Allergic lymphangitis

A 9 year old boy presented with a rash that had appeared suddenly on both feet. He mentioned pruritus without pain. Two days previously he had been bitten on the feet by mosquitoes. Examination...

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Hip pain in a middle aged woman

A 52 year old woman with a history of breast cancer has pain in her right hip after a minor fall. What does the radiograph of her right hip (fig 1) show?bmj;355/nov30_2/i6129/F1F1f1Fig 1 Radiograph...

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Efficacy, acceptability and safety of guided imagery/hypnosis in fibromyalgia – A systematic review and meta-analysis of randomized controlled trials

Abstract

This systematic review aimed at evaluating the efficacy, acceptability and safety of guided imagery/hypnosis (GI/H) in fibromyalgia. Cochrane Library, MEDLINE, PsycINFO and SCOPUS were screened through February 2016. Randomized controlled trials (RCTs) comparing GI/H with controls were analysed. Primary outcomes were ≥50% pain relief, ≥20% improvement of health-related quality of life, psychological distress, disability, acceptability and safety at end of therapy and 3-month follow-up. Effects were summarized by a random effects model using risk differences (RD) or standardized mean differences (SMD) with 95% confidence intervals (CI).Seven RCTs with 387 subjects were included into a comparison of GI/H versus controls. There was a clinically relevant benefit of GI/H compared to controls on ≥50% pain relief [RD 0.18 (95% CI 0.02, 0.35)] and psychological distress [SMD −0.40 (95% CI −0.70, −0.11)] at the end of therapy. Acceptability at the end of treatment for GI/H was not significantly different to the control. Two RCTs with 95 subjects were included in the comparison of hypnosis combined with cognitive behavioural therapy (CBT) versus CBT alone. Combined therapy was superior to CBT alone in reducing psychological distress at the end of therapy [SMD −0.50 (95% CI −0.91, −0.09)]. There were no statistically significant differences between combined therapy and CBT alone in other primary outcomes at the end of treatment and follow-up. No study reported on safety. GI/H hold promise in a multicomponent management of fibromyalgia.

Significance

We provide a systematic review with meta-analysis on guided imagery and hypnosis for fibromyalgia. Current analyses endorse the efficacy and tolerability of guided imagery/hypnosis and of the combination of hypnosis with cognitive–behavioural therapy in reducing key symptoms of fibromyalgia.

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Pain-related Rumination, but not Magnification or Helplessness, Mediates Race and Sex Differences in Experimental Pain

Compared to White individuals and men, Black individuals and women demonstrate a lower tolerance for experimental pain stimuli. Previous studies suggest that pain catastrophizing is important in this context, but little is known about which components of catastrophizing contribute to these race and sex differences. The purpose of the current study was to examine the individual components of catastrophizing (rumination, magnification, and helplessness) as candidate mediators of race and sex differences in experimental pain tolerance.

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The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms

The development of chronic pain following surgery is a major clinical problem that provides an opportunity to study the transition from acute to chronic pain at both epidemiologic and basic science levels. Strategic, coordinated, multidisciplinary research efforts targeting mechanisms of pain chronification can to help minimize or eliminate persistent postsurgical pain.

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Prescription Opioid Taper Support for Outpatients with Chronic Pain: A Randomized Controlled Trial

Patients receiving long-term opioid therapy for chronic pain and interested in tapering their opioid dose were randomly assigned to a 22-week taper support intervention (psychiatric consultation, opioid dose tapering, and 18 weekly meetings with a physician assistant to explore motivation for tapering and learn pain self-management skills) or usual care (N=35). Assessments were conducted at baseline and 22 and 34 weeks after randomization. Using an intention-to-treat approach, we constructed linear regression models to compare groups at each follow-up.

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An investigation into the inhibitory function of serotonin in diffuse noxious inhibitory controls in the neuropathic rat

Abstract

Background

Following neuropathy α2-adrenoceptor-mediated diffuse noxious inhibitory controls (DNIC), whereby a noxious conditioning stimulus inhibits the activity of spinal wide dynamic range (WDR) neurons, are abolished, and spinal 5-HT7 receptor densities are increased. Here, we manipulate spinal 5-HT content in spinal nerve ligated (SNL) animals and investigate which 5-HT receptor mediated actions predominate.

