Health sciences students' career commitment, mental health, and physical activity during the COVID-19 pandemic.

Objective: To understand the biopsychosocial dimensions of university health sciences students' experiences during the COVID-19 pandemic. Participants: Health sciences students (n = 297) from two universities in July and August 2020. Methods: Participants completed a Web-based survey asking about depression, anxiety, physical activity, coronavirus threat, and career commitment. Results: Moderate or severe depression and anxiety were reported by 28.6% and 31.3% of respondents, respectively. Depression and anxiety were positively correlated with perceived coronavirus threat and negatively correlated with career commitment and strenuous physical activity. A change in career commitment interests during the COVID-19 pandemic was reported by 11% of respondents. Conclusions: Identified factors that could be targeted by universities to support their students and secure career commitment include online learning challenges, ability to secure clinical placements, mental health (anxiety and depression), financial challenges, family pressure, and promotion of physical activity.

The current state of physical therapy pain curricula in the United States: a faculty survey.

UNLABELLED: Insufficient pain education is problematic across the health care spectrum. Recent educational advancements have been made to combat the deficits in pain education to ensure that health care professionals are proficient in assessing and managing pain. The purpose of this survey was to determine the extent of pain education in current Doctorate of Physical Therapy schools in the United States, including how pain is incorporated into the curriculum, the amount of time spent teaching about pain, and the resources used to teach about pain. The survey consisted of 10 questions in the following subject areas: basic science mechanisms and concepts about pain, pain assessment, pain management, and adequacy of pain curriculum. The overall response was 77% (167/216) for the first series of responses of the survey (Question 1), whereas 62% completed the entire survey (Questions 2-10). The average contact hours teaching about pain was 31 ± 1.8 (mean ± standard error of the mean) with a range of 5 to 115 hours. The majority of schools that responded covered the science of pain, assessment, and management. Less than 50% of respondents were aware of the Institute of Medicine report on pain or the International Association for the Study of Pain guidelines for physical therapy pain education. Only 61% of respondents believed that their students received adequate education in pain management. Thus, this survey demonstrated how pain education is incorporated into physical therapy schools and highlighted areas for improvement such as awareness of recent educational advancements. PERSPECTIVE: This article demonstrates how pain education is incorporated into physical therapy curricula within accredited programs. Understanding the current structure of pain education in health professional curriculum can serve as a basis to determine if recent publications of guidelines and competencies impact education.

Corticomotor excitability during a noxious stimulus before and after exercise in women with fibromyalgia.

The purposes of this study were to assess corticomotor excitability in people with fibromyalgia during a noxious stimulus before and after fatiguing exercise and examine associations with pain perception. Fifteen women with fibromyalgia completed three sessions: one familiarization and two experimental. The experimental sessions were randomized and involved measurement of pain perception and motor evoked potentials before and after (1) quiet rest and (2) isometric contraction of the elbow flexor muscles. Motor evoked potential amplitude of brachioradialis muscle was measured following transcranial magnetic stimulation delivered before, during, and after a noxious mechanical stimulus. After quiet rest, there was no change in pain perception. After the submaximal contraction, there was considerable variability in the pain response. Based on the changes in the experimental pain, subjects were divided into three groups (increase, decrease, and no change in pain). There was an interaction between pain response and the pain-induced change in motor evoked potentials. Those individuals who had an increase in motor evoked potentials during the pain test had an increase in pain after exercise. Thus, women with fibromyalgia were classified based on their pain response to exercise, and this response was associated with the change in corticomotor excitability during the application of a noxious stimulus.

Pain relief after isometric exercise is not task-dependent in older men and women.

