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1.
J Pain ; 22(1): 1-8, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32553621

RESUMO

A challenge in understanding chronic musculoskeletal pain is that research is often siloed between neuroscience, physical therapy/rehabilitation, orthopedics, and rheumatology which focus respectively on 1) neurally mediated effects on pain processes, 2) behavior and muscle activity, 3) tissue structure, and 4) inflammatory processes. Although these disciplines individually study important aspects of pain, there is a need for more cross-disciplinary research that can bridge between them. Identifying the gaps in knowledge is important to understand the whole body, especially at the interfaces between the silos-between brain function and behavior, between behavior and tissue structure, between musculoskeletal and immune systems, and between peripheral tissues and the nervous system. Research on "mind and body" practices can bridge across these silos and encourage a "whole person" approach to better understand musculoskeletal pain by bringing together the brain and the rest of the body. PERSPECTIVE: Research on chronic musculoskeletal pain is limited by significant knowledge gaps. To be fully integrated, musculoskeletal pain research will need to bridge across tissues, anatomical areas, and body systems. Research on mind and body approaches encourages a "whole person" approach to better understand musculoskeletal pain.


Assuntos
Pesquisa Biomédica , Dor Crônica , Pesquisa Interdisciplinar , Terapias Mente-Corpo , Dor Musculoesquelética , Psicofisiologia , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Humanos , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/psicologia
2.
J Mol Neurosci ; 71(2): 347-357, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32676972

RESUMO

Musculoskeletal pain is a widespread complex regional pain syndrome associated with altered emotional and cognitive functioning along with heightened physical disability that has become a global health concern. Effective management of this disorder and associated disabilities includes accurate diagnosis of its biomarkers and instituting mechanism-based therapeutic interventions. Herein, we explored the role of heraclin, a plant-derived molecule, in musculoskeletal pain and its underlying mechanistic approaches in an experimental mouse model. Reserpine (0.5 mg/kg) for 3 consecutive days evoked hyperalgesia, motor incoordination, lack of exploratory behavior, anxiety, and cognition lapse in mice. Reserpine-challenged mice displayed higher serum cytokine level, altered brain neurotransmitter content, elevated brain and muscle oxidative stress, and upregulated brain nerve growth factor receptor expression. Treatment with heraclin (10 mg/kg for 5 consecutive days) exerted analgesic effect and improved motor coordination and memory deficits in mice. Heraclin arrested serum cytokine rise, normalized brain neurotransmitter content, reduced tissue oxidative stress, and downregulated the nerve growth factor receptor expression. Therefore, it may be suggested that heraclin exerts beneficial effects against reserpine-induced musculoskeletal pain disorder possibly through the attenuation of NGFR-mediated pain and inflammatory signaling. Graphical Abstract.


Assuntos
Analgésicos/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Furocumarinas/uso terapêutico , Dor Musculoesquelética/tratamento farmacológico , Fator de Crescimento Neural/fisiologia , Estresse Oxidativo , Fitoterapia , Animais , Ansiedade/induzido quimicamente , Química Encefálica/efeitos dos fármacos , Transtornos Cognitivos/induzido quimicamente , Citocinas/sangue , Avaliação Pré-Clínica de Medicamentos , Comportamento Exploratório/efeitos dos fármacos , Furocumarinas/farmacologia , Gabapentina/uso terapêutico , Hiperalgesia/induzido quimicamente , Hiperalgesia/tratamento farmacológico , Hiperalgesia/fisiopatologia , Camundongos , Teste do Labirinto Aquático de Morris , Atividade Motora/efeitos dos fármacos , Dor Musculoesquelética/induzido quimicamente , Dor Musculoesquelética/fisiopatologia , Neurotransmissores/análise , Distribuição Aleatória , Reserpina/toxicidade , Substâncias Reativas com Ácido Tiobarbitúrico/análise
3.
BMC Musculoskelet Disord ; 21(1): 186, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32209068

