Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Brocha Stern, Chaya Schachter
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Jonathan Bray
Publication date: Available online 17 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Wanyi Qing, Xian Shi, Qing Zhang, Lihong Peng, Chengqi He, Quan Wei
Publication date: Available online 6 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Christine M. Orndahl, Robert A. Perera, Anna Hung, Levent Dumenci, Daniel L. Riddle
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Stanley Winser, Umar Bello, Priya Kannan
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Stanley Winser, Umar Bello
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): David Levine, Frank Tudini, Michael Healy
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Brocha Stern, Chaya Schachter
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Jonathan Bray
Publication date: Available online 17 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Wanyi Qing, Xian Shi, Qing Zhang, Lihong Peng, Chengqi He, Quan Wei
Publication date: Available online 6 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Christine M. Orndahl, Robert A. Perera, Anna Hung, Levent Dumenci, Daniel L. Riddle
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Stanley Winser, Umar Bello, Priya Kannan
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Stanley Winser, Umar Bello
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): David Levine, Frank Tudini, Michael Healy
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Brocha Stern, Chaya Schachter
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Jonathan Bray
Publication date: Available online 17 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Wanyi Qing, Xian Shi, Qing Zhang, Lihong Peng, Chengqi He, Quan Wei
Publication date: Available online 6 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Christine M. Orndahl, Robert A. Perera, Anna Hung, Levent Dumenci, Daniel L. Riddle
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Stanley Winser, Umar Bello, Priya Kannan
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Stanley Winser, Umar Bello
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): David Levine, Frank Tudini, Michael Healy
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Brocha Stern, Chaya Schachter
Publication date: April 2021
Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 4
Author(s): Jonathan Bray
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
Publication date: Available online 5 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Maria Orlando Edelen, Anthony Rodriguez, Patricia Herman, Ron D. Hays
As in other fields of medicine, development of new medications for management of neuropathic pain has been difficult since preclinical rodent models do not necessarily translate to the clinics. Aside from ongoing pain with burning or shock‐like qualities, neuropathic pain is often characterized by pain hypersensitivity (hyperalgesia and allodynia), most often towards mechanical stimuli, reflecting sensitization of neural transmission.
We therefore performed a systematic literature review (PubMed‐Medline, Cochrane, WoS, ClinicalTrials) and semi‐quantitative meta‐analysis of human pain models that aim to induce central sensitization, and generate hyperalgesia surrounding a real or simulated injury.
From an initial set of 1569 reports, we identified and analyzed 269 studies using more than a dozen human models of sensitization. Five of these models (intradermal or topical capsaicin, low‐ or high‐frequency electrical stimulation, thermode‐induced heat‐injury) were found to reliably induce secondary hyperalgesia to pinprick and have been implemented in multiple laboratories. The ability of these models to induce dynamic mechanical allodynia was however substantially lower. The proportion of subjects who developed hypersensitivity was rarely provided, giving rise to significant reporting bias. In four of these models pharmacological profiles allowed to verify similarity to some clinical conditions, and therefore may inform basic research for new drug development.
While there is no single “optimal” model of central sensitization, the range of validated and easy‐to‐use procedures in humans should be able to inform preclinical researchers on helpful potential biomarkers, thereby narrowing the translation gap between basic and clinical data.
Guidelines recommend self‐management for most people living with persistent musculoskeletal low back pain (PMLBP) when surgery is ruled out. Conveying this message to patients can be challenging. This study examined patients’ perceptions of reassuring communications from surgical spine team practitioners attempting to deliver this message in a single consultation.
Pre‐consultation baseline measures included levels of pain, disability, and previous consultation history. Patients perceptions of reassuring communications were measured within one‐week post consultation. The outcome variables, measured at 3‐month follow‐up, included patients report of subsequent GP visits for back pain, the number of other health care providers consulted for back pain, and distress.
Data from 296 patients (9.8% loss to follow up) was analysed using hierarchical regression models, controlling for demographic, clinical and study‐related factors. In each model, perceived reassurance accounted for a small but significant variance, above and beyond other predictors. Further GP visits were predicted by disability at baseline and perceived reassurance (adjusted R2 of 14.6%). Subsequent consultations with any health care professionals were predicted by a shorter duration of back pain, disability at baseline and perceived reassurance (adj. R2 = 10.6%). Distress was predicted by older age, disability and reassurance (adj. R2 = 59.5%).
Findings suggest that better communication in consultations with orthopaedic spine clinicians might help reduce unnecessary subsequent health care utilization and distress.
In recent years, the delivery of health services has undergone a major paradigm shift towards expanded outpatient services and widespread use of telemedicine. Post herpetic neuralgia (PHN) is a treatment recalcitrant neuropathic pain condition referring to pain persisting more than three months from the initial onset of an acute herpes zoster. QUTENZA® (capsaicin 8% patch) is a single 1‐hour localized treatment for PHN and can provide several months of pain relief per application. However, patient access to capsaicin 8% patch is limited due to sensitive handling protocols that require the patch application to occur under physicians or healthcare professionals under the close supervision of a physician. Herein, we describe the first successful treatment of PHN at‐home, using capsaicin 8% patch, performed under full supervision and instruction from a physician using video telehealth services.