Methods

Using in vivo electrophysiology we recorded WDR neuronal responses to von frey filaments applied to the hind paw before, and concurrent to, a noxious ear pinch (the conditioning stimulus) in isoflurane-anaesthetised rats. The expression of DNIC was quantified as a reduction in WDR neuronal firing in the presence of conditioning stimulus and was investigated in SNL rats following spinal application of (1) selective serotonin reuptake inhibitors (SSRIs) citalopram or fluoxetine, or dual application of (2) SSRI plus 5-HT7 receptor antagonist SB269970, or (3) SSRI plus α2 adrenoceptor antagonist atipamezole.

Results

DNIC were revealed in SNL animals following spinal application of SSRI, but this effect was abolished upon joint application of SSRI plus SB269970 or atipamezole.

Conclusions

We propose that in SNL animals the inhibitory actions (quantified as the presence of DNIC) of excess spinal 5-HT (presumed present following application of SSRI) were mediated via 5-HT7 receptors. The anti-nociception depends upon an underlying tonic noradrenergic inhibitory tone via the α2-adrenoceptor.

Significance

Following neuropathy enhanced spinal serotonin availability switches the predominant spinal 5-HT receptor-mediated actions but also alters noradrenergic signalling. We highlight the therapeutic complexity of SSRIs and monoamine modulators for the treatment of neuropathic pain.

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Spinal cord stimulation in experimental chronic painful diabetic polyneuropathy: Delayed effect of High-frequency stimulation

Abstract

Background

Spinal cord stimulation (SCS) has been shown to provide pain relief in painful diabetic polyneuropathy (PDPN). As the vasculature system plays a great role in the pathophysiology of PDPN, a potential beneficial side-effect of SCS is peripheral vasodilation, with high frequency (HF) SCS in particular. We hypothesize that HF-SCS (500 Hz), compared with conventional (CON) or low frequency (LF)-SCS will result in increased alleviation of mechanical hypersensitivity in chronic experimental PDPN.

Methods

Diabetes was induced in 8-week-old female Sprague–Dawley rats with an intraperitoneal injection of 65 mg/kg of streptozotocin (n = 44). Rats with a significant decrease in mechanical withdrawal response to von Frey filaments over a period of 20 weeks were implanted with SCS electrodes (n = 18). Rats were assigned to a cross-over design with a random order of LF-, CON-, HF- and sham SCS and mechanical withdrawal thresholds were assessed with von Frey testing.

Results

Compared with sham treatment, the average 50% WT score for 5 Hz was 4.88 g higher during stimulation (p = 0.156), and 1.77 g higher post-stimulation (p = 0.008). CON-SCS resulted in 50% WT scores 5.7 g, and 2.51 g higher during (p = 0.064) and after stimulation (p < 0.004), respectively. HF-SCS started out with an average difference in 50% WT score compared with sham of 1.87 g during stimulation (p = 0.279), and subsequently the steepest rise to a difference of 5.47 g post-stimulation (p < 0.001).

Conclusions

We demonstrated a delayed effect of HF-SCS on mechanical hypersensitivity in chronic PDPN animals compared with LF-, or CON-SCS.

Significance

This study evaluates the effect of SCS frequency (5–500 Hz) on mechanical hypersensitivity in the chronic phase of experimental PDPN. High frequency (500 Hz) – SCS resulted in a delayed effect- on pain-related behavioural outcome in chronic PDPN.

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Addition of a Sagittal Cervical Posture Corrective Orthotic Device to a Multimodal Rehabilitation Program Improves Short- and Long-Term Outcomes in Patients With Discogenic Cervical Radiculopathy

Difficulty in Identifying Factors Responsible for Pressure Ulcer Healing in Veterans With Spinal Cord Injury

Disability in Adolescents and Adults Diagnosed With Hypermobility-Related Disorders: A Meta-Analysis

Psychometric Measurement Properties and Clinical Utility of the Keele STarT Back Screening Tool in People With Low Back Pain

An older man with thoracic back pain

A 76 year old man with a history of prostate cancer presented to his general practitioner with increasing mid thoracic back pain. Radiographs of the thoracic spine were obtained (fig 1).What do these...