RESUMO

BACKGROUND: The treatment of first choice for lateral epicondylalgia humeri is conservative therapy. Recent findings indicate that spinal manual therapy is effective in the treatment of lateral epicondylalgia. We hypothesized that thoracic spinal mobilization in patients with epicondylalgia would have a positive short-term effect on pain and sympathetic activity. METHODS: Thirty patients (all analyzed) with clinically diagnosed (physical examination) lateral epicondylalgia were enrolled in this randomized, sample size planned, placebo-controlled, patient-blinded, monocentric trial. Pain-free grip, skin conductance and peripheral skin temperature were measured before and after the intervention. The treatment group (15 patients) received a one-time 2-min T5 costovertebral mobilization (2 Hz), and the placebo group (15 patients) received a 2-min one-time sham ultrasound therapy. RESULTS: Mobilization at the thoracic spine resulted in significantly increased strength of pain-free grip + 4.6 kg ± 6.10 (p = 0.008) and skin conductance + 0.76 µS ± 0.73 (p = 0.000004) as well as a decrease in peripheral skin temperature by - 0.80 °C ± 0.35 (p < 0.0000001) within the treatment group. CONCLUSION: A thoracic costovertebral T5 mobilization at a frequency of 2 Hz shows an immediate positive effect on pain-free grip and sympathetic activity in patients with lateral epicondylalgia. CLINICAL TRIAL REGISTRATION: German clinical trial register DRKS00013964, retrospectively registered on 2.2.2018.


Assuntos
Força da Mão/fisiologia , Manipulações Musculoesqueléticas/métodos , Dor Musculoesquelética/terapia , Cotovelo de Tenista/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Limiar da Dor , Amplitude de Movimento Articular , Cotovelo de Tenista/complicações , Cotovelo de Tenista/fisiopatologia , Vértebras Torácicas , Resultado do Tratamento , Adulto Jovem
4.
Chiropr Man Therap ; 28(1): 13, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-32070377

RESUMO

INTRODUCTION: Chronic musculoskeletal pain is associated with reduced balance performance and falls risk. Manual therapies are commonly used interventions for musculoskeletal pain. There is emerging evidence that manual therapies may improve balance. The aim of this systematic review was to examine the effectiveness of manual therapies for musculoskeletal pain on measures of static and dynamic stability. METHODS: Six electronic databases were searched using pre-defined eligibility criteria and two independent reviewers assessed all identified records. Risk of bias was assessed using the 12-item Cochrane Risk of Bias assessment by two authors independently and any discrepancies resolved through consensus. Meta-analysis was conducted when three or more studies used the same outcome measures including gait speed, timed up and go test, step test and sit-to-stand test. RESULTS: Twenty-six studies were included in the analysis. Both spinal and extremity musculoskeletal pain conditions were represented. Manual therapies included manipulation, mobilisation and massage. The most common intervention compared to manual therapy was exercise. Outcome measures included both clinical and objective measures of stability. Overall the risk of bias was reported as generally low or unclear. CONCLUSION: Improvement in stability measures were reported in studies comparing manual therapy in the short term, but not long-term follow-up. There was no clear association between significant pain reduction and measures of stability. Further prospective studies are recommended to investigate whether manual therapies should be part of an integrative healthcare plan for risk of falls management and when a transition from manual therapy to more active interventions should occur for long term management.


Assuntos
Manipulações Musculoesqueléticas/métodos , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/terapia , Equilíbrio Postural , Humanos
6.
Keio J Med ; 69(2): 37-42, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31281137

RESUMO

Percutaneous ultrasonic tendon needling has been used to treat persistent lateral epicondylitis, and its efficacy has been demonstrated. However, whether ultrasonography is necessary remains unclear. The purpose of this retrospective study was to evaluate the efficacy of percutaneous tendon needling without ultrasonography for lateral epicondylitis. A total of 36 patients who underwent tendon needling without ultrasonography for lateral epicondylitis were retrospectively included in the study. The tendinotic lesion was needled by fenestration approximately 20-30 times without sonographic assistance. The Visual Analogue Scale (VAS) pain score, the grip strength, and success rates were assessed at baseline and at 1, 3, 6, and 12 months after treatment. The Nirschl tennis elbow score was evaluated at baseline and at 6 and 12 months after the needling procedure. The mean VAS pain score and grip strength at 3, 6, and 12 months significantly improved compared to the baseline values. At 6 and 12 months, the success rates had significantly increased compared to the rates at 1 month. The mean Nirschl scores at 6 and 12 months were significantly better than the baseline value. No severe complications were observed during the study period. Percutaneous tendon needling without ultrasonography is a simple and safe technique. The procedure is effective for lateral epicondylitis that is unresponsive to conventional conservative treatments.