INTRODUCTION: This study assessed the effect of isometric contractions that varied in intensity and duration on pain perception in adults older than 60 yr. METHODS: Pain perception was measured in 24 men and women (mean ± SD age = 72.2 ± 6.2 yr) using a pressure pain device applied to the right index finger before and after isometric contractions of the left elbow flexor muscles of the following doses: 1) three brief maximal voluntary contractions (MVC), 2) 25% MVC held for 2 min, and 3) 25% MVC held to task failure. RESULTS: Older adults reported increased pain thresholds (58 s vs 49 s, P < 0.001) and decreased pain ratings (2.8 vs 3.4, P < 0.001) after exercise, and these changes were similar across all three tasks (P = 0.94 and P = 0.55, respectively). Sex differences were identified with older women reporting greater pain sensitivity (lower pain thresholds [P = 0.01] and higher pain ratings [P = 0.004]) and larger reductions in pain ratings than men (23% vs 9%, P = 0.003) after isometric contractions. CONCLUSIONS: Older adults experienced similar reductions in pain after several different intensities and durations of isometric contractions. Both older men and women experienced increases in pain threshold, but only older women experienced reductions in pain ratings.

Pain perception after isometric exercise in women with fibromyalgia.

OBJECTIVE: The purpose of this study was to identify exercise protocols incorporating isometric contractions that provide pain relief in women with fibromyalgia. DESIGN: A before-after trial. SETTING: A physical therapy department in an academic setting. PARTICIPANTS: Fifteen women (mean ± SD, 52±11y) with fibromyalgia. INTERVENTIONS: Subjects completed 4 sessions: 1 familiarization and 3 experimental. The following randomized experimental sessions involved the performance of isometric contractions with the elbow flexor muscles that varied in intensity and duration: (1) 3 maximal voluntary contractions (MVCs), (2) 25% MVC held to task failure, and (3) 25% MVC held for 2 minutes. MAIN OUTCOME MEASURES: Experimental pain (pain threshold and pain rating), Fibromyalgia Impact Questionnaire, and fibromyalgia pain intensity (visual analog scale). RESULTS: After all 3 isometric contractions, there was considerable variability between subjects in the pain response. Based on the changes in experimental pain, subjects were divided into 3 groups (increase, decrease, no change in pain). Multiple regression analysis revealed that age, baseline experimental pain, and change in fibromyalgia pain intensity were significant predictors of the experimental pain response after the isometric contractions. CONCLUSIONS: We identified subgroups of women with fibromyalgia based on how they perceived pain after isometric contractions. The greatest pain relief for women with fibromyalgia occurred at a younger age and in women with the greatest experimental pain before exercise. Additionally, we established a link between experimental and clinical pain relief after the performance of isometric contractions.

Update on the relation between pain and movement: consequences for clinical practice.

It is generally thought that exercise is beneficial to alleviate pain. However, prolonged movement may lead to the development of painful injuries, because of the overload of low-threshold motor units. Especially in individuals with a pain condition, exercise prescription and the impact of fatigue is less clear. This may be because of the dual effects, aggravation and relief, which fatigue has on pain. The purpose of this review is to ascertain the relation between pain and the motor system, both in the development and management of pain. Recent studies show that fatigue alters pain-induced increases in corticomotor excitability and leads to within and between-muscle adaptations. Studies of acute pain have shown complex adaptations such as increased movement variability, which may be because of a search for motor solutions to prolong overall task performance. In contrast, chronic pain seems to limit movement duration, speed, and variability which could be protective in the short term but also counterproductive over time. Owing to these adaptations in movement strategies, pain chronicity may help to dictate exercise prescription. For example, the correct dosage of multimuscle, dynamic exercises would act to promote movement variability. Thus, it seems that exercise involving the use of different movement strategies could be effective in helping people to obtain exercise-induced benefits while avoiding injury and pain reaggravation.

Fatiguing exercise attenuates pain-induced corticomotor excitability.

The purpose of this study was to assess net corticomotor excitability during a painful stimulus before and after exercise. In the first study, 25 subjects participated in three sessions: one familiarization session and two experimental sessions. The two experimental sessions were randomized and involved measurement of pain perception before and after (1) a submaximal isometric fatiguing contraction with the left elbow flexor muscles and (2) 30 min of quiet rest. Pain perception was assessed using a pressure device applied to the right index finger for 2 min. Motor evoked potentials (MEPs) of the left brachioradialis muscle were measured following transcranial magnetic stimulation (TMS) which was delivered before, during, and after the 2 min pain test. In the second study, 12 subjects participated in one session which involved application of TMS to elicit MEPs at the same time points as in study one, before and after a submaximal fatiguing contraction, but in the absence of pain. In the absence of the mechanical noxious stimulus, MEP amplitude was reduced following the fatiguing contraction and unchanged over this time period. In study one, pain threshold increased and pain ratings decreased following the isometric contraction but not after 30 min of quiet rest. During application of the mechanical noxious stimulus to the right index finger, MEP amplitude of the left brachioradialis muscle increased indicating an increase in net corticomotor excitability. The pain-induced increase in MEPs was attenuated following the isometric fatiguing contraction and this occurred in parallel with the decrease in pain.