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Increased Risk of New-Onset Fibromyalgia among Chronic Osteomyelitis Patients: Evidence from a Taiwan Cohort Study

Chronic inflammation, which changes the neurotransmitter metabolism and kindles neuroendocrine system dysfunction in central nervous system, might cause fibromyalgia (FM) formation. In FM patients without traditional FM risk factors, such as hypertension, hyperlipidemia, diabetes, sleep disorder, depression, and anxiety, chronic inflammatory process is a possible risk factor for FM. Thus, we investigated whether chronic osteomyelitis (COM), a disease characterized by chronic inflammation, increases FM risk.

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Testing assumptions in human pain models: Psychophysical differences between first and second pain

Acute pain arises from activation of myelinated (A delta) and unmyelinated (C) nociceptive afferents, leading to 1st (A-fiber) or 2nd (C-fiber) pain sensations. The current study sought to investigate first and second pain within glabrous and hairy skin sites in human upper-limbs. Fifty healthy adults (25 males/25 females, 18-30 yrs: mean = 20.5 ± 1.4) participated in a psychophysical study investigating electronically rated, thermal first and second pain sensations within the glabrous skin at the palm and hairy skin of the forearm.

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Conditioned pain modulation and pressure pain sensitivity in the adult Danish general population: The DanFunD study

Increased pressure pain sensitivity and impaired descending pain control have been associated with chronic pain, but knowledge on the variability in the adult general population is lacking.Pressure pain thresholds (PPTs) and descending pain control as assessed by conditioning pain modulation (CPM) were recorded in a randomly selected sample (n=2199, 53% females) of the Danish adult general population aged 18-70 years. PPTs were recorded over the tibialis anterior muscle and the upper trapezius muscle.

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Severe Pain in Veterans: The Impact of Age and Sex, and Comparisons to the General Population

This study provides national prevalence estimates of US military Veterans with severe pain, and compares Veterans to nonveterans of similar age and sex. Data used are from the 2010-2014 National Health Interview Survey (NHIS) on 67,696 adults who completed the Adult Functioning and Disability (AFD) Supplement. Participants with severe pain were identified using a validated pain severity coding system imbedded in the NHIS AFD. It was estimated that 65.5% of US military Veterans reported pain in the previous 3 months, with 9.1% classified as having severe pain.

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AAPT Diagnostic Criteria for Chronic Cancer Pain Conditions

Chronic cancer pain is a serious complication of malignancy or its treatment. Currently, no comprehensive, universally accepted cancer pain classification system exists. Clarity in classification of common cancer pain syndromes would improve clinical assessment and management. Moreover, an evidence-based taxonomy would enhance cancer pain research efforts by providing consistent diagnostic criteria, ensuring comparability across clinical trials. As part of a collaborative effort between the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) and the American Pain Society (APS), the ACTTION-APS Pain Taxonomy (AAPT) initiative worked to develop the characteristics of an optimal diagnostic system.

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Demographic Predictors of Pain Sensitivity: Results from the OPPERA Study

The demographic factors of sex, age, and race/ethnicity are well recognized as relevant to pain sensitivity and clinical pain expression.Of these, sex differences have been the most frequently studied, and most of the literature describes greater pain sensitivity for women.The other two factors have been less frequently evaluated, and current literature is not definitive.Taking advantage of the large OPPERA study cohort, we evaluated the association of sex, age, and self-reported race with 34 measures of pressure, mechanical, and thermal pain sensitivity encompassing both threshold and suprathreshold perception.Women were significantly more pain sensitive than men for 29/34 measures.Age effects were small, and only significant for 7/34 measures, however the age range was limited (18-44 y.o.).Race/ethnicity differences varied across groups and pain assessment type.Non-Hispanic whites (NHW) were less pain sensitive than African-Americans (for 21/34 measures), Hispanics (19/34), and Asians (6/34).No pain threshold measure showed significant racial differences, while several suprathreshold pain measures did.This suggests that racial differences are not related to tissue characteristics or inherent nociceptor sensitivity.Rather, the differences observed for suprathreshold pain ratings or tolerance are more likely related to differences in central nociceptive processing, including modulation imposed by cognitive, psychological, and/or affective factors.