Preclinical and clinical pain science have since long suffered from lack of joint ventures that, as securely as possible, have approached problems that are relevant for the understanding of clinical pain phenomenologies and treatment (Yezierski & Hansson, 2018), the core of translational pain medicine. The uncoupling of the two has led to loss of momentum and few novel efficacious treatment remedies where needed the most, i.e., in long term pain states. Here, the area of translational pain medicine is craving for a road map so that preclinical and clinical scientists can walk hand in hand into the future with a common agenda on how to approach the search for much needed improved treatment strategies.
Our group previously presented a case series aided by a three‐dimensional (3D) magnetic resonance imaging (MRI) reconstruction that described injection into the space of Okada as a possible cause of unsuccessful epidural analgesia or injection following the commonly used loss of resistance to air (LORA) technique (Reina et al., (2021).
Distraction tasks that place continuous, high demand on executive resources have been shown to reduce pain intensity and pain unpleasantness ratings in healthy adult samples. We examined the effects of a high‐demand ‘working memory’ 1‐back task compared to a low‐demand ‘motor control’ task on pain intensity and unpleasantness ratings in healthy children. Additionally, dispositional mindfulness was examined to explore the mechanisms of distraction on the affective processing of pain.
To examine these hypotheses 57 children (9‐13 years old) experienced 3 randomly presented heat levels (not painful, slightly painful, moderately painful) during 2 distraction conditions involving different levels of cognitive load (a high load ‘working memory’ task and a low load ‘motor’ control task) in counter‐balanced order. Children completed measures of dispositional mindfulness.
As predicted, children’s pain intensity and pain unpleasantness ratings were lower in the high load condition compared to the low load condition. These differences were amplified in the moderately painful heat trials. In contrast to predictions, dispositional mindfulness did not significantly predict the effectiveness of distraction. Dispositional mindfulness was significantly related to measures of children’s attentional and emotional control abilities; however, a serial mediation model did not produce significant indirect or overall effects to suggest a strong influence of mindfulness on the effectiveness of distraction.
Results demonstrate that distraction that places high demand on executive resources is more effective for acute pain management for children. Further research is needed to explore cognitive and affective moderators of the effectiveness of distraction for children.
Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size, suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesised that using virtual reality that alters hand image to match the patient’s desired hand appearance, would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect.
A blinded randomised controlled trial of 45 participants with refractory upper‐limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for one minute. The image was digitally altered according to the patient’s description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre and post‐intervention. A subgroup was followed up two weeks after a course of repeated interventions.
BPD (mean‐6, ±SD 7.9, p=0.036, effect size (ES)=0.6) and pain intensity (mean‐0.43, ±SD 1.3, p=0.047, ES=0.5) reduced in 23 participants after single exposure compared to controls (n=22). At follow‐up, the subgroup (experimental n=21; control n=18) showed sustained pain reduction only (p=0.037, ±SD 1.9, ES=0.7), with an overall 1.2 decrease on an 11‐point scale.
Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Further research to optimise this therapeutic effect is required.
Unlike motor symptoms, the effects of deep brain stimulation (DBS) on non‐motor symptoms associated with dystonia remain unknown.
The objective of this study was to assess the effects of DBS on evoked experimental pain and cutaneous sensory thresholds in a crossover, double‐blind on/off study and compare these results with those of healthy volunteers (HV).
Sixteen patients with idiopathic dystonia (39.9 ± 13 years old, n = 14 generalized) with DBS of the globus pallidus internus underwent a battery of quantitative sensory testing and assessment using a pain top‐down modulation system (conditioned pain modulation, CPM). Results for the more and less dystonic body regions were compared in on and off stimulation. The patients' results were compared to age‐ and sex‐matched HV. Descending pain modulation CPM responses in dystonic patients (on‐DBS, 11.8 ± 40.7; off‐DBS, 1.8 ± 22.1) was abnormally low (defective) compared to HV (−15.6 ± 23.5, respectively p = .006 and p = .042). Cold pain threshold and cold hyperalgesia were 54.8% and 95.7% higher in dystonic patients compared to HV. On‐DBS CPM correlated with higher Burke‐Fahn‐Marsden disability score (r = 0.598; p = .014). While sensory and pain thresholds were not affected by DBS on/off condition, pain modulation was abnormal in dystonic patients and tended to be aggravated by DBS.
The analgesic effects after DBS do not seem to depend on short‐duration changes in cutaneous sensory thresholds in dystonic patients and may be related to changes in the central processing of nociceptive inputs.
This study determines the prevalence and particularities of headache and pain with neuropathic characteristics (NC) in a large French group of patients with pituitary adenoma (PA).
Analysis of validated self‐administered questionnaires, radiological characteristics and treatment strategies of PA was performed.
