Perspectives of people with spinal cord injury on a pain education resource.

Introduction: Spinal cord injury (SCI) often leads to neuropathic pain that negatively affects quality of life. Several qualitative research studies in individuals with SCI who experience neuropathic pain indicate the lack of adequate information about pain. We previously developed an educational resource, the SeePain, based on scientific literature and a series of qualitative interviews of people with SCI, their significant others/family members, and SCI healthcare providers. Methods: However, to quantitatively evaluate the utility of this educational resource in a larger sample, we examined the agreement and usefulness ratings of statements regarding clarity/comprehensibility, content, and format of the SeePain, derived from the thematic analysis of our previous qualitative interviews. Participants completed a survey that provided a digital version of the SeePain and then rated their agreement/usefulness with the statements using numerical rating scales. Results: There were overall high perceived agreement and usefulness ratings regarding the SeePain's clarity, content, and format. A factor analysis reduced the agreement and usefulness ratings into 4 components (content, clarity, format, and delivery medium). Group comparisons showed that individuals with higher education were more likely to endorse electronic and website formats, and the usefulness of a shorter version of the SeePain; females and younger individuals showed greater endorsement for clarity. Finally, higher pain intensity ratings were associated with greater agreement and usefulness of the content of the SeePain. Discussion: Overall, these results support the utility of the SeePain as a source of information regarding pain that may facilitate communication about pain and its management following SCI.

Development of a pain education resource for people with spinal cord injury.

Many people with spinal cord injury (SCI) develop chronic pain, including neuropathic pain. Unfortunately, current treatments for this condition are often inadequate because SCI-associated neuropathic pain is complex and depends on various underlying mechanisms and contributing factors. Multimodal treatment strategies including but not limited to pharmacological treatments, physical rehabilitation, cognitive training, and pain education may be best suited to manage pain in this population. In this study, we developed an educational resource named the SeePain based on published pain literature, and direct stakeholder input, including people living with SCI and chronic pain, their significant others, and healthcare providers with expertise in SCI. The SeePain was then 1) systematically evaluated by stakeholders regarding its content, comprehensibility, and format using qualitative interviews and thematic analysis, and 2) modified based on their perspectives. The final resource is a comprehensive guide for people with SCI and their significant others or family members that is intended to increase health literacy and facilitate communication between SCI consumers and their healthcare providers. Future work will quantitatively validate the SeePain in a large SCI sample.

Neuropsychological Function in Traumatic Brain Injury and the Influence of Chronic Pain.

Cognitive dysfunction, pain, and psychological morbidity all present unique challenges to those living with traumatic brain injury (TBI). In this study we examined (a) the impact of pain across domains of attention, memory, and executive function, and (b) the relationships between pain and depression, anxiety, and post-traumatic stress disorder (PTSD) in persons with chronic TBI. Our sample included 86 participants with a TBI and chronic pain (n = 26), patients with TBI and no chronic pain (n = 23), and a pain-free control group without TBI (n = 37). Participants visited the laboratory and completed a comprehensive battery of neuropsychological tests as part of a structured interview. Multivariate analysis of covariance using education as a covariate, failed to detect a significant group difference for neuropsychological composite scores of attention, memory, and executive function (p = .165). A follow-up analysis using multiple one-way analysis of variance (ANOVA) was conducted for individual measures of executive function. Post-hoc testing indicated that those in both TBI groups preformed significantly worse on measures of semantic fluency when compared to controls (p < 0.001, ηρ2 = .16). Additionally, multiple ANOVAs indicated that those with TBI and pain scored significantly worse across all psychological assessments (p < .001). We also found significant associations between measures of pain and most psychological symptoms. A follow-up stepwise linear regression among those in the TBI pain group indicated that post concussive complaints, pain severity, and neuropathic pain symptoms differentially contributed to symptoms of depression, anxiety, and PTSD. These findings suggest deficits in verbal fluency among those living with chronic TBI, with results also reinforcing the multidimensional nature of pain and its psychological significance in this population.

Neurometabolite alterations in traumatic brain injury and associations with chronic pain.