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Baseline Patient-Reported Outcomes Correlate Weakly With Radiographic Parameters: A Multicenter, Prospective NIH Adult Symptomatic Lumbar Scoliosis Study of 286 Patients

Study Design. Prospective, cross-sectional study. Objective. The aim of the study was to determine which radiographic parameters drive patient-reported outcomes (PROs) in primary presentation adult symptomatic lumbar scoliosis (ASLS). Summary of Background Data. Previous literature suggests correlations between PROs and sagittal plane deformity (sagittal vertical axis [SVA], pelvic incidence-lumbar lordosis [PI-LL] mismatch, pelvic tilt [PT]). Prior work included revision and primary adult spinal deformity patients. The present study addresses only primary presentation ASLS. Methods. Prospective baseline data were analyzed on 286 patients enrolled in an NIH RO1 clinical trial by nine centers from 2010 to 2014. Inclusion criteria: 40 to 80 years old, lumbar Cobb (LC) 30° or higher and Scoliosis Research Society-23 score 4.0 or less in Pain, Function or Self-Image domains, or Oswestry Disability Index (ODI) 20 or higher. Patients were primary presentation (no prior spinal deformity surgery) and had complete baseline data: standing coronal/sagittal 36” radiographs and PROs (ODI, Scoliosis Research Society-23, Short Form-12). Correlation coefficients were calculated to evaluate relations between radiographic parameters and PROs for the study population and a subset of patients with ODI 40 or higher. Analysis of variance was used to identify differences in PROs for radiographic modifier groups. Results. Mean age was 60.3 years. Mean spinopelvic parameters were: LL = −39.2°; SVA = 3.1 cm; sacral slope = 32.5°; PT = 23.9°; PI-LL mismatch = 16.8°. Only weak correlations (0.2–0.4) were identified between population sacral slope, SVA and SVA modifiers, and SRS function. SVA and SVA modifiers were weakly associated with ODI. Although there were more correlations in subset analysis of high-symptom patients, all were weak. Analysis of variance identified significant differences in ODI reported by SVA modifier groups. Conclusion. In primary presentation patients with ASLS and a subset of “high-symptom” patients (ODI ≥ 40), only weak associations between baseline PROs and radiographic parameters were identified. For this patient population, these results suggest regional radiographic parameters (LC, LL, PT, PI-LL mismatch) are not drivers of PROs and cannot be used to extrapolate effect on patient-perceived pathology. Level of Evidence: 2

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Randomized, Double-blind, Placebo-controlled Phase III Trial of Duloxetine Monotherapy in Japanese Patients With Chronic Low Back Pain

Study Design. A 14-week, randomized, double-blind, multicenter, placebo-controlled study of Japanese patients with chronic low back pain (CLBP) who were randomized to either duloxetine 60 mg once daily or placebo. Objective. This study aimed to assess the efficacy and safety of duloxetine monotherapy in Japanese patients with CLBP. Summary of Background Data. In Japan, duloxetine is approved for the treatment of depression, diabetic neuropathic pain, and pain associated with fibromyalgia; however, no clinical study of duloxetine has been conducted for CLBP. Methods. The primary efficacy measure was the change in the Brief Pain Inventory (BPI) average pain score from baseline to Week 14. Secondary efficacy measures included BPI pain (worst pain, least pain, pain right now), Patient's Global Impression of Improvement, Clinical Global Impressions of Severity, and Roland-Morris Disability Questionnaire, among other measures, and safety and tolerability. Results. In total, 458 patients were randomized to receive either duloxetine (n = 232) or placebo (n = 226). The BPI average pain score improved significantly in the duloxetine group compared with that in the placebo group at Week 14 [−2.43 ± 0.11 vs. −1.96 ± 0.11, respectively; between-group difference (95% confidence interval), − 0.46 [−0.77 to−0.16]; P = 0.0026]. The duloxetine group showed significant improvement in many secondary measures compared with the placebo group, including BPI pain (least pain, pain right now) (between-group difference: −1.69 ± 0.10, P = 0.0009; −2.42 ± 0.12, P P = 0.0230, respectively), Patient's Global Impression of Improvement (2.46 ± 0.07, P = 0.0026), Clinical Global Impressions of Severity (−1.46 ± 0.06, P = 0.0019), and Roland-Morris Disability Questionnaire (−3.86 ± 0.22, P = 0.0439). Adverse events occurring at a significantly higher incidence in the duloxetine group were somnolence, constipation, nausea, dizziness, and dry mouth, most of which were mild or moderate in severity and were resolved or improved. Conclusion. Duloxetine 60 mg was effective and well tolerated in Japanese CLBP patients. Level of Evidence: 2