Of the 221 sent questionnaires, 146 could be used for statistical analysis, 50% of which were completed by women. Among responders, 58.9% had pain: 30.1% migraine, 15.7% pain with NC and 13.1% other types of pain. Migraine was more common in patients with PA than in the general population (30.1% vs. 21.3%, p = .010) and attacks received appropriate treatment for less than 20% of these patients. Furthermore, the prevalence of chronic migraine was much higher than in the general population (6.8% vs. 2.2%, p = .003). Neuropathic pain was also more frequent in PA patients than in the general population (15.8% vs. 6.9%, p < .001). Neuropathic pain was most often located in the extremities and was frequently described as an ‘electric shock’, ‘numbness’, or ‘pins‐and‐needles’. Multivariate analyses linked migraine to younger age, anxiety, pain with NC, and a visible tumour on MRI, regardless of its invasiveness or secretory nature.
Migraine headaches and neuropathic pain are more frequent and disabling in PA patients than in the general population. Both types of pain are comorbid in PA patients and are poorly treated. Migraine is associated with the presence of a tumour. Thus, biological mechanisms of this relationship need to be characterized to design optimal treatments for these individuals.
Migraine headaches and neuropathic pain are more common in PA patients than in the general population and are generally poorly treated. A systematic screening for migraine should be done by physicians in daily practice to provide adequate therapeutics.
Massive screening campaigns for SARS‐CoV‐2 are currently carried out throughout the world, relying on reverse‐transcriptase‐polymerase chain reaction (RT‐PCR) following nasopharyngeal swabbing performed by a healthcare professional. Yet, due to the apprehension of pain induced by nasopharyngeal probing, poor adhesion to those screening campaigns can be observed. To enhance voluntary participation and to avoid unnecessary exposition to SARS‐CoV‐2, self‐swabbing could be proposed. To date, no data have been published concerning pain induced by conventional‐ or self‐swabbing. Thus, the primary objective of the present study was to evaluate pain induced with the conventional swabbing method and compare it to self‐swabbing. Secondary objectives focused on swabbing‐induced discomfort and acceptability of the two methods.
The study was conducted in Clermont‐Ferrand medical school (France). Overall, 190 students were randomised into two groups and experienced either self‐ or conventional‐swabbing. Each subject had to rate pain, discomfort and acceptability of such swabbing on a 0–10 numeric rating scale.
No significant difference was found between the two methods. The mean pain level was 2.5 ± 1.9, 28% rating pain as ≥4/10. Discomfort was 4.8 ± 2.2, 66% indicating significant (≥4/10) discomfort. Higher pain and discomfort were associated with female sex. Acceptability was ≥8/10 for 89.0% of the subjects and all would have accepted to undergo a new test with the same technique if necessary.
Both conventional and self‐swabbing induce low levels of pain for most young healthy volunteers whereas discomfort is very frequent. Nonetheless, both methods are indifferently well‐accepted in medical students. Future studies amongst symptomatic subjects are awaited.
Using the thinnest available swabs, procedural pain induced by nasopharyngeal swabbing for SARS‐CoV‐2 screening is very low for most subjects and should not limit voluntary participation in screening campaigns. Self‐swabbing does not lead to more pain or discomfort compared to conventional swabbing, is well‐accepted, and could be proposed to optimize screening campaigns, at least in healthcare professionals.
The rat mid‐thoracic contusion model has been used to study at‐level tactile allodynia, a common type of pain that develops after spinal cord injury (SCI). An important advantage of this model is that not all animals develop hypersensitivity. Therefore, it can be used to examine mechanisms that are strictly related to the development of pain‐like behaviour separately from mechanisms related to the injury itself. However, how to separate animals that develop hypersensitivity from those that do not is unclear.
The aims of the current study were to identify where hypersensitivity and spasticity develop and use this information to identify metrics to separate animals that develop hypersensitivity from those that do not to study differences in their behaviour. To accomplish these aims, a grid was used to localize hypersensitivity on the dorsal trunk relative to thoracic dermatomes and supraspinal responses to tactile stimulation were tallied. These supraspinal responses were used to develop a hypersensitivity score to separate animals that develop hypersensitivity, or pain‐like response to nonpainful stimuli.
Similar to humans, the development of hypersensitivity could occur with the development of spasticity or hyperreflexia. Moreover, the time course and prevalence of hypersensitivity phenotypes (at‐, above‐, or below level) produced by this model were similar to that observed in humans with SCI.
However, the amount of spared spinal matter in the cord did not explain the development of hypersensitivity, as previously reported. This approach can be used to study the mechanisms underlying the development of hypersensitivity separately from mechanisms related to injury alone.
Although evidence‐based psychological treatments for chronic pain (CP) have been demonstrated to be effective for a variety of outcomes, modest effects observed in recent reviews indicate scope for improvement. Self‐compassion promotes a proactive attitude towards self‐care and actively seeking relief from suffering. Consequently, more compassionate people experience better physical, psychological and interpersonal well‐being.