Assuntos
Agulhamento Seco/métodos , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Cotovelo de Tenista/terapia , Adulto , Idoso , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Estudos Retrospectivos , Tendões/inervação , Tendões/fisiopatologia , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento , Ultrassonografia
7.
J Sport Rehabil ; 29(5): 640-649, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31094625

RESUMO

CONTEXT: Pain in sport has been normalized to the point where athletes are expected to ignore pain and remain in the game despite the possible detrimental consequences associated with playing through pain. While rehabilitation specialists may not have an influence on an athlete's competitive nature or the culture of risk they operate in, understanding the consequences of those factors on an athlete's physical well-being is definitely in their area of responsibility. OBJECTIVE: To explore the factors associated with the experiences of subelite athletes who play through pain in gymnastics, rowing, and speed skating. DESIGN: The authors conducted semistructured interviews with subelite athletes, coaches, and rehabilitation specialists. They recruited coach participants through their provincial sport organization. Athletes of the recruited coaches who were recovering from a musculoskeletal injury and training for a major competition were then recruited. They also recruited rehabilitation specialists who were known to treat subelite athletes independently by e-mail. SETTING: An observation session was conducted at the athlete's training facility. Interviews were then conducted either in a room at the university or at a preferred sound-attenuated location suggested by the participant. PARTICIPANTS: The authors studied 5 coaches, 4 subelite athletes, and 3 rehabilitation specialists. INTERVENTIONS: The authors photographed athletes during a practice shortly before an important competition, and we interviewed all the participants after that competition. Our photographs were used during the interview to stimulate discussion. RESULTS: The participant interviews revealed 3 main themes related to playing through pain. They are: Listening to your body, Decision making, and Who decides. CONCLUSION: When subelite athletes, striving to be the best in their sport continue to train with the pain of an injury, performance is affected in the short-term and long-term consequences are also possible. Our study provides some insight into the contrasting forces that athletes balance as they decide to continue or to stop.


Assuntos
Atletas/psicologia , Traumatismos em Atletas/fisiopatologia , Dor Musculoesquelética/fisiopatologia , Percepção da Dor/fisiologia , Reabilitação , Especialização , Adolescente , Antropologia Cultural/métodos , Traumatismos em Atletas/psicologia , Desempenho Atlético/psicologia , Criança , Quiroprática , Tomada de Decisões , Feminino , Ginástica/lesões , Ginástica/fisiologia , Ginástica/psicologia , Humanos , Relações Interpessoais , Masculino , Dor Musculoesquelética/psicologia , Mialgia/fisiopatologia , Mialgia/psicologia , Fisioterapeutas/psicologia , Patinação/lesões , Patinação/fisiologia , Patinação/psicologia , Esportes Aquáticos/lesões , Esportes Aquáticos/fisiologia , Esportes Aquáticos/psicologia , Adulto Jovem
8.
J Voice ; 34(3): 490.e11-490.e21, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30529025

RESUMO

OBJECTIVES: The purpose of the present study was to investigate the effect of Voice Therapy (VT) with and without Transcutaneous Electrical Nerve Stimulation (TENS) in women with Muscle Tension Dysphonia (MTD). METHODS: A total of 20 women with MTD participated in the study. Participants underwent evaluation of auditory-perceptual assessment, acoustic voice analysis, Vocal Tract Discomfort (VTD), and musculoskeletal pain before and after the treatment. The participants were divided into two groups: (1) TENS + VT group (10 participants) and (2) VT group (10 participants). Both groups received 10 sessions of treatment, twice a week, each lasting 50 minutes. The statistical analysis was performed using Wilcoxon signed ranked and Mann-Whitney U tests (P < 0.05). RESULTS: After VT, significant improvements were observed in all auditory-perceptual parameters and all VTD items except for the tickling frequency and severity. The VT caused significant reduction in the frequency of pain in anterior neck, posterior neck, and the larynx. Also, VT resulted in a significant reduction in pain intensity only in the larynx. After VT + TENS, significant improvements were observed in all auditory-perceptual parameters, shimmer, and all VTD items. Moreover, the VT + TENS led to a significant decrease in the frequency and intensity of pain in anterior neck, posterior neck, the larynx, masseters, shoulders, and upper back. The findings of between-group comparison after treatment showed significantly more reduction in the frequency (dry and pain items) and severity (tight and pain items) of the VTD in VT + TENS group compared with VT group. Regarding the musculoskeletal pain, significantly more reduction in the frequency and intensity of pain in anterior neck and the larynx was observed in VT + TENS group compared with VT group. CONCLUSIONS: The VT and VT + TENS could lead to positive outcomes in auditory perceptual assessment, acoustic voice analysis, the VTD, and assessment of musculoskeletal pain. In some items of frequency and severity of VTD scale and assessment of musculoskeletal pain, VT + TENS also produced better results compared with VT. As a result, TENS was recommended as a complementary therapy for patients with MTD, especially when these patients had more complaints about VTD and musculoskeletal pain.