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Longitudinal Assessment of Self-Reported Recent Back Pain and Combat Deployment in the Millennium Cohort Study

Study Design. A prospective cohort study. Objective. Activities performed during military operations vary in complexity and physical demand. The risk for mental illness following military combat deployment has been well documented. However, information regarding the possible contribution of back pain to decreased mental and functional health is scarce. To our knowledge, this is the first study to prospectively assess deployment and self-reported recent back pain in a population-based U.S. military cohort. Summary of Background Data. The study consisted of Millennium Cohort participants who were followed for the development of back pain for an average of 3.9 years. Methods. Descriptive statistics and longitudinal analyses were used to assess the temporal relationship of deployment with self-reported recent back pain at follow-up (N = 53,933). Results. Recent back pain was self-reported by 8379 (15.5%) participants at follow-up. After adjusting for covariates, deployers with combat experiences had higher odds [odds ratio (OR) = 1.38, 95% confidence interval (95% CI): 1.28–1.50] of recent back pain than noncombat deployers. There was no association between recent back pain and nondeployers compared with noncombat deployers. Service support/supply handlers were at an increased odds of reporting recent back pain (OR = 1.11, 95% CI: 1.02–1.21) than functional support/administration occupations. Occupations associated with a physically demanding work environment had a higher risk of back pain. Conclusion. Deployers with combat experiences were more likely to report back pain postdeployment. This well-defined group of military personnel may potentially benefit from integrated prevention efforts. Level of Evidence: 3

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Sex Life and Impact of Operative Intervention on Sex Life-related Pain in Degenerative Spinal Conditions: An Analysis of the SPORT Study

Study Design. This study is a therapeutic retrospective cohort study Objectives. This study aims to determine whether sexual function is relevant for patients with spinal stenosis (SPS) and degenerative spondylolisthesis (DS) and to determine the impact of operative inter vqAvention on sexual function for these patients. Summary of Background Data. The benefits of nonoperative versus operative treatment for patients with SPS and DS with regards to sexual function are unknown. Methods. Demographic, treatment, and follow-up data, including the Oswestry Disability Index (ODI), were obtained on patients enrolled in the SPORT study. Based on the response to question #9 in the ODI, patients were classified into a sexual life relevant (SLR) or sexual life not relevant (NR) group. Univariate and multivariate analysis of patient characteristics comparing the NR and SLR group were performed. Operative treatment groups were compared to the nonoperative group with regards to response to ODI question #9 to determine the impact of surgery on sexual function. Results. A total of 1235 patients were included to determine relevance of sex life. Three hundred sixty-six patients (29%) were included in the NR group. Eight hundred sixty-nine patients (71%) were included in the SLR group. Patients that were older, female, unmarried, had three or more stenotic levels, and had central stenosis were more likely to be in the NR group. Eight hundred twenty-five patients were included in the analysis comparing operative versus nonoperative treatment. At all follow-up time points, the operative groups had a lower percentage of patients reporting pain with their sex life compared to the nonoperative group (P < 0.05 at all time points except between more than one level fusion and nonoperative at 4 years’ follow-up). Conclusion. Sex life is a relevant consideration for the majority of patients with DS and SPS; operative treatment leads to improved sex life-related pain. Level of Evidence: 3

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Comorbidities that cause pain and the contributors to pain in individuals with chronic obstructive pulmonary disease

[Perspectives] Bending the rules

“All human life is there—joy, pain, honour, dishonour, revenge, temptation, self-destructive ambition.” You might imagine, especially in the light of current events, that playwright Jonathan Maitland is talking about politics. But the subject of his new play Deny Deny Deny is sport—a topic that, while common enough at the movies, is seldom tackled on stage.