We conducted a single‐blind, randomized, controlled trial to examine the effects of a Mindful Self‐Compassion program (MSC) on relevant clinical outcomes in patients with CP. Patients were randomly assigned to one of the two intervention arms: MSC or cognitive‐behavioural therapy (CBT). The protocols of both intervention arms were standardized and consisted of a 150‐min session once a week during 8 weeks formatted to groups of no more than 20 participants. The primary outcome was self‐compassion, measured with the Self‐Compassion Scale (SCS). The secondary outcomes were other pain‐related scores, quality‐of‐life measures, and anxiety and depression scores.
In all, 62 and 61 patients were assigned to the MSC and CBT groups, respectively. The MSC intervention was more effective than CBT for self‐compassion (average treatment effect [ATE] = 0.126, p < 0.05). The secondary outcomes, pain acceptance (ATE = 5.214, p < 0.01), pain interference (ATE = −0.393, p < 0.05), catastrophizing (ATE = −2.139, p < 0.10) and anxiety (ATE = −0.902, p < 0.05), were also favoured in the experimental arm (MSC). No serious adverse events were observed.
Mindful Self‐Compassion is an appropriate therapeutic approach for CP patients and may result in greater benefits on self‐compassion and emotional well‐being than CBT.
This randomized controlled trial compares the novel intervention (MSC program) with the gold standard psychological intervention for CP (CBT). MSC improves the levels of self‐compassion, a therapeutic target that is receiving attention since the last two decades, and it also improves anxiety symptoms, pain interference and pain acceptance more than what CBT does. These results provide empirical support to guide clinical work towards the promotion of self‐compassion in psychotherapeutic interventions for people with CP.
Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment.
Characterize the presence and distribution of pain, myofascial dysfunction and sensitisation beyond the pelvis in women with endometriosis‐associated chronic pelvic pain.
Cross‐sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain‐focused abdominopelvic gynaecologic examination with the identification of pelvic floor muscle spasm. Neuro‐musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger points in 13 paired muscles. Pressure‐pain thresholds were measured over interspinous ligaments and trigger points. Women completed the body territories element of the Body Pain Index.
All women had a pelvic floor muscle spasm that they self‐identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure‐pain thresholds and trigger points in over two‐thirds of 26 assessed regions. Widespread spinal segmental sensitisation was present in 17/30, thoracic in 21/30 and lumbosacral/pelvic in 18/30. Cervical sensitisation manifested as low pressure‐pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p = .024) and lumbosacral/pelvic (p = .036) sensitisation and report over 10 painful body areas (p = .009).
Women with endometriosis‐associated chronic pelvic pain often have myofascial dysfunction and sensitisation beyond the pelvic region that may be initiated or maintained by on‐going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population.
Clinicaltrials.gov identifier: NCT01553201.
Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies and these women have regional pelvic sensitisation and myofascial dysfunction. Pelvic floor muscle spasm is a major pain focus in this population. Sensitisation and myofascial dysfunction are widespread, beyond the pelvic region. On‐going pelvic floor spasm may initiate or maintain sensitisation. Myofascial/sensitisation manifestations warrant consideration when managing pain in this population.
Research among adult and paediatric samples suggests that pain‐related injustice appraisals contribute to adverse pain‐related functioning. However, a singular focus on pain‐related injustice appraisals carries the risk of underestimating the role of broader concepts of justice. This study examined the unique roles of child pain‐related injustice appraisals and just‐world beliefs in understanding disability and physical, emotional, social and academic functioning, as well as the mediating role of injustice appraisals in the relationship between just‐world beliefs and functioning.
Participants comprised a school sample of 2,174 children (Study 1) and a clinical sample of 146 paediatric chronic pain patients (Study 2) who completed the Injustice Experience Questionnaire (IEQ), Personal and General Belief in a Just World scales (JWB‐P/G), Functional Disability Inventory (FDI), Pain Catastrophizing Scale for Children (PCS‐C) and Pediatric Quality of Life Inventory (PEDSQL).
For both samples, child pain‐related injustice appraisals were associated with poorer functioning, after controlling for just‐world beliefs, catastrophizing, pain intensity, age and sex. In the school sample, injustice appraisals mediated the associations of both personal and general just‐world beliefs with functioning. In the clinical sample, injustice appraisals mediated the association of personal, but not general, just‐world beliefs with all functioning scales.
The current findings attest to the unique role of pain‐related injustice appraisals in understanding child pain‐related functioning and their explanatory value in understanding the relationship between fundamental just‐world beliefs and child pain‐related functioning.
The present study adds to emerging literature on the adverse effects of child pain‐related injustice appraisals in the context of pain, through showing that pain‐related injustice appraisals are uniquely associated with pain‐related functioning and mediate the relationship between just‐world beliefs and pain‐related functioning. These findings suggest that interventions may target pain‐related injustice appraisals as a mechanism for change in children.
The adolescent years represent a key period for the development of musculoskeletal complaints (MSC) and the differences between boys and girls. We evaluated the prevalence and course of MSC and factors associated with MSC while growing up from age 11 to age 20.
Questionnaire‐based data at age 11 (n = 2,638), age 14 (n = 2,517), age 17 (n = 2,094) and at age 20 (n = 2,206) from the ongoing Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort were analyzed. MSC refers to pain of lower back, upper‐ and/or lower extremities. A multivariable logistic regression analysis was used to evaluate a number of factors in relation to persistent pain (pain reported at three out of four measurements).