Assuntos
Disfonia/terapia , Músculos Laríngeos/inervação , Tono Muscular , Dor Musculoesquelética/terapia , Estimulação Elétrica Nervosa Transcutânea , Qualidade da Voz , Treinamento da Voz , Adulto , Terapia Combinada , Disfonia/diagnóstico , Disfonia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/fisiopatologia , Distribuição Aleatória , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
9.
J Manipulative Physiol Ther ; 42(7): 503-513, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31864435

RESUMO

OBJECTIVE: The purpose of this systematic review was to investigate the effectiveness of manual therapy (MT) for chronic musculoskeletal pain (CMP) in the upper limbs and thorax of female breast cancer survivors and to investigate the changes in the quality of life and function of these patients. METHODS: Systematic searches were performed in the databases MEDLINE/PubMed, Cumulative Index of Nursing and Allied Health/EBSCO, Web of Science, and Physiotherapy Evidence Database, through March 2018, to identify randomized controlled trials investigating whether MT was effective to treat CMP pain in female breast cancer survivors (PROSPERO number CDR42017074175). RESULTS: The database searches retrieved 1562 titles, and after screening, 5 papers were included for full analysis. The manual therapy techniques described in the included studies involved myofascial induction, myofascial release, classic massage, ischemic compression of trigger points, and myofascial therapy. A meta-analysis, using a fixed-effects model, found that MT decreased CMP intensity (standardized mean difference: 0.32; 95% CI 0.06-0.57), but no significant difference was observed in quality of life after the MT intervention in comparison with a control condition (standardized mean difference: 0.14; 95% CI 0.17-0.46). CONCLUSION: Current evidence suggests that MT is considered effective for treating CMP in the upper limbs and thorax of female breast cancer survivors.


Assuntos
Neoplasias da Mama/terapia , Sobreviventes de Câncer/psicologia , Manipulações Musculoesqueléticas/métodos , Dor Musculoesquelética/terapia , Qualidade de Vida/psicologia , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Feminino , Humanos , Massagem/métodos , Dor Musculoesquelética/fisiopatologia , Modalidades de Fisioterapia
10.
Curr Opin Support Palliat Care ; 13(4): 408-416, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31651528

RESUMO

PURPOSE OF REVIEW: Multiple myeloma is a haematological malignancy of differentiated B lymphocytes, known as plasma cells. The disease is common in the UK (incidence of 9 cases per 100 000 people) and the most frequent presentation is bone pain caused by skeletal damage. Patients with myeloma also experience neuropathic pain induced by chemotherapy. The management of pain in multiple myeloma is frequently demanding and often sub-optimally addressed. This review seeks to summarize a rational approach to the management of pain experienced by multiple myeloma patients. RECENT FINDINGS: Bone pain has a dramatic detrimental impact on a patient's physical capacity, and therefore, quality of life. Various mechanisms of bone pain have been elucidated; however, neuropathic bone pain in multiple myeloma is not completely understood. Potential mechanisms for this phenomenon; namely increased intraosseous pressure and the acidity of the bone marrow in the disease state will be interrogated. The current analgesic pathways used to treat multiple myeloma bone pain and new advances in therapies that may confer future benefit to patients will briefly be reviewed. SUMMARY: Holistic care and the provision of an array of pain relief methods is required to achieve effective pain control in multiple myeloma bone pain and requires a concerted effort from the healthcare team to be realized.


Assuntos
Analgésicos/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Dor Musculoesquelética/tratamento farmacológico , Dor Musculoesquelética/etiologia , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Antineoplásicos/efeitos adversos , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/efeitos adversos , Glicólise/fisiologia , Humanos , Fator 1 Induzível por Hipóxia/biossíntese , Maconha Medicinal/uso terapêutico , Mieloma Múltiplo/complicações , Mieloma Múltiplo/tratamento farmacológico , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/terapia , Neuralgia/fisiopatologia , Neuralgia/terapia , Osteoclastos/metabolismo , Manejo da Dor/métodos , Cuidados Paliativos , Qualidade de Vida
11.
Curr Opin Support Palliat Care ; 13(3): 270-276, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31313700

