Effects of Fitness Level and Exercise Intensity on Pain and Mood Responses

Abstract

Background

The phenomenon of exercise‐induced hypoalgesia and concomitant mood changes is well established. How exercise‐induced hypoalgesia and affective responses are shaped by the intensity of an acute exercise bout and individual fitness levels is as yet not well understood. This study investigates whether heat pain threshold (PTh), pain tolerance (PTol), and affective parameters are modulated by the intensity of an acute exercise bout and/or individuals' fitness level. Stronger analgesic responses are hypothesized after high‐intensity exercise in physically fitter subjects, possibly in sync with concomitant mood changes.

Methods

Thirty‐three healthy men were recruited (sedentary: N=17 or recreational: N=14; mean age: 25.3±4.4 years). After a fitness assessment on a cycle ergometer, subjects underwent three experimental conditions on separate days: high (20 minutes exercise 20% above lactate threshold), low (20 minutes exercise 20% below lactate threshold) and control (seated rest). Before and after each intervention Positive and Negative Affect Schedule, PTh and PTol (cold water emersion test) were assessed.

Results

Results indicate an increase of the Positive Affect Scale (high: 26.7±9.0 vs. 32.9±7.1, p<0.001; low: 26.3±7.2 vs. 32.0±7.0, p<0.001) and PTh (high: 45.1±3.1 °C vs. 46.0±2.6 °C, p=0.003; low: 45.4±2.7 °C vs. 45.9±2.6 °C, p=0.012) after both exercise conditions. In an exploratory analysis, PTol significantly increased only after the high exercise condition (51.2±33.7 sec. vs. 72.4±64.0 sec., p=0.045). Fitness level was positively correlated with the increase in PTol from pre to post high‐intensity exercise (r=0.59, p(one‐tailed)=0.002).

Conclusion

Exercise‐induced hypoalgesia depends on exercise intensity and appears to be influenced by individual fitness status, independent of mood responses.

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[Correspondence] Time to revisit indications for cholecystectomy

Aafke van Dijk and colleagues1 presented the findings from their multicentre, randomised, non-inferiority trial (SECURE), designed to compare a conventional indication for cholecystectomy with a more restrictive and criteria-based strategy in patients with abdominal pain and ultrasound-proven gallstones. At 12-month follow-up, non-inferiority of restrictive strategy regarding pain improvement was not shown compared with standard of care.1

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[Correspondence] Time to revisit indications for cholecystectomy – Author's reply

We thank Dimitrios Moris and Theodore Pappas for their comments and suggestions to further optimise the selection criteria for laparoscopic cholecystectomy in patients with abdominal pain and gallstones. We accept the concerns about the protocol violations. The SECURE trial1 was designed to better select patients for cholecystectomy, but it stops short of answering the question of how to treat patients with abdominal symptoms and gallstones.

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[Clinical Picture] Trigeminal neuralgia plus hemifacial spasm caused by a dilated artery: a case of painful tic convulsif syndrome

A 61-year-old woman came to our neurosurgery clinic complaining of spasms and episodic pain on the left side of her face; the spasms had been present for 20 years and the pain for 5 years. She said that initially the facial spasms affected only the corner of her left eye but over the years progressed to involve most of the muscles of the lower left side of her face. For the past 7 years, she had been given botulinum toxin injections twice per year, which had provided some relief. The pain, which developed alongside the spasms, was characterised by frequent episodes of excruciating, lancinating pain—rated by the patient as very severe using a visual analogue pain scale—along the ophthalmic and maxillary branches of the trigeminal nerve.

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The context of values in pain control: understanding the price effect in placebo analgesia

Placebo effects, a sum of different factors including non-specific effects, regression to the mean, natural history, and placebo responses, substantially contribute to clinical outcomes in diseases such as Parkinson's disease, depression, and immune function, as well as in acute and chronic pain conditions.10,33 Recent studies on placebo effects implicate the importance of informational context relative to medical treatments, most of which have no direct therapeutic effects on the body.42 One distinct feature of every therapeutic intervention is price, or treatment cost.

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Sex differences in interleukin-6 responses over time following laboratory pain testing among patients with knee osteoarthritis

Knee osteoarthritis (KOA) is a chronic pain condition that is one of the leading causes of physical impairment and disability across the world.40 The prevalence of KOA is expected to continuously escalate due to population aging and increases in obesity rates.63 Women are particularly at-risk for developing chronic pain and KOA.20,43 Further, women generally report higher pain-related symptoms (including KOA symptoms57), evoked-pain sensitivity, and lower pain tolerance compared to men.20,43

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Sensitivities to Thermal and Mechanical Stimuli: Adults with Sickle Cell Disease Compared to Healthy, Pain-free African American Controls

Until recent findings that sickle cell disease (SCD) pain has characteristics consistent with central or peripheral sensitization,12,27,28,43 it was typically viewed as acute or persistent pain and treated mostly with opioids. Often the etiology of SCD pain is thought to be only episodic, driven by vaso-occlusion and somatic or visceral tissue damage,1,2,4 however, it has become increasingly clear that adults with SCD also experience chronic pain. A growing body of evidence now supports,12,27,28,40,43, but is not conclusive, that sensitization contributes to chronic pain in some adults with SCD.

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