Prevalence of MSC increased from 14.2% at age 11 to 22.1% at age 20 for boys, and from 17.4% at age 11 to 37.9% at age 20 for girls. Persistent pain was found among 5.1% of the boys and 16.5% of the girls. Being bullied, sleeping problems and tiredness during the day were significantly associated with persistent pain, in both boys and girls, while the latter two were more prevalent among girls. Self‐reported (sports‐) accidents, and among girls also early onset of puberty, were also significantly associated with persistent pain, but lifestyle factors, such as physical activity and smoking, were not.
The prevalence of MSC increases during adolescence, with a widening gap between boys and girls. The factors associated with MSC are similar in boys and girls, though the prevalence of some of these differ by sex.
Measuring a group of youngsters 4 times between age 11 and 20 shows an increase in the percentage reporting musculoskeletal complaints (MSC) with a widening gap between girls and boys, with more pain among girls. Boys and girls do hardly differ with respect to factors associated with MSC, being mainly psychosocial factors and (sports) accidents.
A noxious stimulus following a more intense stimulus often feels less painful than continuous noxious stimulation. This effect, known as offset analgesia (OA), may be due to descending inhibitory control, to changes in peripheral neural transmission or both. The timing and location of noxious thermal stimulation were manipulated to better understand the peripheral and central contributions to OA.
In a first experiment, participants (n = 29) provided continuous pain ratings as stimuli were delivered to the palm or dorsum of each hand. Offset trials included 44°C (T1), 45°C (T2) and 44°C (T3) stimulation periods. Baseline trials were identical except the T3 temperature fell to 35°C. Constant trials were 44°C throughout. The duration of T1 and T2 was either 1 s or 6 s, whereas T3 was always 12 s. In a second experiment, participants (n = 43) rated pain levels of noxious stimuli presented to the forearms with varying T1 and T2 durations (3, 6, 10 or 13 s) and a 20 s T3 period.
OA effects became stronger with increasing inducing durations. OA, however, was not found on the palm even at longer durations.
The increase in OA with duration suggests that accumulated nociceptive signalling is more important to triggering OA than is a decrease in nociceptors’ instantaneous firing rates. The lack of OA on the palm, however, implies a key role for the rapidly adapting Type II AMH fibres that may be absent or not readily activated on the palm. Unravelling the relative central and peripheral contribution to OA requires further investigation.
Offset analgesia (OA) is a fundamentally temporal phenomenon dependent on dynamic changes in stimulus intensity. Here we demonstrate increased OA with increased stimulus duration. This finding implies the more slowly‐responding AMH‐I peripheral mechanoreceptors contribute to OA. The more rapidly responding AMH‐II peripheral mechanoreceptors, however, may be absent or more difficult to activate in the palm where we did not observe OA. This finding implies that the AMH‐II receptors are necessary for OA. Our studies suggest methods to unravel the different peripheral and central contributions to OA.
While pain is very common in older adults, the associated impact on daily life, including usage of medication and healthcare, varies considerably and often pain remains inadequately treated. It is not clear what is associated with this variation.
Latent class analysis (LCA) is a model‐based approach to identifying underlying subgroups in a population. In this study LCA was used to examine biopsychosocial risk classes of adults aged 50 years and older, who were often troubled by pain, from The Irish Longitudinal Study on Ageing (TILDA), (n = 2,896), and the associations with future medication and healthcare use.
Four biopsychosocial risk classes (Low Biopsychosocial Risk, Physical Health Risk, Mental Health Risk, High Biopsychosocial Risk) were identified, with the 'High Biopsychosocial Risk' class accounting for 24% of older adults with pain. This class were much more likely to use medication and healthcare services when followed up across three waves of the TILDA study. In contrast, the Physical Health Risk and the Mental Health Risk classes reported lower usage of medication and healthcare at waves 2 and 3. Amongst the higher risk classes of older adults who are troubled by pain, there is considerable consumption of medication and healthcare services evident.
Given our ageing population and significant number of adults in this high risk class, there is a need to optimize current pain management approaches among older adults. Intensive non‐pharmacological approaches to pain management in older adults, tailored to individual biopsychosocial risk indicators for each individual class, may be worth exploring.
While pain is very common in older adults, the usage of medication and healthcare varies considerably and often pain remains inadequately treated. Given our ageing population and the significant number of older adults reporting high biopsychosocial risk (24%), there is a need to optimize current pain management approaches. Intensive non‐pharmacological approaches to pain management in older adults, tailored to individual biopsychosocial risk indicators for each individual class, may be worth exploring.
Dependence‐like behaviour may complicate withdrawal and increase risk of relapse of medication overuse headache (MOH). The most effective treatment for reducing dependence‐like behaviour is unknown.
To compare patient‐reported outcomes among three treatment strategies for MOH. The primary outcome was change in Severity of Dependence Scale (SDS) score from baseline to 6 months.
