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PURPOSE: Animal studies have demonstrated anti-inflammatory, and anti-nociceptive properties of hyperbaric oxygen therapy (HBOT). However, physiological data are scarce in humans. In a recent experimental study, the authors used the burn injury (BI) model observing a decrease in secondary hyperalgesia areas (SHA) in the HBOT-group compared to a control-group. Surprisingly, a long-lasting neuroplasticity effect mitigating the BI-induced SHA-response was seen in the HBOT-preconditioned group. The objective of the present study, therefore, was to confirm our previous findings using an examiner-blinded, block-randomized, controlled, crossover study design. PATIENTS AND METHODS: Nineteen healthy subjects attended two BI-sessions with an inter-session interval of ≥28 days. The BIs were induced on the lower legs by a contact thermode (12.5 cm2, 47C°, 420 s). The subjects were block-randomized to receive HBOT (2.4 ATA, 100% O2, 90 min) or ambient conditions ([AC]; 1 ATA, 21% O2), dividing cohorts equally into two sequence allocations: HBOT-AC or AC-HBOT. All sensory assessments performed during baseline, BI, and post-intervention phases were at homologous time points irrespective of sequence allocation. The primary outcome was SHA, comparing interventions and sequence allocations. RESULTS: Data are mean (95% CI). During HBOT-sessions a mitigating effect on SHA was demonstrated compared to AC-sessions, ie, 18.8 (10.5-27.0) cm2 vs 32.0 (20.1-43.9) cm2 (P=0.021), respectively. In subjects allocated to the sequence AC-HBOT a significantly larger mean difference in SHA in the AC-session vs the HBOT-session was seen 25.0 (5.4-44.7) cm2 (P=0.019). In subjects allocated to the reverse sequence, HBOT-AC, no difference in SHA between sessions was observed (P=0.55), confirming a preconditioning, long-lasting (≥28 days) effect of HBOT. CONCLUSION: Our data demonstrate that a single HBOT-session compared to control is associated with both acute and long-lasting mitigating effects on BI-induced SHA, confirming central anti-inflammatory, neuroplasticity effects of hyperbaric oxygen therapy.
RESUMO
Background and aims Quantitative sensory testing of thermal perception (QTT) is a valuable method in clinical and experimental assessment of the function of small nerve fibres. Previous studies have indicated existence of spatial summation for warmth, cool and heat pain stimulation, but study designs and assessment methods have not always been mutually consistent. The aims of this study were, first, to examine spatial summation of QTT by differently sized contact thermodes, and, second, to evaluate if these differences are significant from a clinical and scientific perspective. Methods Sixteen healthy subjects were included. Warmth detection (WDT), cool detection (CDT) and heat pain (HPT) thresholds were assessed in random order, with the stimulation areas of the contact thermodes of 3.0, 6.3 and 12.5 cm2, blinded to the subjects. Assessments were made bilaterally at volar part of the distal arm and medial part of the lower leg. Data analyses were by a mixed model with random effect for subject and fixed-effects for the variables, site (arm/leg), thermode area (ln thermode area) and side (dominant/non-dominant), in addition to conventional pairwise non-parametric comparisons. Results Data from 2 subjects were excluded. In the remaining 14 subjects only 4 subjects were able to identify the correct sequence of thermode sizes. The model demonstrated highly statistical significant relationships regarding main effects: thermode area (P < 0.0001) and stimulation site (P < 0.0001; except for CDT P = 0.011). The only significant interaction was between thermode area*site (P = 0.005) for CDT. The study demonstrated in 17 of 18 possible comparisons between thermode size and stimulation site, a significant spatial summation for WDT, CDT and HPT. Conclusion This randomized, single-blind study of thermal thresholds demonstrated spatial summation and that considerable deviations may occur if values obtained with differing thermode sizes are used uncritically. Implications Data from the present study enable interpolation of thermal thresholds with differing thermode sizes, facilitating comparisons across studies.