Conditioned pain modulation and psychological factors in young adults with recurrent or chronic neck pain.

BACKGROUND: Controversy exists with the presence of alterations in descending pain inhibition mechanisms in patients with non-specific neck pain (NSNP). The aim of the present study was to evaluate the status of conditioned pain modulation CPM, remote pressure pain thresholds (PPT), and psychological factors in a specific subgroup of patients with NSNP such as young adult students. In addition, possible associations between CPM, psychological factors, and pain characteristics were analyzed. METHODS: Thirty students with recurrent or chronic NSNP and 30 pain-free students were included in this cross-sectional study. The following measures were assessed: CPM, remote PPT, psychological factors (depression, anxiety, pain catastrophizing, and kinesiophobia), pain characteristics (duration, intensity, severity of chronic pain, interference with daily life), and central sensitization inventory (CSI). RESULTS: No significant differences were found in the efficacy of CPM between students with chronic or recurrent NSNP and pain-free students (ß coefficient = -0.67; 95% CI = -1.54, 0.20). However, students with pain showed a significantly higher remote PPT (mean difference = -1.94; 95% CI = -2.71, -1.18). and a greater presence of anxious (mean difference = 6; 95% CI = 2, 9) and depressive symptoms (mean difference = 8.57; 95% CI = 3.97, 13.16). In addition, significant moderate or strong correlations were found between CPM and pain intensity (partial r = 0.41), pain catastrophizing and mean pain intensity (r = 0.37), grade (r = 0.50), and interference of pain (r = 0.57), kinesiophobia and disability (r = 0.38), and depression and CSI (r = 0.39). CONCLUSIONS: Young adult students with chronic or recurrent NSNP present remote hyperalgesia and symptoms of depression and anxiety but not dysfunctional CPM.

[Physiotherapy and health education protocol in chronic musculoskeletal shoulder pain. Experience in Primary Care]. / Protocolo de fisioterapia y educación para la salud en dolor crónico de hombro de origen musculoesquelético. Experiencia en atención primaria.

OBJECTIVE: To evaluate the experiencie with a health education program in Primary Care in patients with chronic shoulder pain of musculoskeletal origin, on pain and disability and establish the protocol in primary care. DESIGN: Quasi-experimental longitudinal descriptive observational study. LOCATION: Arroyo de la Vega Health Center, Alcobendas, Madrid. PARTICIPANTS: Patients referred by their Primary Care Physician to the Primary Care Physiotherapy Unit for shoulder pain of musculoskeletal origin. INTERVENTION: 7 group sessions of health education and therapeutic exercise. MAIN MEASUREMENTS: Pain intensity was assessed through the Visual Analogue Scale (VAS), the disability of the upper limb with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the level of disability and shoulder pain with the Shoulder Pain and Disability Index (SPADI) questionnaire. RESULTS: Statistically significant differences were found in the reduction of pain and disability (P<.01), in addition, drug use and recurrences were reduced. CONCLUSIONS: The shoulder physiotherapy protocol with health education was effective in reducing pain and disability in patients with chronic shoulder pain of musculoskeletal origin in Primary Care.

Comparative study of observed actions, motor imagery and control therapeutic exercise on the conditioned pain modulation in the cervical spine: a randomized controlled trial.

Aim: The aim of this study was to compare the effects of cervical exercise, motor imagery (MI) and action observation (AO) of cervical exercise actions on conditioned pain modulation and pressure pain thresholds. The second objective was to assess the effects of these interventions on cervical motor activity (ranges of motion and muscle endurance), attention, and the ability to generate motor images.Study design: Single-blinded randomized controlled trial.Materials and methods: Fifty-four healthy subjects were randomly assigned to each group. Response conditioned pain modulation, pressure pain threshold, were the main variables. The secondary outcome measures included, cervical range of motion, Neck flexor endurance test, mental movement representation associated and psychosocial variables.Results: All groups showed significant differences in time factor for all evaluated variables (p < .01) except pressure pain threshold over the tibial region. The post hoc analysis revealed significant within-group differences in the AE and AO groups in conditioned pain modulation (p < .05), with medium effect size in time [AE (d -0.61); AO (d -0.74)].Conclusion: The results showed that within-group changes in conditioned pain modulation, cervical muscle endurance, and attention where founded only in the AE and AO groups. Variations in pain thresholds at pressure in the trapezium area were also obtained in the three groups. Changes in the ranges of flexion-extension and rotation movement were presented exclusively in the exercise group, and in the capacity to generate motor images only in the AO group. However, there was no difference in the pressure pain threshold over the tibial region.

Effect of laterality discrimination on joint position sense and cervical range of motion in patients with chronic neck pain: a randomized single-blind clinical trial.

Purpose: The main objective of the present study was to evaluate the effects of laterality discrimination training on neck joint position sense and cervical range of motion (ROM) in patients with chronic non-specific neck pain (NSCNP). Materials and methods: Forty-eight patients with NSCNP were randomly assigned to the neck group (NG) that observed neck images or the foot group (FG) that observed foot images. Response time, response accuracy, cervical ROM, and joint position error (JPE) were the main variables. The secondary outcome measures included psychosocial variables. Results: Differences between groups in the cervical ROM for flexion (p = .043) were obtained, being NG group the one which obtained greater values. NG showed an improvement in right rotation (p = .018) and a decrease in flexion was found in the FG (p = .039). In JPE, differences between groups were obtained in the left rotation (p = .021) and significant changes were found in the NG for flexion, extension, and left rotation movements (p < .05). Moderate associations were found between left and right accuracy regarding to post-intervention flexion and right rotation (r = 0.46, r = 0.41; p < .05) in NG. Conclusion: Improvements in cervical range of motion and joint position sense are obtained after the performance of the laterality discrimination task of images of the neck but not the feet. Visualization of images of the painful region presents moderate correlations with the accuracy and response time in the movements of flexion and right rotation.