Patients with MOH were randomized to (1) withdrawal combined with preventive medication from start (W+P), (2) preventive medication without withdrawal (P), or (3) withdrawal with optional preventive medication 2 months after withdrawal (W). At baseline, 2, and 6 months, patients filled out SDS (used for measurements of dependence‐like behaviour and treatment feasibility), Headache Under‐Response of Treatment (HURT) and WHO Quality of Life BREF questionnaires.
Out of 120 patients with MOH, 100 completed the 6‐month follow‐up and filled out questionnaires. The W+P arm was the most effective in treating MOH. After 6 months, the SDS score was reduced by 3.69 (95% CI 3.23–4.49) in the W+P arm, by 3.19 (95% CI 2.43–3.96) in the W arm, and by 1.65 (95% CI 0.96–2.33) in the P arm (p = 0.04). At baseline and after 2 months, the P arm was considered the most feasible treatment, but at 6‐month follow‐up, there was no difference in feasibility score, change in HURT score, or quality of life.
Dependence‐like behaviour was reduced most in the two withdrawal arms. Withdrawal combined with preventive medication is recommended for the treatment of MOH.
Withdrawal combined with preventive medication from start is the treatment strategy that reduces dependence‐like behaviour the most in MOH patients. Patients initially considered preventive treatment without withdrawal as the most feasible treatment. However, no difference in feasibility between the three arms was found at 6‐month follow‐up. Withdrawal combined with preventive medication is recommended for treatment of MOH.
Stress activates several neural pathways that inhibit pain sensation. Nucleus accumbens (NAc), as an important component of the mesolimbic dopaminergic system, has a major role in pain modulation and is differentially affected by stress. Based on the nature of stressors, the direction of this effect is controversial. We previously showed that forced swim stress‐induced analgesia through activation of NAc dopamine receptors. In this study, we aimed to examine the role of dopamine receptors within the NAc in restraint stress (RS)‐induced analgesia.
Male Wistar rats weighing 230–250 g were unilaterally implanted with a cannula into the NAc. D1‐like dopamine receptor antagonist, SCH‐23390 (0.25, 1 and 4 µg/0.5 µL saline), or D2‐like dopamine receptor antagonist, Sulpiride (0.25, 1 and 4µg/0.5µl DMSO), were microinjected into NAc in two separate super groups 5 min prior to exposure to RS. Their control groups just received intra‐accumbal saline or DMSO (0.5 µl) respectively. The formalin test was performed after animals were subjected to RS using Plexiglas tubes.
The results demonstrated that RS produces analgesia in both phases of the formalin test. Intra‐NAc injection of SCH‐23390 equally reduced RS‐induced analgesia in both early and late phases of the formalin test, while Sulpiride reduced RS‐induced analgesia just at the late phase.
These findings suggest that the dopaminergic system might act as a potential endogenous pain control system in stress conditions. However, the lack of evaluation of the role of the dopaminergic system in RS‐induced antinociception in acute pain conditions is considered as a limitation for this study. In addition, a comprehensive evaluation of this endogenous pain control system in animal and clinical studies will guide future efforts for developing more effective medication.
Restraint stress (RS) induces the antinociceptive behaviors in both phases of formalin test. Blockade of intra‐accumbal dopamine receptors impresses the antinociception induced by RS. Blockade of D1‐like dopamine receptor equally reduced RS‐induced analgesia in both early and late phases of the formalin test. Blockade of D2‐like dopamine receptor reduced RS‐induced analgesia just at the late phase.
In the context of neuropathic pain, the contribution of regeneration to the development of positive symptoms is not completely understood. Several efforts have been done to described changes in axotomized neurons, however, there is scarce data on changes occurring in intact neurons, despite experimental evidence of functional changes. To address this issue, we analysed by immunohistochemistry the presence of phosphorylated signal transducer and activator of transcription 3 (pSTAT3), an accepted marker of regeneration, within DRGs where axotomized neurons were retrogradely labelled following peripheral nerve injury. Likewise, we have characterized abnormal electrophysiological properties in intact fibres after partial nerve injury.
We showed that induction of pSTAT3 in sensory neurons was similar after partial or total transection of the sciatic nerve and to the same extent within axotomized and non‐axotomized neurons. We also examined pSTAT3 presence on non‐peptidergic and peptidergic nociceptors. Whereas the percentage of neurons marked by IB4 decrease after injury, the proportion of CGRP neurons did not change, but its expression switched from small‐ to large‐diameter neurons. Besides, the percentage of CGRP+ neurons expressing pSTAT3 increased significantly 2.5‐folds after axotomy, preferentially in neurons with large diameters. Electrophysiological recordings showed that after nerve damage, most of the neurons with ectopic spontaneous activity (39/46) were non‐axotomized C‐fibres with functional receptive fields in the skin far beyond the site of damage.
Neuronal regeneration after nerve injury, likely triggered from the site of injury, may explain the abnormal functional properties gained by intact neurons, reinforcing their role in neuropathic pain.
