a role in tumour pain but has no influence on the initiation and progression of skin cancer. Its cleavage inhibits the development of allodynia in the mouse melanoma model and might be useful as new therapeutic approach for the treatment of cancer pain.

What does this study add?

SNAP-25 is differentially regulated during melanoma-induced tumour pain. Its cleavage by BoNT/A might be a suitable therapeutic option for tumour pain patients since tumour-associated pain can be strongly and significantly reduced after preventive and therapeutic BoNT/A treatment, respectively.

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Establishment of cutpoints to categorize the severity of chronic pain using composite ratings with Rasch analysis

Abstract

Background

Establishment of cutpoints for classifying mild, moderate and severe pain is commonly based on single rating of worst or average pain. However, single pain measure may serve as a brief and partial surrogate for composite pain ratings. This study aimed to base composite pain ratings to establish optimal cutpoint that maximized the difference of pain interference on daily function and compare its utility with those based on single worst and average pain.

Methods

Data were from a cohort study of 322 patients with chronic pain. Brief pain inventory (including four items measuring the least, worst, average and current pain) was administered. Rasch analysis and Serlin et al.'s (Pain, 61, 1995, 277) method were used to derive optimal cutpoint.

Results

Rasch analysis calibrated the least, worst, average and current pain items into a unidimensional hierarchy and produced composite pain measurement. The optimal cutpoint for composite pain (mild, ≤4; moderate, >4−6; severe, >6−10 on the 0−10 numeric rating scale) differed from those cutpoints for worst (≤6; >6−8; >8−10) and average pain (≤5; >5−7; >7−10). The optimal cutpoint for composite pain was better able than those for worst and average pain to distinguish among groups on patient-rated pain quality and quality of life. The optimal cutpoint for average pain had better discriminant ability than that for worst pain.

Conclusion

The results suggest that using optimal cutpoint for composite pain may be useful to classify clinically important groups in patients with chronic pain and that average pain may be an alternative choice if a single item is used.

What does this study add?

Using composite pain, optimal classification for mild, moderate and severe pain exhibited better discriminant ability than using single worst/average pain. The difficulty hierarchy of the least, worst, average and current pain helps to screen people with irregular responses.

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Differential psychophysiological effects of operant and cognitive behavioural treatments in women with fibromyalgia

Abstract

Background

Determination of psychophysiological effects of operant behavioural (OBT) and cognitive behavioural treatment (CBT) for fibromyalgia patients.

Methods

One hundred and fifteen female patients randomized to OBT (N = 43), CBT (N = 42), or whole-body infrared heat (IH) (N = 30) were compared before and after group treatment as well as at 6- and 12-month follow-ups using intent-to-treat analysis (12 drop-outs). Thirty matched pain-free controls (CON) served as reference group for the initial psychophysiological analysis. Surface electromyogram (EMG), blood pressure, heart rate (HR) and skin conductance levels (SCL) were continuously recorded during adaptation, baseline, social conflict, mental arithmetic and relaxation tasks.

Results

At baseline, fibromyalgia patients showed higher SCL and HR, lower diastolic blood pressure and EMG in comparison to controls. OBT and CBT compared to IH significantly reduced pain intensity [OBT: effect size (ES) = 1.21 CI: 0.71–1.71, CBT: ES = 1.23, CI: 0.72–1.74]. OBT increased diastolic blood pressure [ES = 1.13, CI: 0.63–1.63 and CBT reduced SCL (ES) = −0.66, CI: −1.14–0.18] 12 months after treatment. Both CBT and OBT significantly increased EMG levels (OBT: ES = 0.97, CI: 0.48–1.46, CBT: ES = 1.17, CI: 0.67–1.68). In contrast, the IH group did not show any significant changes in the psychophysiological parameters.

Conclusion

Increased diastolic blood pressure and decreased pain after OBT suggest a reactivation of baroreflex-mechanisms in fibromyalgia and a normalization of the blood pressure and pain functional relationship. Reduced SCL following CBT may indicate reduced general arousal levels. Increased muscle tension after CBT and OBT suggest a normalization of physical parameters. The reduction in pain seems to be mediated by different psychophysiological processes, providing support for mechanism-based treatments might be indicated for CBT and OBT.

What does this study add?

• Differential physiological stress responses followed different psychological interventions.
• While OBT influenced blood pressure by restoring blood pressure-pain interaction, CBT reduced stress-related sudomotor activity.
• These results implicate specific mediating mechanisms in fibromyalgia suggesting a basis for matching based on specific patient psychophysiological features.

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Predictors of Exercise Adherence in Patients with Meniscal Tear and Osteoarthritis

The outcome of Hip exercise in Patellofemoral Pain: A Systematic Review

Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in clinical practice. Current evidence shows that there are hip strength deficits, delayed onset and shorter activation of gluteus medius in people with PFP. The aim of this review was to systematically review the literature to investigate the outcome of hip exercise inpeople with PFP.