RESUMO

PURPOSE OF REVIEW: Myofascial pain syndrome is a chronic pain condition characterized by the presence of myofascial trigger point, a hyperirritable painful spot involving a limited number of muscle fibers. The literature suggest that myofascial trigger points should be considered peripheral pain generators and this critical review will summarize recent findings concerning the clinical evaluation and the treatment of myofascial trigger points. RECENT FINDINGS: The clinical features of myofascial trigger points and their contribution to the patient pain and disability have been detailed in several recent studies, which support the clinical relevance of the condition. Recent studies reported that manual palpation to identify MTrPs has good reliability, although some limitations are intrinsic to the diagnostic criteria. During the last decade, a plethora of treatments have been proposed and positive effects on pain and function demonstrated. SUMMARY: The myofascial trigger point phenomenon has good face validity and is clinically relevant. Clinicians are encouraged to consider the contribution of myofascial trigger points to the patient's pain and disability through a careful medical history and a specific manual examination. Patients with myofascial trigger points will benefit from a multimodal treatment plan including dry needling and manual therapy techniques. Internal and external validity of research within the field must be improved.


Assuntos
Dor Musculoesquelética/fisiopatologia , Síndromes da Dor Miofascial/diagnóstico , Síndromes da Dor Miofascial/fisiopatologia , Pontos-Gatilho/fisiopatologia , Doença Crônica , Humanos , Anamnese , Síndromes da Dor Miofascial/terapia , Medição da Dor , Exame Físico , Reprodutibilidade dos Testes , Terapia de Tecidos Moles/métodos
12.
Hum Brain Mapp ; 40(15): 4381-4396, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31298464

RESUMO

The evaluation of brain changes to a specific pain condition in pediatric and adult patients allows for insights into potential mechanisms of pain chronicity and possibly long-term brain changes. Here we focused on the primary somatosensory system (SS) involved in pain processing, namely the ventroposterolateral thalamus (VPL) and the primary somatosensory cortex (SI). We evaluated, using MRI, three specific processes: (a) somatotopy of changes in the SS for different pain origins (viz., foot vs. arm); (b) differences in acute (ankle sprain versus complex regional pain syndrome-CRPS); and (c) differences of the effects of CRPS on SS in pediatric versus adult patients. In all cases, age- and sex-matched individuals were used as controls. Our results suggest a shift in concurrent gray matter density (GMD) and resting functional connectivity strengths (rFC) across pediatric and adult CRPS with (a) differential patterns of GMD (VPL) and rFC (SI) on SS in pediatric vs. adult patterns that are consistent with upper and lower limb somatotopical organization; and (b) widespread GMD alterations in pediatric CRPS from sensory, emotional and descending modulatory processes to more confined sensory-emotional changes in adult CRPS and rFC patterns from sensory-sensory alterations in pediatric populations to a sensory-emotional change in adult populations. These results support the idea that pediatric and adult CRPS are differentially represented and may reflect underlying differences in pain chronification across age groups that may contribute to the well-known differences between child and adult pain vulnerability and resilience.


Assuntos
Dor Crônica/fisiopatologia , Conectoma/métodos , Rede Nervosa/fisiologia , Distrofia Simpática Reflexa/fisiopatologia , Córtex Somatossensorial/fisiopatologia , Adolescente , Adulto , Fatores Etários , Idoso , Traumatismos do Tornozelo/patologia , Traumatismos do Tornozelo/fisiopatologia , Estudos de Casos e Controles , Criança , Suscetibilidade a Doenças , Substância Cinzenta/patologia , Substância Cinzenta/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Modelos Neurológicos , Dor Musculoesquelética/patologia , Dor Musculoesquelética/fisiopatologia , Rede Nervosa/anatomia & histologia , Especificidade de Órgãos , Medição da Dor , Distrofia Simpática Reflexa/diagnóstico por imagem , Distrofia Simpática Reflexa/patologia , Córtex Somatossensorial/diagnóstico por imagem , Córtex Somatossensorial/patologia , Entorses e Distensões/fisiopatologia , Tálamo/diagnóstico por imagem , Tálamo/patologia , Tálamo/fisiopatologia , Adulto Jovem
14.
Clin Orthop Relat Res ; 477(8): 1769-1776, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31107321