Traumatic brain injury (TBI) can lead to a variety of comorbidities, including chronic pain. Although brain tissue metabolite alterations have been extensively examined in several chronic pain populations, it has received less attention in people with TBI. Thus, the primary aim of this study was to compare brain tissue metabolite levels in people with TBI and chronic pain (n = 16), TBI without chronic pain (n = 17), and pain-free healthy controls (n = 31). The metabolite data were obtained from participants using whole-brain proton magnetic resonance spectroscopic imaging (1H-MRSI) at 3 Tesla. The metabolite data included N-acetylaspartate, myo-inositol, total choline, glutamate plus glutamine, and total creatine. Associations between N-acetylaspartate levels and pain severity, neuropathic pain symptom severity, and psychological variables, including anxiety, depression, post-traumatic stress disorder (PTSD), and post-concussive symptoms, were also explored. Our results demonstrate N-acetylaspartate, myo-inositol, total choline, and total creatine alterations in pain-related brain regions such as the frontal region, cingulum, postcentral gyrus, and thalamus in individuals with TBI with and without chronic pain. Additionally, NAA levels in the left and right frontal lobe regions were positively correlated with post-concussive symptoms; and NAA levels within the left frontal region were also positively correlated with neuropathic pain symptom severity, depression, and PTSD symptoms in the TBI with chronic pain group. These results suggest that neuronal integrity or density in the prefrontal cortex, a critical region for nociception and pain modulation, is associated with the severity of neuropathic pain symptoms and psychological comorbidities following TBI. Our data suggest that a combination of neuronal loss or dysfunction and maladaptive neuroplasticity may contribute to the development of persistent pain following TBI, although no causal relationship can be determined based on these data.

A preliminary study evaluating self-reported effects of cannabis and cannabinoids on neuropathic pain and pain medication use in people with spinal cord injury.

Approximately 60% of individuals with a spinal cord injury (SCI) experience neuropathic pain, which often persists despite the use of various pharmacological treatments. Increasingly, the potential analgesic effects of cannabis and cannabinoid products have been studied; however, little research has been conducted among those with SCI-related neuropathic pain. Therefore, the primary objective of the study was to investigate the perceived effects of cannabis and cannabinoid use on neuropathic pain among those who were currently or had previously used these approaches. Additionally, the study aimed to determine if common pain medications are being substituted by cannabis and cannabinoids. Participants (N = 342) were recruited from existing opt-in listserv sources within the United States. Of those, 227 met the inclusion criteria and were enrolled in the study. The participants took part in an anonymous online survey regarding past and current use of cannabis and their perceived effects on neuropathic pain, including the use of pain medication. Those in the sample reported average neuropathic pain intensity scores over the past week of 6.8 ± 2.1 (0 to 10 scale), reflecting a high moderate to severe level of pain. Additionally, 87.9% noted that cannabis reduced their neuropathic pain intensity by more than 30%, and 92.3% reported that cannabis helped them to better deal with their neuropathic pain symptoms. Most participants (83.3%) also reported substituting their pain medications with cannabis, with the most substituted medication categories being opioids (47.0%), gabapentinoids (42.8%) and over-the-counter pain medications (42.2%). These preliminary results suggest that cannabis and cannabinoids may be effective in reducing neuropathic pain among those with SCI and may help to limit the need for certain pain medications.

Multidimensional pain phenotypes after Traumatic Brain Injury.

More than 50% of individuals develop chronic pain following traumatic brain injury (TBI). Research suggests that a significant portion of post-TBI chronic pain conditions is neuropathic in nature, yet the relationship between neuropathic pain, psychological distress, and somatosensory function following TBI is not fully understood. This study evaluated neuropathic pain symptoms, psychological and somatosensory function, and psychosocial factors in individuals with TBI (TBI, N = 38). A two-step cluster analysis was used to identify phenotypes based on the Neuropathic Pain Symptom Inventory and Beck's Anxiety Inventory scores. Phenotypes were then compared on pain characteristics, psychological and somatosensory function, and psychosocial factors. Our analyses resulted in two different neuropathic pain phenotypes: (1) Moderate neuropathic pain severity and anxiety scores (MNP-AS, N = 11); and (2) mild or no neuropathic pain symptoms and anxiety scores (LNP-AS, N = 27). Furthermore, the MNP-AS group exhibited greater depression, PTSD, pain severity, and affective distress scores than the LNP-AS group. In addition, thermal somatosensory function (difference between thermal pain and perception thresholds) was significantly lower in the MNP-AS compared to the LNP-AS group. Our findings suggest that neuropathic pain symptoms are relatively common after TBI and are not only associated with greater psychosocial distress but also with abnormal function of central pain processing pathways.

Periodized Resistance Training With and Without Functional Training Improves Functional Capacity, Balance, and Strength in Parkinson's Disease.