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Effects of Individualised Directional Preference Management Versus Advice For Reducible Discogenic Pain: A Pre-Planned Secondary Analysis of A Randomised Controlled Trial

Low back disorders are prevalent and directional preference management is a common treatment with mixed evidence for effectiveness.

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Fusion for lumbar spinal stenosis?

Patients with lumbar spinal stenosis (narrowing of the spinal canal causing compression of the nerve roots) present with a combination of low back pain and leg pain, numbness, and heaviness. The...

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[Comment] Offline: The uses of disease

Health is good. Disease is bad. So we are taught. The panoply of a doctor's education and training, indeed the whole hypertrophied industry of medicine, is founded on these two assumptions. But perhaps we should also view disease as an ally, a state to be explored, even cultivated. I do not mean we should tolerate pain or distress. Yet maybe disease creates possibilities for life that might otherwise be denied to us. In his Journals (July 25, 1930), André Gide wrote: “I believe that illnesses are the keys that can open certain doors for us.

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Post-traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research

Abstract

Background and objective

The co-occurrence of chronic pain and post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) has gained increasing research attention. Studies on associations among pain and PTSS or PTSD in youth have largely been conducted in the context of acute injury or trauma. Less is known about the risk for co-occurrence with paediatric chronic pain. In this review, we (1) propose a conceptual framework to outline factors salient during childhood that may be associated with symptom severity, co-occurrence and mutual maintenance, (2) present relevant literature on PTSS in youth with acute and chronic pain and identify research gaps and (3) provide recommendations to guide paediatric research examining shared symptomatology.

Databases and data treatment

Electronic databases (PubMed and Google Scholar) were used to identify relevant articles using the search terms ‘child, adolescent, paediatric, chronic pain, acute pain, post-traumatic stress symptoms and post-traumatic stress disorder’. Studies were retrieved and reviewed based on relevance to the topic.

Results

Our findings revealed that existing biobehavioural and ecological models of paediatric chronic pain lack attention to traumatic events or the potential development of PTSS. Paediatric studies are also limited by lack of a conceptual framework for understanding the prevalence, risk and trajectories of PTSS in youth with chronic pain.

Conclusions

Our new developmentally informed framework highlights individual symptoms and shared contextual factors that are important when examining potential associations among paediatric chronic pain and PTSS. Future studies should consider bidirectional and mutually maintaining associations, which will be aided by prospective, longitudinal designs.

What does this review add?

• This review presents relevant literature on pain and PTSS in youth and proposes a conceptual framework to examine factors salient during childhood that may be associated with symptom severity, comorbidity and mutual maintenance of chronic pain and PTSS in paediatric populations.
• We highlight dynamic factors that may change across children's development and provide recommendations to guide paediatric research examining potential associations among PTSS and chronic pain.

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An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis in the Treatment of Neuropathic Pain from Spinal Cord Injury and Disease

Using eight hour human laboratory experiments, we evaluated the analgesic efficacy of vaporized cannabis in patients with neuropathic pain related to injury or disease of the spinal cord, the majority of whom were experiencing pain despite traditional treatment. After obtaining baseline data, 42 participants underwent a standardized procedure for inhaling 4 puffs of vaporized cannabis containing either placebo, 2.9%, or 6.7% delta-9-tetrahydrocannabinol on three separate occasions. A second dosing occurred 3 hours later; participants chose to inhale 4 to 8 puffs.

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Pain hypersensitivity in congenital blindness is associated with faster central processing of C-fibre input

Abstract

Background

We have recently shown that visual deprivation from birth exacerbates responses to painful thermal stimuli. However, the mechanisms underlying pain hypersensitivity in congenital blindness are unclear.

Methods

To study the contribution of Aδ- and C-fibres in pain perception, we measured thresholds and response times to selective C- and Aδ-fibre activation in congenitally blind, late blind and normally sighted participants. Ultrafast constant-temperature heat pulses were delivered to the hand with a CO₂ laser using an interleaved adaptive double staircase procedure. Participants were instructed to respond as quickly as possible when detecting a laser-induced sensation. We used a 650 ms cut-off criterion to distinguish fast Aδ- from slow C-fibre–mediated sensations.

Results

Congenitally blind participants showed significantly faster reaction times to C- but not to Aδ-fibre–mediated sensations. In contrast, thresholds for Aδ- and C-fibre stimulation did not differ between groups. Late blind individuals did not differ from sighted controls in any aspect. A follow-up experiment using only suprathreshold stimuli for Aδ- and C-fibre activation confirmed these findings and further showed that congenitally blind individuals detected significantly more C-fibre–mediated stimuli than sighted controls. A decomposition analysis of the reaction times indicated that the faster response times in the congenitally blind are due to more efficient central processing of C-fibre–mediated sensations.

Conclusion

The increased sensitivity to painful thermal stimulation in congenital blindness may be due to more efficient central processing of C-fibre–mediated input, which may help to avoid impending dangerous encounters with stimuli that threaten the bodily integrity.

What does this study add?