Positive symptoms in patients with peripheral neuropathies correlate to abnormal functioning of different subpopulations of primary afferents. Peripheral nerve damage triggers regenerating programs in the cell bodies of axotomized but also in non‐axotomized nociceptors which is in turn, develop abnormal spontaneous and evoked discharges. Therefore, intact nociceptors have a significant role in the development of neuropathic pain due to their hyperexcitable peripheral terminals. Therapeutical targets should focus on inhibiting peripheral hyperexcitability in an attempt to limit peripheral and central sensitization.
The nociceptive flexion reflex (NFR) is a spinal reflex induced by painful stimuli resulting in an appropriate withdrawal response. The NFR is considered to be an objective physiological correlate of spinal nociception. Previous research has already demonstrated that physical activity (PA) can influence pain assessments. To date, no studies have directly examined the relationship between PA and spinal nociception. Hence, this study aimed to investigate whether the NFR threshold can be predicted by report‐based and monitor‐based measures of PA in healthy adults.
PA and the NFR threshold of 58 healthy adults were assessed. PA was evaluated by self‐report using the International Physical Activity Questionnaire and by monitor‐based accelerometry data. The NFR threshold was elicited through transcutaneous electrical stimulation of the sural nerve and quantified by the biceps femoris muscle electromyogram. Hierarchical linear regression analyses were performed to determine the relationship between PA and the NFR, while controlling for confounders.
Monitor‐based measured step count and activities of moderate‐ to vigorous‐intensity predicted the NFR threshold accounting for 23.0% (p = .047) to 37.1% (p = .002) of the variance. Larger amounts of step counts and higher participation in moderate‐ to vigorous‐intensity activities predicted higher NFR thresholds. Monitor‐based activities of sedentary intensity predicted the NFR threshold accounting for 35.8% (p = .014) to 35.9% (p = .014) of the variance. Spending more time per day on activities of sedentary intensity predicted lower NFR thresholds.
The study provides preliminary evidence indicating that a physically active lifestyle may reduce spinal nociception in healthy adults, while a sedentary lifestyle enhances spinal nociception.
The present study provides preliminary evidence that the influencing effects of physical activity on pain are the result of a strong descending control and do not purely rely on supraspinal mechanisms. These study results highlight the importance of considering physical activity levels when evaluating nociceptive processing, given the prognostic value of physical activity in spinal nociception. Furthermore, this study encourages future research to examine the effects of moderate‐ to vigorous‐intensity exercise programmes on spinal nociception in chronic pain populations.
Publication date: Available online 17 March 2021
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Wanyi Qing, Xian Shi, Qing Zhang, Lihong Peng, Chengqi He, Quan Wei
To evaluate if early improvements in pain and function with subcutaneous tanezumab are meaningful and sustained over 24 weeks.
Patients with moderate‐to‐severe osteoarthritis (hip or knee) in Europe and Japan were randomized to placebo, tanezumab 2.5 mg, or tanezumab 5 mg (baseline, Week 8, and Week 16). Outcomes included: average daily index joint pain score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales, rescue medication use, WOMAC responders (within‐patient ≥30% reduction in WOMAC Pain or Physical Function), Outcome Measures in Rheumatology‐Osteoarthritis Research Society International (OMERACT‐OARSI) responders (within‐patient), and Patient‐reported Treatment Impact Assessment‐Modified questionnaire.
Patients received placebo (n=282), tanezumab 2.5 mg (n=283), or tanezumab 5 mg (n=284). Changes from baseline in average daily index joint pain (within the first week) and WOMAC subscales (Week 2 through Week 24) were greater for each tanezumab group versus placebo (least squares [LS] mean, unadjusted p≤0.05). Rescue medication use (days/week) was lower for each tanezumab group versus placebo from Week 2 through Week 12 (LS mean, unadjusted p≤0.05) but not at Week 16 or 24. A higher proportion of each tanezumab group than placebo achieved ≥30% reduction from baseline in WOMAC Pain or Physical Function, or OMERACT‐OARSI response (Week 2 through Week 24, unadjusted p≤0.05), or were satisfied with treatment at Week 24 (unadjusted p≤0.05).
Subcutaneous tanezumab, compared with placebo, reduced pain within the first week, and pain and function were improved throughout 24 weeks. The proportions of responders and patients satisfied were higher with tanezumab than placebo.
There is a broad range of evidence on optimism dampening the pain experience, as assessed by subjective self‐report. Facial expression of pain conveys supplementary information about the pain experience, is an integral part of pain communication and assists psychosocial pain coping. Nevertheless, the effect of induced optimism on facial activity during pain has to our knowledge not been examined.
In our experiment, 40 healthy participants underwent two blocks of thermal stimulation containing phasic non‐painful and painful stimuli. Between the two blocks, the Best Possible Self imagery and writing task was performed to induce situational optimism, while a control group wrote about their typical day. Facial activity and self‐report ratings of intensity and unpleasantness were recorded. Facial activity was analysed using the Facial Action Coding System.
The optimism manipulation was successful in increasing state optimism. It did not affect self‐report ratings, but resulted in a stronger facial expression of pain, caused especially by increases in Action Units 4 (furrowed brows) and 6_7 (narrowed eyes).