RESUMO

BACKGROUND: A large body of research shows that psychologic distress and ineffective coping strategies substantially contribute to more severe pain and increased physical limitations among patients with orthopaedic disorders. However, little is known about the relationship between positive psychology (constructs that enable individuals to thrive and adapt to challenges) and pain and physical limitations in this population. QUESTIONS/PURPOSES: (1) Which positive-psychology factors (satisfaction with life, gratitude, coping through humor, resilience, mindfulness, and optimism) are independently associated with fewer upper-extremity physical limitations after controlling for the other clinical and demographic variables? (2) Which positive-psychology factors are independently associated with pain intensity after controlling for relevant clinical and demographic variables? METHODS: In a cross-sectional study, we recruited patients presenting for a scheduled appointment with an orthopaedic surgeon at a hand and upper-extremity clinic of a major urban academic medical center. Of 125 approached patients, 119 (44% men; mean age, 50 ± 17 years) met screening criteria and agreed to participate. Patients completed a clinical and demographic questionnaire, the Numerical Rating Scale to assess pain intensity, the Patient-reported Outcomes Measurement Information System (PROMIS) Upper Extremity Physical Function computerized adaptive test to assess physical limitations, and six measures assessing positive-psychology constructs: The Satisfaction with Life Scale, the Gratitude Questionnaire, the Coping Humor Scale, the Brief Resilience Scale, the Cognitive and Affective Mindfulness Scale-Revised, and the Life Orientation Test-Revised. We first examined bivariate associations among physical limitations, pain intensity, and all positive-psychology factors as well as demographic and clinical variables. All variables that demonstrated associations with physical limitations or pain intensity at p < 0.05 were included in two-stage multivariable hierarchical regression models. RESULTS: After controlling for the potentially confounding effects of prior surgical treatment and duration since pain onset (step1; R total = 0.306; F[7,103] = 6.50), the positive-psychology variables together explained an additional 15% (R change = 0.145, F change [5, 103] = 4.297, p = 0.001) of the variance in physical limitations. Among the positive-psychology variables tested, mindfulness was the only one associated with fewer physical limitations (ß = 0.228, t = 2.293, p = 0.024, 4% variance explained). No confounding demographic or clinical variables were found for pain intensity in bivariate analyses. All positive-psychology variables together explained 23% of the variance in pain intensity (R = 0.23; F[5,106] = 6.38, p < 0.001). Among the positive-psychology variables, satisfaction with life was the sole factor independently associated with higher intensity (ß = -0.237, t = -2.16, p = 0.033, 3% variance explained). CONCLUSIONS: Positive-psychology variables explained 15% of the variance in physical limitations and for 23% of the variance in pain intensity among patients with heterogenous upper extremity disorders within a hand and upper extremity practice. Of all positive-psychology factors, mindfulness and satisfaction with life were most important for physical limitations and pain intensity, respectively. As positive-psychology factors are more easily modifiable through skills-based interventions than pain and physical limitations, results suggest implementation of such interventions to potentially improve outcomes in this population. Skills-based interventions targeting mindfulness and satisfaction with life may be of particular benefit. LEVEL OF EVIDENCE: Level II, prognostic study.


Assuntos
Adaptação Psicológica , Mãos/inervação , Dor Musculoesquelética/psicologia , Otimismo , Qualidade de Vida , Extremidade Superior/inervação , Adulto , Idoso , Efeitos Psicossociais da Doença , Estudos Transversais , Avaliação da Deficiência , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Plena , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Satisfação Pessoal , Valor Preditivo dos Testes , Resiliência Psicológica , Índice de Gravidade de Doença
15.
J Athl Train ; 54(3): 255-269, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30721093

RESUMO

CONTEXT: Patellofemoral pain (PFP) is a chronic condition that presents with lower extremity muscle weakness, decreased flexibility, subjective functional limitations, pain, and decreased physical activity. Patterned electrical neuromuscular stimulation (PENS) has been shown to affect muscle activation and pain after a single treatment, but its use has not been studied in a rehabilitation trial. OBJECTIVE: To determine the effects of a 4-week impairment-based rehabilitation program using PENS on subjective function, pain, strength, range of motion, and physical activity in individuals with PFP. DESIGN: Randomized controlled trial. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 21 patients with PFP (5 males, 16 females; age = 23.4 ± 7.6 years, height = 168.0 ± 7.5 cm, mass = 69.0 ± 19.5 kg). INTERVENTION(S): Participants completed a 4-week supervised rehabilitation program in conjunction with random assignment to receive PENS or sham treatments. MAIN OUTCOME MEASURE(S): Subjective function, pain, strength, range of motion, and physical activity levels were assessed prerehabilitation and postrehabilitation. Subjective function and pain were also assessed at 6 and 12 months postrehabilitation. Repeated-measures analyses of variance and Tukey post hoc testing were conducted with α ≤ .05. We calculated Cohen d effect sizes with 95% confidence intervals. RESULTS: Both groups had statistically and clinically meaningful differences in subjective function, pain, strength, range of motion, and activity level after 4 weeks of impairment-based rehabilitation. Improved subjective function was observed in both groups at 6 and 12 months after the interventions. The PENS group had improvements in current pain for all 3 postrehabilitation times compared with baseline measures. CONCLUSIONS: An impairment-based intervention effectively improved subjective function, pain, strength, range of motion, and physical activity levels in individuals with PFP. Participants who received PENS in addition to the rehabilitation program had improved current pain at 6 and 12 months postrehabilitation compared with baseline scores. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02441712.