• Hypersensitivity to heat pain in congenital blindness is associated with faster responses to C-fibre activation, likely caused by more efficient central processing of C-fibre–mediated input.

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D1- and D2-like dopamine receptors within the nucleus accumbens contribute to stress-induced analgesia in formalin-related pain behaviours in rats

Abstract

Background

Stressful experiences can produce analgesia, termed stress-induced analgesia (SIA). Meanwhile, it has been widely established that the mesolimbic dopamine pathway and nucleus accumbens (NAc) have a profound role in pain modulation. In this study, we examined the role of accumbal dopamine receptors in antinociception caused by forced swim stress (FSS) in order to understand more about the function of these receptors within the NAc in FSS-induced analgesia.

Method

Stereotaxic surgery was unilaterally performed on adult male Wistar rats weighing 230–250 g (some on the left and some on the right side of the midline). Two supergroups were microinjected into the NAc with a D1-like dopamine receptor antagonist, SCH-23390, at doses of 0.25, 1 and 4 μg/0.5 μl saline per rat or Sulpiride as a D2-like dopamine receptor antagonist at the same doses [0.25, 1 and 4 μg/0.5 μl dimethyl sulfoxide (DMSO) per rat]; while their controls just received intra-accumbal saline or DMSO at 0.5 μl, respectively. The formalin test was performed after rats were subjected to FSS (6 min, 25 ± 1 °C) to assess pain-related behaviours.

Results

The results demonstrated that intra-accumbal infusions of SCH-23390 and Sulpiride dose-dependently reduced FSS-induced antinociception in both phases of the formalin test. However, the percentage decrease in area under the curve (AUC) values calculated for treatment groups compared to formalin-control group was more significant in the late phase than the early phase.

Conclusion

Our findings suggest that D1- and D2-like dopamine receptors in the NAc are involved in stress-induced antinociceptive behaviours in the formalin test as an animal model of persistent inflammatory pain.

What does this study add

• Forced swim stress (FSS) induces the antinociception in both phases of formalin test.
• Blockade of accumbal dopamine receptors attenuate the antinociception induced by FSS.
• Stress-induced analgesia is dose-dependently reduced by dopamine receptor antagonists in both phases, although it is more prominent during the late phase.

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In sickness and in health: A cross-sectional analysis of concordance for musculoskeletal pain in 13,507 couples

Abstract

Background

Musculoskeletal pain conditions are common and create substantial burden for the individual and society. While research has shown concordance between couples for risk of some diseases, e.g. heart disease or diabetes, little information is available on such effects for musculoskeletal pain conditions. Our aims were to investigate the presence of concordance between couples for consultations about pain, and to examine theoretical influences on such concordance.

Methods

This was a 1-year cross-sectional study of musculoskeletal pain consultations in a UK primary care database. In total 27,014 patients (13,507 couples) aged between 30 and 74 years were included. The main outcome measure was the presence of a musculoskeletal morbidity read code indicating a consultation for musculoskeletal conditions (any, back, neck, knee, shoulder, foot, osteoarthritis). Logistic regression was used to test associations with odds ratios (OR) and 95% confidence intervals (95% CI).

Results

Patients whose partner had a musculoskeletal pain consultation were also more likely to consult for a musculoskeletal condition (OR 1.22, 95% CI 1.12–1.32). This association was found to be strongest for shoulder disorders (OR 1.91, 95% CI 1.06–3.47). No significant associations were found for other pain conditions.

Conclusion

Results show that partner concordance is present for consultations for some musculoskeletal conditions but not others. Possible explanations for concordance include the shared health behaviours between couples leading to potential heightened awareness of symptoms. Given the high prevalence of musculoskeletal pain within populations, it may be worth considering further the mechanisms that explain partner concordance.

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Body space in social interactions: a comparison of reaching and comfort distance in immersive virtual reality.

Related Articles

Body space in social interactions: a comparison of reaching and comfort distance in immersive virtual reality.

PLoS One. 2014;9(11):e111511

Authors: Iachini T, Coello Y, Frassinetti F, Ruggiero G

Abstract
BACKGROUND: Do peripersonal space for acting on objects and interpersonal space for interacting with con-specifics share common mechanisms and reflect the social valence of stimuli? To answer this question, we investigated whether these spaces refer to a similar or different physical distance.
METHODOLOGY: Participants provided reachability-distance (for potential action) and comfort-distance (for social processing) judgments towards human and non-human virtual stimuli while standing still (passive) or walking toward stimuli (active).
PRINCIPAL FINDINGS: Comfort-distance was larger than other conditions when participants were passive, but reachability and comfort distances were similar when participants were active. Both spaces were modulated by the social valence of stimuli (reduction with virtual females vs males, expansion with cylinder vs robot) and the gender of participants.
CONCLUSIONS: These findings reveal that peripersonal reaching and interpersonal comfort spaces share a common motor nature and are sensitive, at different degrees, to social modulation. Therefore, social processing seems embodied and grounded in the body acting in space.

PMID: 25405344 [PubMed - indexed for MEDLINE]