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Effectiveness of an educational physiotherapy and therapeutical exercise program in adult patients with hemophilia. A randomized clinical trial

Severe abdominal pain in an 85 year old woman

An 85 year old woman was admitted to hospital with a rigid, mildly distended, severely painful abdomen and absent bowel sounds. She was in atrial fibrillation and was hypotensive. A computed...

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Differences in analgesic use in community-dwelling persons with and without Alzheimer's disease

Abstract

Background

There are conflicting findings about analgesic use among persons with cognitive impairment compared to cognitively intact older persons. The objective of our study was to investigate the prevalence of analgesic use in community-dwelling persons with and without Alzheimer's disease (AD), within six months after AD diagnosis and to find out factors associated with the use of analgesics and specific analgesic groups.

Method

We utilized data from register based MEDALZ (Medication use and Alzheimer's disease) cohort consisting of all community-dwelling persons diagnosed with AD during 2005–2011 in Finland and their matched comparison persons without AD. Altogether, 67,215 persons with AD and one comparison person for each case were included. Drug use data were collected from the Prescription Register and comorbidities from Special Reimbursement and Hospital Discharge Registers.

Results

Statistically significant (p < 0.001) yet mostly small differences were found for analgesics use: analgesics were used by 34.9% and 33.5% of persons with and without AD, respectively. Paracetamol was the most frequently used analgesic both among persons with (25.0%) and without AD (19.1%). Persons with AD used less frequently NSAIDs (Nonsteroidal Anti-inflammatory Drugs) (13.2% vs. 17.3%) and mild opioids (5.0% vs. 7.1%), while the use of strong opioids was more common in comparison to persons without AD (1.3% vs. 1.1%, respectively). Analgesic users were more likely women, aged ≥80 years, had asthma/COPD, cardiovascular disease, diabetes, cancer, hip fracture, osteoporosis, rheumatoid arthritis, and lower socioeconomic position.

Conclusion

Further studies are needed to evaluate the adequateness of pain relief in older persons with and without AD.

Significance

Persons with Alzheimer's disease (AD) used more frequently paracetamol and less frequently NSAIDs and mild opioids. A decreasing trend of NSAID use was observed among persons with AD during the study period.

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Abnormal brain responses to action observation in complex regional pain syndrome

Patients with complex regional pain syndrome (CRPS) display various abnormalities in central motor function, and their pain is intensified when they perform or just observe motor actions. Here, we examined the abnormalities of brain responses to action observation in CRPS. We analyzed 3-T functional magnetic resonance images from 13 upper-limb CRPS patients (all females, ages 31–58 years) and 13 healthy, age- and sex-matched control subjects. The functional magnetic resonance imaging data were acquired while the subjects viewed brief videos of hand actions shown in the first-person perspective.

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Chronic Fatigue Syndrome and Chronic Widespread Pain in Adolescence: Population birth cohort study

Whilst many studies have investigated the overlap between pain phenotypes and chronic fatigue syndrome (CFS) in adults, little is known about the relationship between these conditions in adolescents. The study's aim was therefore to identify whether a relationship exists between chronic widespread pain (CWP) and CFS in adolescents and investigate whether the two share common associations with a set of covariates. A questionnaire was administered to offspring of the Avon Longitudinal Study of Parents and Children at age 17, asking about site, duration, and pain intensity, from which participants with CWP were identified.

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Sustained morphine administration induces TRPM8 dependent cold hyperalgesia

It is not uncommon for patients chronically treated with opioids to exhibit opioid induced hyperalgesia (OIH), and this has been widely reported both clinically and experimentally. The molecular substrate for this hyperalgesia is multifaceted, and associated with a complex neural reorganization even in the periphery. For instance, we have recently shown that chronic morphine-induced heat hyperalgesia is associated with an increased expression of GluN2B containing N-methyl-D-aspartate (NMDA) receptors, as well as of the neuronal excitatory amino acid transporter 3/excitatory amino acid carrier 1, in small diameter primary sensory neurons only.