Assuntos
Terapia por Estimulação Elétrica/métodos , Dor Musculoesquelética , Síndrome da Dor Patelofemoral , Adolescente , Adulto , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Força Muscular , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/reabilitação , Medição da Dor/métodos , Síndrome da Dor Patelofemoral/fisiopatologia , Síndrome da Dor Patelofemoral/reabilitação , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento
16.
Physiother Theory Pract ; 35(4): 363-372, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29528796

RESUMO

This case series describes three patients who presented with right medial elbow pain managed unsuccessfully with conservative treatment that included medication, massage, exercise therapy, ultrasound therapy, neurodynamic mobilization, and taping. Diagnosis of cubital tunnel syndrome was based on palpatory findings, a positive elbow flexion test, and a positive Tinel's sign. Conventionally, the intervention for this entrapment has been surgical decompression, with successful outcomes. This is potentially a first-time description of the successful management of cubital tunnel syndrome with dry needling (DN) using a recently published DN grading system. The patients were seen twice a week for 2 weeks with immediate improvements noted in all the outcome measures after the first treatment session. At discharge, they were pain-free and fully functional, which was maintained up to a 6-month follow-up.


Assuntos
Síndrome do Túnel Ulnar/terapia , Cotovelo/inervação , Dor Musculoesquelética/terapia , Agulhas , Modalidades de Fisioterapia/instrumentação , Nervo Ulnar/fisiopatologia , Adulto , Fenômenos Biomecânicos , Síndrome do Túnel Ulnar/diagnóstico , Síndrome do Túnel Ulnar/fisiopatologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Recuperação de Função Fisiológica , Resultado do Tratamento
17.
Clin J Pain ; 35(1): 87-99, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30222613

RESUMO

INTRODUCTION: In recent years, there has been an increase in the use of motor imagery (MI) in the rehabilitation of musculoskeletal pain conditions. Across the literature, most reviews have yet to consider Laterality Judgement Task training as a form of MI method. This review aimed to evaluate the effectiveness of using MI as an adjunct to standard rehabilitation on the improvement of pain and range of motion parameters when managing patients with musculoskeletal pain conditions. METHODS: Searches of 8 major electronic databases were conducted. Data for pain and range of motion were extracted. Meta-analyses (where possible) with either a fixed or random-effect(s) model, standardized mean differences (SMDs), and tests of heterogeneity were performed. RESULTS: Eight clinical controlled trials were identified and included in the meta-analyses. When compared with standard rehabilitation alone, the adjunctive role of MI provided superior pain relief (pooled SMD, -2.25; 95% confidence interval, -4.11 to -0.4; P=0.02), and greater improvement in range of motion (pooled SMD, 3.04; 95% confidence interval, 0.66-5.43; P=0.01) in chronic musculoskeletal pain disorders. DISCUSSION: The results suggest that MI may be effective for pain relief and improvement in range of motion among chronic musculoskeletal pain conditions, although conclusion is based on a limited certainty of evidence as assessed using the GRADES (Grading of Recommendation, Assessment, Development and Evaluation) approach.


Assuntos
Imagens, Psicoterapia/métodos , Doenças Musculoesqueléticas/fisiopatologia , Doenças Musculoesqueléticas/terapia , Manejo da Dor/métodos , Amplitude de Movimento Articular , Dor Crônica , Humanos , Movimento , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/terapia
18.
Physiother Theory Pract ; 35(4): 373-382, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29474114

RESUMO

This case report describes a 45-year-old male who presented with chronic right lateral elbow pain managed unsuccessfully with conservative treatment that included anti-inflammatory medication, injection, massage, exercise, bracing, taping, electro-physical agents, and manual therapy. Diagnosis of radial tunnel syndrome (RTS) was based on palpatory findings, range of motion testing, resisted isometrics, and a positive upper limb neural tension test 2b (radial nerve bias). Conventionally, the intervention for this entrapment has been surgical decompression, with successful outcomes. This is potentially a first-time report, describing the successful management of RTS with dry needling (DN) using a recently published DN grading system. Immediate improvements were noted in all the outcome measures after the first treatment, with complete pain-resolution maintained at a 6-month follow-up. A model is proposed describing the mechanism by which DN could be used to intervene for nerve entrapment interfaces.


