Test-retest Reliability in Reporting the Pain Induced by a Pain Provocation Test: Further Validation of a Novel Approach for Pain Drawing Acquisition and Analysis.

BACKGROUND: Pain drawings (PD) are frequently used in research to illustrate the pain response to pain provocation tests. However, there is a lack of data on the reliability in defining the extent and location of pain. We investigated the test-retest reliability in reporting an acute painful sensation induced by a pain provocation test using a novel approach for PD acquisition and analysis in healthy volunteers. METHODS: Forty healthy volunteers participated. Each participant underwent 2 upper limb neurodynamic tests 1 (ULNT1), once to the point of pain onset (PO) and once until the point of submaximal pain (SP). After each ULNT1, participants completed 2 consecutive PD with an interval of 1 minute. Custom software was used to quantify the pain extent and analyze the pain overlap. The test-retest reliability of pain extent was examined using Intraclass Correlation Coefficient (ICC 2,1 ) and Bland-Altman plots. Pain location reliability was examined using the Jaccard similarity coefficient (JSC). RESULTS: The ICC values for PO and SP were 0.98 (95% CI: 0.96-0.99) and 0.97 (95% CI: 0.95-0.98), respectively. The mean difference and 95% limits of agreement (± 1.96 SD) in the Bland-Altman plots were 14 pixels (-1080;1110) for PO, and 145 (-1610;1900) for SP. The median JSCs (Q1;Q3) were 0.73 (0.64;0.80) for PO and 0.76 (0.65;0.79) for SP. CONCLUSIONS: Pain drawings is a reliable instrument to investigate pain extent and pain location in healthy individuals experiencing an acute painful sensation induced by a pain provocation test.

Comparison of the effectiveness of manual massage, long-wave diathermy, and sham long-wave diathermy for the management of delayed-onset muscle soreness: a randomized controlled trial.

BACKGROUND: Delayed-onset muscle soreness (DOMS) is a specific symptom that typically arises after unaccustomed eccentric muscular effort. It increases typically 24-72 h post-exercise and can affect physical performance. The pathophysiology of DOMS remains unclear, although it seems to be related to the remodeling phase of myofibrils. Different types of treatments have been proposed to minimize DOMS after exercise; however, no clear gold standard treatment exists. Among the most popular and easy-to-apply treatments, manual massage is often performed by clinicians and has been documented to be effective in reducing symptoms. For several years, long-wave diathermy (LWD) has been performed to manage musculoskeletal complaints, such as DOMS; however, no studies have reported its efficacy thus far.This study aimed to compare the clinical effectiveness of LWD, sham LWD, and manual massage in participants with lower limb DOMS. METHODS: Participants with lower limb DOMS were included in the study. They were randomly assigned to undergo real LWD, sham LWD, or manual massage. The Numeric Pain Rating Scale (NPRS) score was the primary outcome, and the Patient Global Impression of Change (PGIC) Scale score was the secondary outcome. Outcomes were collected before and immediately after the treatment. Analysis of variance was performed to compare the post-treatment NPRS value variability among the groups and to compare the pre- and post-treatment NPRS differences among the groups. RESULTS: No clinically relevant differences were observed regarding the NPRS value variability among real LWD, sham LWD and manual massage groups. Differences were observed in the PGIC Scale scores. CONCLUSIONS: Future studies are needed to have a better understanding about the treatment of DOMS in clinical practice. TRIAL REGISTRATION: The trial was registered on 29th February 2016 in ClinicalTrials.gov (NCT02693678).

Effect of massage on DOMS in ultramarathon runners: A pilot study.

In recent years, the popularity of ultramarathons has increased. During these competitions, musculoskeletal problems are very common. Among the more frequent of those problems is the onset of muscle pain, which is defined in the literature as delayed-onset muscle soreness (DOMS). The present study aimed to collect epidemiological data regarding the onset of musculoskeletal problems during the Tor des Geants (International ultramarathon race of 330 km in length and 24,000 m in elevation difference) and to describe the effects of massage on reducing pain and overall perceived improvement in a sample of 25 athletes who complained of DOMS. Two hundred and twenty-one treatments were performed on 220 ultramarathon runners, of which 207 were males and 34 were females; the age group most represented ranged from 40 to 50 years. The most common symptom was pain, which occurred in more than 95% of cases, and the most affected area was the lower extremities (90% of subjects). In the analysed subjects, treatment with massage generated a significant (p < 0.0001) improvement. The numeric pain rating scale (NPRS) value was 3.6 points on average (SD 2.1) after massage, and there were no cases of worsening DOMS after massage as determined using the patient global impression of change (PGIC). The values of minimal clinically important difference (MCID) in DOMS management were calculated on the basis of the ROC curves and two other anchor-based methods in the PGIC and were 2.8-3.9 points on the NPRS. In the context analysed, massage was an effective treatment to reduce DOMS during the onset of symptoms.