Epigenetic and miRNA expression changes in people with pain: a systematic review

Recent scientific evidence demonstrates how most chronic and degenerative disorders are not determined by genetic mutations or polymorphisms, but are rather consequence of complex gene-environment interactions.22,27 Such evidence has been changing our understanding of both common and complex diseases, and an increasing amount of basic science and clinical research has been trying to determine which mechanisms are responsible for linking environmental and lifestyle factors to changes in gene expression.

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Management of patients with a musculoskeletal pain condition that is likely chronic: Results from a national cross sectional survey

Chronic musculoskeletal pain (e.g. back and neck pain, pain due to arthritis, leg pain, arm pain of >3 months duration) affects between 11 and 24% of the general population,5, 10 with some estimates as high as 48% for chronic musculoskeletal complaints.19 Costs attributable to musculoskeletal pain have risen in the United States between 1996 and 2014 from $400 billion to nearly a trillion dollars (i.e. 3.4% of GDP to 5.8% of GDP) and these will no doubt rise even further as the prevalence of musculoskeletal disorders are expected to increase as the population ages.

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Test-retest and inter-examiner reliability of a novel bedside quantitative sensory testing battery in postherpetic neuralgia patients

Quantitative sensory testing (QST) is a well-established method of psychophysical evaluation of the somatosensory system, based on measurements of responses to calibrated, graded innocuous or noxious stimuli2,31,39.It has been used traditionally in the research setting to phenotype patients with a variety of pain disorders39. QST yields valuable information about the functional status of the somatosensory system from peripheral receptor to the cortex, and it may be used to quantify and monitor the presence and severity of either positive sensory phenomena (such as amplified pain perception reported in allodynia or hyperalgesia) or negative phenomena (e.g., loss of function as in hypoesthesia or hypoalgesia)1,44.

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The “culture” of pain control: A review of opioid-induced dysbiosis (OID) in antinociceptive tolerance

In October 2017, the United States government declared a state of public health emergency in response to the growing prescription opioid epidemic. Social, political, and medical rhetoric has recently demanded improvements in clinical pain control, prompting the publication of the “Guideline for Prescribing Opioids for Chronic Pain” by the Centers for Disease Control and Prevention (CDC) in March, 2016.31 Over the last decade, opioid use in the US has risen dramatically, with the number of prescriptions written by health care providers in 2012 (∼259 million) exceeding the total adult population (∼240 million).

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Two weeks of wearing a knee brace compared to minimal intervention on kinesiophobia at 2 and 6-weeks in people with patellofemoral pain: A randomized controlled trial

Publication date: Available online 10 December 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Liliam B. Priore, Simon Lack, Carmen Garcia, Fabio M. Azevedo, Danilo de Oliveira Silva

Abstract

Objective

To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function and physical activity level in individuals with patellofemoral pain (PFP).

Design

Single-blind randomized controlled trial [1:1], parallel

Participants

Fifty individuals with PFP.

Main Outcome Measures

Primary: Kinesiophobia (Tampa Scale of Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire) and objective function (forward step-down test). Outcomes were assessed at baseline (T₀), at the end of the intervention (2-weeks) (T₁) and at 6-weeks after baseline (T₂).

Intervention

Participants were randomly assigned to one of two interventions groups: (i) use of knee brace for 2 weeks during daily living, sports or painful tasks (brace group); (ii) educational leaflet with information about PFP (leaflet group).

Results

The knee brace reduced kinesiophobia in people with PFP compared to minimal intervention with moderate effect size at T₁ = mean difference (95%CI) -5.56 (-9.18 to -1.93) and T₂ = -5.24 (-8.58 to -1.89). There was no significant difference in self-reported and objective function and physical activity level.

Conclusion

The knee brace improved kinesiophobia immediately after intervention (at 2-weeks) and at 6-weeks follow-up in people with PFP compared to minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise-therapy interventions for people with PFP.

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Effectiveness of platelet rich plasma injections for non-surgical management of carpal tunnel syndrome: a systematic review and meta-analysis of randomized controlled trials

Publication date: Available online 7 December 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Michael Catapano, Joseph Catapano, Gregory Borschel, Seyed Mohammad Alavania, Lawrence R. Robinson, Nimish Mittal

Abstract

Objective

To systematically review and evaluate the efficacy and complication profile of platelet-rich plasma (PRP) injection into the carpal tunnel for management of carpal tunnel syndrome (CTS).

Data Sources

PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Sciences (from inception to January 1^st, 2019).

Study Selection

Controlled trials addressing PRP for CTS.

Data Extraction

Two reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. The outcomes of interest were the visual analog score (VAS) for pain and the Boston Carpal Tunnel Questionnaire (BCTQ), including the subscales of the symptom severity scale (SSS) and the functional status scale (FSS). Other reported outcome measures and complications were analyzed descriptively.

Data Synthesis

Four randomized control studies satisfied the inclusion criteria and analyzed a total of 191 cases with a final follow-up of either 3 or 6-months. Control groups included splinting in two studies, corticosteroid injection in one study, and saline injection in one study. There was a statistically and clinically significant improvement in the BCTQ {Std. Mean Difference(95%CI) = -2.06[-3.41, -0.70], p=.003} between groups. Subgroup analysis showed significant improvement in SSS {Std. Mean Difference(95%CI) = -1.95[-3.65, -0.25], p=.02} but not for FSS {Std. Mean Difference(95%CI) = -2.19[-4.77, 0.40], p=.10}. There was a similar improvement in VAS and nerve conduction studies in those receiving PRP compared to controls. Complication rate in the included studies was low with 4/97 participants receiving PRP injections experiencing transient pruritis, burning and/or tingling.

Conclusion

PRP represents a promising therapy for patients with mild to moderate CTS; however, included studies were limited as follow-up was short, included patients were heterogeneous, and the number of included studies was low. Further investigation is necessary to determine its true efficacy and effect and to better delineate the long-term results in patients with CTS.

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Pressure Pain Threshold in Subjects with Piriformis Syndrome: Test-Retest, Intra-, and Inter-Rater Reliability, and Minimal Detectible Changes

Publication date: Available online 7 December 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Abbas Tabatabaiee, Ismail Ebrahimi Takamjani, Javad Sarrafzadeh, Reza Salehi, Maryam Ahmadi.

Abstract

Objective

This study aimed to assess the test-retest, intra-, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles.

Study Design

This study used a comparative and reliability-based design.

Setting

Rehabilitation clinic.

Participants

Thirty patients with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by two raters (rater 1 and 2), which have selected at random order. The rater 1 repeated the PPT measurements 24-72 hours after initial assessment.

Interventions

Not applicable.

Main Outcome Measures

PPT.

Results

Excellent intra-rater intra-class coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86–0.96) and the healthy piriformis (ICC: 0.88–0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent inter-rater reliability (ICC: 0.64–0.92) and test-retest reliability (ICC: 0.72–0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76 [95% confidence interval [CI]:15.69–9.82], P < 0.001).

Conclusion

Digital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.

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