Assuntos
Cotovelo/inervação , Dor Musculoesquelética/terapia , Agulhas , Modalidades de Fisioterapia/instrumentação , Nervo Radial/fisiopatologia , Neuropatia Radial/terapia , Fenômenos Biomecânicos , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Neuropatia Radial/diagnóstico , Neuropatia Radial/fisiopatologia , Recuperação de Função Fisiológica , Resultado do Tratamento
19.
Int J Clin Pharmacol Ther ; 56(9): 400-410, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30079886

RESUMO

OBJECTIVE: To determine the incidence of vitamin D deficiency, anxiety, and depression disorders in an outpatient population with musculoskeletal pain (MSP), and to evaluate the effects of correcting a vitamin D deficiency on MSP and psychological symptoms. MATERIALS AND METHODS: A total of 261 outpatients with MSP and 100 controls were involved. The Hospital Anxiety and Depression Scale (HADS) was used to assess psychological symptoms. Serum vitamin D was measured. Outpatients with vitamin D insufficiency and deficiency received oral vitamin D supplementation. Pain severity and psychological symptoms were evaluated before and after vitamin D supplementation plus dairy products. RESULTS: Vitamin D deficiency was found in 88.7% of participants in the MSP group and 69% of controls. Clinical anxiety was reported by 38.3% of participants in the MSP group and 9% of controls, while clinical depression was reported by 31.8% of participants in the MSP group and 2% of controls. Multisite pain was significantly and positively associated with anxiety, depression, and pain severity, and was inversely associated with daily calcium intake. Anxiety was inversely associated with vitamin D level, daily calcium intake, and age. A similar pattern was observed for depression. MSP was the most significant independent predictor of anxiety (OR = 7.84) and depression (OR = 5.89). Relative to baseline, all measured outcome parameters significantly improved after vitamin D supplementation plus increased intake of dairy products. CONCLUSION: Low serum vitamin D is associated with MSP along with low calcium intake, depression, and anxiety. Supplementation with vitamin D improved MSP and associated disorders.
.


Assuntos
Antidepressivos/uso terapêutico , Ansiedade/dietoterapia , Laticínios , Depressão/dietoterapia , Suplementos Nutricionais , Dor Musculoesquelética/dietoterapia , Pacientes Ambulatoriais , Deficiência de Vitamina D/dietoterapia , Vitamina D/administração & dosagem , Adolescente , Adulto , Fatores Etários , Ansiedade/epidemiologia , Ansiedade/psicologia , Cálcio da Dieta/administração & dosagem , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Incidência , Jordânia/epidemiologia , Masculino , Dor Musculoesquelética/epidemiologia , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/psicologia , Razão de Chances , Prevalência , Recomendações Nutricionais , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/fisiopatologia , Deficiência de Vitamina D/psicologia , Adulto Jovem
20.
J Bodyw Mov Ther ; 22(2): 438-448, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29861247

RESUMO

In recent times there have been, concurrently, increasing volumes of research questioning whether biomechanics have any relevance at all to musculoskeletal medicine; and a blossoming field of Pain Science identifying that perception of, and context for, pain is often more important than the tissues generating the pain in the first instance. From the academic world to social media, much excitement has been generated in supporting this new direction. However, most of the great work arising from the Pain Science arena is focused on pain itself and on the patients' conscious beliefs around their pain. A redirection of focus toward function beyond the pain, and awareness of how unconscious behavioral programming accounts for the majority of lifestyle habits and perceptions, may facilitate more effective outcomes. Other unconscious processes which are known to contribute to persistent pain, yet are still largely unacknowledged in musculoskeletal practice, are those involved in central sensitivity. A plethora of systemic and visceral conditions are known to contribute to central sensitivity yet are barely considered in typical clinical screening or management. The more that is understood about the complexity of these and other interacting factors in pain, the more the inadequacies of our prevailing research and clinical methodologies are exposed. The question posed is, are unconscious processes the next key field of exploration and "harvest" in musculoskeletal medicine and, if so, how can we most effectively address them?


Assuntos
Conscientização , Saúde Holística , Estilo de Vida , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/psicologia , Envelhecimento , Comportamento , Fenômenos Biomecânicos , Pesquisa Biomédica , Dançaterapia , Emoções , Nível de Saúde , Humanos , Saúde Mental , Modelos Teóricos , Espiritualidade
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