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Capsule-preserving hydrodilatation with corticosteroid versus corticosteroid injection alone in refractory adhesive capsulitis of shoulder: a randomized controlled trial

User-independent assessment of conditioning pain modulation by cuff pressure algometry

Abstract

Background

The use of conditioning pain modulation (CPM) is hampered by poor reproducibility and lack of user-independent paradigms. This study refined the CPM paradigm by applying user-independent cuff algometry.

Methods

In 20 subjects, the CPM effect of conditioning with cuff stimulation on the arm was investigated by pain test stimuli on the contralateral leg before and in parallel with different cuff conditionings (10, 30, 60 kPa/60 s; 30, 60 kPa/10 s). As test stimulus, another cuff was inflated (1 kPa/s) until the subjects detected the pain tolerance threshold (PTT) during which the pain detection threshold (PDT) and the pressure at a pain intensity of 6 cm on a 10-cm visual analogue scale (PVAS6) were extracted. For comparison, pressure pain thresholds (PPTs) as test stimuli were recorded by the user-dependent handheld pressure algometry. Combinations of cuff locations for conditioning (pain intensity standardized) and contralateral test stimuli were additionally evaluated (leg–arm, leg–leg, arm–thigh). The test–retest reliability in two sessions 1 month apart was assessed in five CPM protocols.

Results

In all protocols, the PDT, PVAS6 and PTT increased during conditioning compared with baseline (p < 0.05). The CPM effect (i.e. conditioning minus baseline) for PVAS6, PTT and PPT increased for increasing conditioning intensities (p < 0.05). The CPM effects were not significantly different for changes in conditioning durations or conditioning/test stimulus locations. In two sessions, the CPM effects for PVAS6 and PTT assessed after 60 s of conditioning on the leg/thigh showed the highest intra-class correlations (0.47–0.73), where they were 0.04–0.6 for PPTs.

Conclusions

The user-independent cuff algometry is reliable for CPM assessment and for supra-pain threshold test stimuli better than the user-dependent technology.

Significance

A user-independent CPM technique where the conditioning is controlled by one cuff stimulation, and the test-stimulus is provided by another cuff stimulation. This study shows that cuff algometry is reliable for CPM assessment.

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Bilateral experimental neck pain reorganize axioscapular muscle coordination and pain sensitivity

Abstract

Background

Neck pain is a large clinical problem where reorganized trunk and axioscapular muscle activities have been hypothesised contributing to pain persistence and pain hypersensitivity. This study investigated the effects of bilateral experimental neck pain on trunk and axioscapular muscle function and pain sensitivity.

Methods

In 25 healthy volunteers, bilateral experimental neck pain was induced in the splenius capitis muscles by hypertonic saline injections. Isotonic saline was used as control. In sitting, subjects performed slow, fast and slow-resisted unilateral arm movements before, during and after injections. Electromyography (EMG) was recorded from eight shoulder and trunk muscles bilaterally. Pressure pain thresholds (PPTs) were assessed bilaterally at the neck, head and arm. Data were normalized to the before-measures.

Results

Compared with control and post measurements, experimental neck pain caused (1) decreased EMG activity of the ipsilateral upper trapezius muscles during all but slow-resisted down movements (p < 0.001), and (2) increased EMG activity in the ipsilateral erector spinae muscle during slow and fast movements (p < 0.02), and in the contralateral erector spinae muscle during all but fast up and slow-resisted down movements (p < 0.007). The PPTs in the painful condition increased at the head and arm compared with post measurements and the control condition (p < 0.001). In the post-pain condition, the neck PPT was decreased compared with the control condition (p < 0.001).

Conclusion

Acute bilateral neck pain reorganized axioscapular and trunk muscle activity together with local hyperalgesia and widespread hypoalgesia indicating that acute neck pain immediately affects trunk and axioscapular function which may affect both assessment and treatment.

Significance

Bilateral clinical neck pain alters axioscapular muscle coordination but only effects of unilateral experimental neck pain has been investigated. Bilateral experimental neck pain causes task-dependent reorganized axioscapular and trunk muscle activity in addition to widespread decrease in pressure pain sensitivity.

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Abdominal pain after colonoscopy

A 43 year old woman was admitted to the surgical assessment unit with increasing abdominal pain 36 hours after a colonoscopy and polypectomy. On examination her abdomen was tender and mildly...

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