ABSTRACT: Strand, KL, Cherup, NP, Totillo, MC, Castillo, DC, Gabor, NJ, and Signorile, JF. Periodized resistance training with and without functional training improves functional capacity, balance, and strength in Parkinson's disease. J Strength Cond Res 35(6): 1611-1619, 2021-Periodized progressive resistance training (PRT) is a common method used to improve strength in persons with Parkinson's disease (PD). Many researchers advocate the addition of functional training to optimize translation to activities of daily living; however, machine-based PRT, using both force and velocity training components, may elicit similar benefits. Thirty-five persons with PD (Hoehn and Yahr I-III) were randomized into a strength, power, and hypertrophy (SPH; n = 17) or strength, power, and functional (SP + Func; n = 18) group, training 3 times weekly for 12 weeks. Both groups performed machine-based strength and power training on days 1 and 2 each week, respectively; whereas, on day 3, SPH group performed machine-based hypertrophy training and SP + Func group performed functional training. Functional performance was tested using the timed up and go, 30-second sit-to-stand (30-s STS), gallon-jug shelf-transfer, and seated medicine ball throw (SMBT) tests. Balance (Mini-BESTest), strength, motor symptoms (UPDRS-III), quality of life, and freezing of gait (FOG) were also assessed. Repeated measures analysis of variance revealed a main effect for time (p ≤ 0.05) with significant improvements for the sample in the 30-s STS (p = 0.002), SMBT (p = 0.003), Mini-BESTest (p < 0.001), upper-body strength (p = 0.002) and lower-body strength (p < 0.001). A significant group × time interaction was seen for FOG, with SP + Func alone showing improvement (p = 0.04). Furthermore, the SPH group produced a clinically important difference for the UPDRS-III (mean difference = 4.39, p = 0.18). We conclude that both exercise strategies can be equally effective at improving functional capacity, balance, and muscular strength in individuals with PD. In addition, FOG and motor symptoms may be targeted through SP + Func and SPH, respectively. The results provide options for individualized exercise prescriptions.

Yoga Meditation Enhances Proprioception and Balance in Individuals Diagnosed With Parkinson's Disease.

This study compared the effectiveness of two proprioceptive exercise programs for persons diagnosed with Parkinson's disease (PD). Thirty-three patients with mild to moderate PD were randomly assigned to a yoga meditation program (YoMed) or to an established proprioceptive training program (PRO). Both interventions included twice weekly sessions (45 minutes each), spanning a 12-week period. Outcome measures included: joint position sense (JPS45°, JPS55°, JPS65°) and joint kinesthesia (JKFlex and JKExt), the Tinetti Balance Assessment Tool (TIN), Falls Efficacy Scale (FES), Balance Error Scoring System (BESS), dynamic posturography (DMA and TIME) and the Timed Up-and-Go Test (TUG). Test administrators were blinded to group affiliation. Significant between-group differences favoring the YoMed group were observed for TIN (p = 0.01, d = 0.77) and JKFlex (p = 0.05, d = -0.72). DMA and TIME scores significantly improved for both groups, and no adverse events were reported. These findings indicate that the YoMed program is safe and effective for patients with PD. Researchers should continue to examine the clinical efficacy of mind-body techniques to improve movement control and body awareness in this population.

Power vs strength training to improve muscular strength, power, balance and functional movement in individuals diagnosed with Parkinson's disease.