The role of the menstrual cycle phase in pain perception before and after an isometric fatiguing contraction.

The purpose of this study was to compare exercise-induced analgesia in young women after a fatiguing isometric contraction during different phases of the menstrual cycle. Twenty female subjects performed a submaximal (25% maximal voluntary contraction) isometric contraction until task failure during both the mid-follicular and mid-luteal phases of their menstrual cycle. Pain perception (i.e., pain threshold and pain ratings) was measured before and after the isometric fatiguing contraction. Other measures included mean arterial pressure, heart rate, and anxiety levels. Time to task failure of the fatiguing contraction was similar for the two phases of the menstrual cycle. Following the performance of the isometric contraction: (1) pain thresholds increased and pain ratings decreased; (2) anxiety levels increased; and (3) mean arterial pressure and heart rate increased. These changes were not dependent on the phase of the menstrual cycle. Thus, the menstrual cycle phase does not influence the magnitude of exercise-induced analgesia.

Dose response of isometric contractions on pain perception in healthy adults.

INTRODUCTION: The purpose of the study was to compare pain ratings and thresholds in men and women before and after isometric contractions of varying intensity and duration performed with the elbow flexor muscles. METHODS: Pain perception was assessed, using a pressure device applied to the contralateral finger, before and after the following isometric contractions: 1) three brief maximal voluntary contractions (MVC), 2) 25% MVC sustained until task failure, 3) 25% MVC sustained for 2 min, and 4) 80% MVC sustained until task failure. RESULTS: High-intensity and long-duration, low-intensity isometric contractions produced an analgesic response. The greatest change in pain threshold and pain ratings, when pressure was applied to the contralateral finger, was after the long-duration, low-intensity contraction sustained until failure. Sex differences were present with women reporting 1) lower pain thresholds and higher pain ratings during quiet rest and 2) higher pain ratings before and after isometric contractions. CONCLUSION: These results suggest that activation of high-threshold motor units is involved in exercise-induced analgesia.

Phosphorylation of CREB and mechanical hyperalgesia is reversed by blockade of the cAMP pathway in a time-dependent manner after repeated intramuscular acid injections.

Spinal activation of the cAMP pathway produces mechanical hyperalgesia, sensitizes nociceptive spinal neurons, and phosphorylates the transcription factor cAMP-responsive element binding protein (CREB), which initiates gene transcription. This study examined the role of the cAMP pathway in a model of chronic muscle pain by assessing associated behavioral changes and phosphorylation of CREB. Bilateral mechanical hyperalgesia of the paw was induced by administering two injections of acidic saline, 5 d apart, into the gastrocnemius muscle of male Sprague Dawley rats. Interestingly, the increases in immunoreactivity for CREB and phosphorylated CREB (p-CREB) in the spinal dorsal horn occur 24 hr, but not 1 week, after the second injection of acidic saline compared with pH 7.2 intramuscular injections. Spinal blockade of adenylate cyclase prevents the expected increase in p-CREB that occurs after intramuscular acid injection. The reversal of mechanical hyperalgesia by adenylate cyclase or protein kinase A inhibitors spinally follows a similar pattern with reversal at 24 hr, but not 1 week, compared with the vehicle controls. The p-CREB immunoreactivity in the superficial dorsal horn correlates with the mechanical withdrawal threshold such that increases in p-CREB are associated with decreases in threshold. Therefore, activation of the cAMP pathway in the spinal cord phosphorylates CREB and produces mechanical hyperalgesia associated with intramuscular acid injections. The mechanical hyperalgesia and phosphorylation of CREB depend on early activation of the cAMP pathway during the first 24 hr but are independent of the cAMP pathway by 1 week after intramuscular injection of acid.