All Action Units, which were affected by the optimism induction, are known to be prevalent during pain stimulation. The increase in facial expression might reflect reduced inhibition of pain communication in temporarily optimistic participants. Optimism might lead to expecting positive and helpful reactions from others and, by that, to great readiness to elicit these reactions by non‐verbal social behaviour.
This study is the first to indicate that state optimism increases the facial expression of pain as a social signal for help and empathy without concomitant changes in the subjective pain experience.
Fatigue is a widespread complaint in both healthy and diseased individuals (Engberg et al., 2017; Finsterer et al., 2014) that is often described as an overwhelming sense of tiredness, lack of energy, and feeling of exhaustion (Gruet et al., 2013). Fatigue can be classified as mental fatigue, which relates to the cognitive or perceptual dimensions of fatigue, and physical fatigue, which concerns the performance of the motor system (Gruet et al., 2013).
Neuropathic pain negatively affects quality of life among people living with HIV (PLWH). This study examined the feasibility of conducting a full‐scale randomized‐controlled trial of online acceptance and commitment therapy (“ACT OPEN”) for neuropathic pain in PLWH.
Using a parallel‐groups design, thirty‐eight participants were randomized to ACT OPEN or a waitlist control (2:1). Participants completed standard self‐report outcome measures at baseline, and two‐ and five‐months post‐randomization. Participants were aware of their allocation, but assessment was blinded.
Twenty‐five participants were randomized to ACT OPEN and 13 to the control (of 133 referrals). ACT OPEN completion was 69% and two‐month trial retention was 82%. Treatment credibility and satisfaction scores for ACT OPEN were comparable to scores reported in previous trials of cognitive‐behavioural treatments for pain. Four adverse events were reported during the study, including one serious adverse event; all of these were unrelated to the research procedures. Small to moderate effects and 95% confidence intervals suggest that the true effect may favour ACT OPEN for improvements in pain intensity/interference and depression.
A full‐scale RCT of online ACT for pain management in PLWH may be feasible with refinements to trial design to facilitate recruitment.
Nature, Published online: 12 March 2021; doi:10.1038/d41586-021-00644-5
Targeted approach could lead to an opioid-free way of treating chronic pain.
Persistent pain during pregnancy is a significant health issue, which could be correlated with psychological distress resulting from inadequate social support. This study aims to investigate whether the relationship between poor social support and antenatal pain is mediated by psychological distress. We also aimed to examine whether social cohesion moderates the influence of psychological distress on the relationship between social support and antenatal pain.
We analysed 94,517 pregnancies of women from a Japanese national birth cohort completed questionnaires assessing pain, psychological distress, social support and social cohesion. Psychological distress was assessed using the Kessler Psychological Distress Scale. Two types of models were used: the mediation model to examine whether the association between social support and pain was mediated by psychological distress; the moderated mediation model to analyse whether social cohesion buffered the negative effect of inadequate social support on pain. Demographic, socioeconomic and psychological factors were controlled for in all analyses.
Psychological distress was fully mediated the association between social support and pain. Social cohesion had a focal moderation effect on the inverse association between social support and psychological distress (unstandardized regression coefficient [β] = 0.09; 95% CI, 0.07–0.11) and functioned as moderator for the indirect effect of social support on antenatal pain (index of moderated mediation = 0.006; 95% CI, 0.004–0.007).
Poor social support was related to antenatal pain through psychological distress, possibly buffered by social cohesion. During the antenatal period, social support and cohesion are important for women.
In this study, poor social support was found to be associated with pain intensity during pregnancy, which was mediated by psychological distress and might be buffered by desirable social cohesion. This finding could potentially help healthcare providers and policy makers to understand the importance of desirable social cohesion in preventing pain among pregnant women.
While pain is common in older adults, the association with physical activity is unclear. Currently, the role physical activity plays in impacting pain developing over time is not well‐defined.
Latent transition analysis (LTA) is a model‐based approach to identifying underlying subgroups in a population, longitudinally, based on measured characteristics. In this study LTA was used to explore the associations between physical activity levels and pain classes of adults aged over 50 years, from the Irish Longitudinal Study on Ageing (n=8,175) across three waves of data collection (4 years).
Using three previously established pain classes (No Pain; Low‐Moderate Impact Pain; High Impact Pain), 66% of older adults were classified as having ‘No Pain’ across the three waves. At Wave 1, individuals reporting low (OR = 4.00, 95% CI =3.21, 5.17) or moderate (OR = 1.59, 95% CI = 1.27, 1.99) levels of physical activity are more likely to be in the High Impact Pain class, than the No Pain class. Longitudinally, individuals in the No Pain class with low or moderate physical activity, were more likely to transition to the High Impact Pain class, compared to those with higher physical activity scores (from Wave 1 to Wave 2, OR = 1.90, 95% CI=1.15, 3.37; and from Wave 2 to Wave 3, OR = 2.27, 95% CI=1.40, 4.74).
Older adults who do not meet minimum physical activity guidelines for moderate intensity exercise are at increased risk of higher impact pain when followed over four years.