BACKGROUND: Declines in strength and power are cardinal symptoms of Parkinson's disease (PD), a progressive neuromuscular disorder. Progressive resistance training (PRT) has been shown to reduce a wide variety of PD-related motor deficits; however, no study has examined differences between the two most common RT methodologies utilized in this population, high-load, low velocity strength training (ST) and low-load, high-velocity power training (PT). The primary purpose of this study was to compare the effects of ST and PT on measures of strength, power, balance and functional movement in persons with PD. METHOD: Thirty-five persons with mild to moderate PD (Hoehm and Yahr Stages = 1-3; UPDRS Part III = 30.6 ±â€¯14.0) were randomized into either a ST or PT group involving 12 weeks of supervised PRT (2 visits per week). Leg press (LP) and chest press (CP) muscular strength (1RM) and muscular peak power (PP) were assessed before and after the twelve week training period as primary outcome measures. In addition, secondary measures of balance (Berg Balance Assessment (BBA), dynamic posturography (DMA), Modified Falls Efficacy Scale (MFES)), functional movement (timed up-and-go), and quality of life (PDQ-39 summary index and Mobility subscore) were obtained at the same time points, given the impact of PD symptoms on fall probability and independence. RESULTS: Repeated measures ANCOVA revealed significant improvements in LP 1RM (Mdiff = 54.89 kg, 95% CI: 43.38, 66.40; p < .05; d = 3.38) and CP 1RM (Mdiff = 7.33 kg, 95% CI: 4.75, 9.91; p < .05; d = 2.02). Additionally, significant improvements were seen in LPPP (Mdiff = 112.27 W, 95% CI: 56.03, 168.51; p < .05; d = 1.42) and CPPP (Mdiff = 52.1 W, 95% CI: 23.38, 80.86; p = .001; d = 1.29). No significant improvements were seen for any secondary outcome measures, however BBA scores were shown to significantly decrease following the intervention (Mdiff = -1.686, 95% CI: -2.89, -0.482; p = .007 d = -0.96), although this change did not reach clinical significance (clinically meaningful change = ±4.0). In addition, the ST group demonstrated significantly poorer PDQ-39SI scores (Mdiff = 4.96, 95% CI: 0.54, 9.38; p = .029), whereas the entire sample showed significantly poorer PDQ-39MOB scores (Mdiff = 4.80, 95% CI: 0.17, 9.43; p = .043; d = 0.71). CONCLUSIONS: Both ST and PT appear to be effective at reducing the neuromuscular deficits associated with PD; however, the use of these interventions for improving functional performance was not supported.

Optimal loads for power in older men and women using plate-loaded resistance machines.

BACKGROUND: Age-related decrements in power affect quality of life in older adults; however, no studies have determined the optimal loads that maximize power outputs using the most commonly employed lifting equipment, plate-loaded machines. METHODS: Fifteen older men (69.2 ±â€¯6.9 y) and 22 older women (68.9 ±â€¯5.9 y) performed two sessions of strength and power testing. Individuals completed ten plate-loaded exercises to determine their maximum dynamic strengths (1RM) and peak power outputs (PP). Power was tested at 40, 50, 60, 70 and 80% 1RM using a linear position transducer. PP was expressed relative to the highest power produced (PPREL). RESULTS: Multi-joint exercises produced optimal load values at 50-60%1RM for leg press, 50%1RM for chest press, and 40-60%1RM for seated row, with no significant differences among loads for shoulder press. Single-joint exercise optimal loads were seen at 50-60% for hip adduction, 50-70%1RM for calf raise, 60-80%1RM for biceps curl, and 50-80%1RM for triceps extension, with no significant differences between loads for hip abduction or leg curl. No significant differences were found between sexes for any exercise. CONCLUSIONS: Different optimal load ranges are required for individual plate-loaded exercises in older persons. Specifically, multi-joint exercises demonstrated a narrow optimal load range favoring the velocity end of the load-velocity curve, while single-joint exercises produced a wider optimal load range extending into the upper limits of the load end of the curve.

Cortical neural arousal is differentially affected by type of physical exercise performed.

Critical flicker frequency (CFF) threshold is a visual discrimination task designed to assess cortical neural arousal, where higher values are associated with increased information processing and improved cognitive function. Previous studies using CFF assessments before and after exercise have only used one type of exercise (e.g., short, fatiguing, steady state, time to exhaustion, etc.). Therefore, the purpose of this study was to determine the effect of exercise type and intensity on neural arousal. 22 recreational runners (10 men, 12 women; age 25 ± 6 years) volunteered to participate in the study. They completed a VO2max test (short, fatiguing trial), and three 30-min treadmill runs (longer, steady-state trials) at rating of perceived exertion (RPE) levels of 13, 15, and 17. Before and after each exercise test, subjects were asked to complete the CFF test; Mtot and Mdi were calculated, which are the average and difference of the ascending/descending frequency trials, respectively. There were no main effects found for either intensity (p = 0.641) or time (p = 0.283); there was, however, a significant interaction found (intensity*time; p = 0.001). In the VO2max test and in the longer, steady-state runs at RPE13 and 15, there was no change in Mtot. There was a significant increase in Mtot after the run at RPE17 (p = 0.019). For Mdi, the VO2max test elicited a significant decrease (p = 0.005), but there was no change after the steady-state runs. The results suggest that short, fatiguing and longer, steady-state exercise affect cortical neural arousal differently. Increases in arousal, and perhaps the related domain of information processing, are more likely to come from steady-state exercise at a vigorous intensity.