Localized and widespread pressure pain hypersensitivity in patients with episodic or chronic migraine: A systematic review and meta-analysis.

OBJECTIVE: This meta-analysis compared pressure pain sensitivity in trigeminal, cervical spine and remote pain-free areas between migraine patients and headache-free controls considering diagnosis (episodic versus chronic) and sex.Databases and data treatment: Electronic databases were searched for cross-sectional or prospective case-control studies comparing pressure pain thresholds between migraine and headache-free controls. Data were extracted by two reviewers. The risk of bias and methodological quality was assessed by Newcastle-Ottawa Quality Assessment Scale. Meta-analyses of trigeminal, extra-trigeminal (cervical spine) and remote pain-free areas were compared. Frequency of migraine and sex were taken into account. Mean differences (MD) and random effects were calculated. RESULTS: Eighteen studies were included. Patients with migraine showed lower pressure pain thresholds than headache-free controls: trigeminal (MD -71.33 kPa, 95%CI -92.14 to -50.53), cervical spine (MD -68.50 kPa, 95%CI -84.67 to -52.33), and remote pain-free (MD -62.49 kPa, 95%CI -99.52 to -25.45) areas. Differences were consistently significant for episodic migraine in all locations, but only significant in the trigeminal area for chronic migraine (MD -67.36 kOPa, 95%CI -101.31 to -33.42). Overall, women had lower pressure pain thresholds than men. The methodological quality of most studies (66.7%) was good. The results showed a high heterogeneity. CONCLUSION: This meta-analysis found low to high quality evidence showing lower pressure pain thresholds in trigeminal, extra-trigeminal, and remote pain-free areas in migraine sufferers when compared with headache-free controls. Hypersensitivity to pressure pain locally and widespread was consistently observed in episodic migraine, but locally in chronic migraine as compared to headache-free controls. Women with migraine were more sensitive than men.Registration number: https://doi.org/10.17605/OSF.IO/YJTAK.

Association between muscle trigger points, ongoing pain, function, and sleep quality in elderly women with bilateral painful knee osteoarthritis.

OBJECTIVE: The objectives of this study were to investigate if referred pain elicited by active trigger points (TrPs) reproduced the symptoms in individuals with painful knee osteoarthritis (OA) and to determine the relationship between the presence of active TrPs, intensity of ongoing pain, function, quality of life, and sleep quality in individuals with painful knee OA. METHODS: Eighteen women with bilateral painful knee OA, aged 79 to 90 years, and 18 matched controls participated. Muscle TrPs were bilaterally explored in several muscles of the lower extremity. Trigger points were considered active if the elicited referred pain reproduced knee symptoms, and TrPs were considered latent if the elicited pain did not reproduce symptoms. Pain was collected with a numerical pain rate scale (0-10), function was assessed with Western Ontario and McMaster Universities, quality of life was assessed with the Medical Outcomes Study Short Form 36 questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index. RESULTS: Women with knee OA exhibited a greater number of active TrPs (mean, 1 ± 1; P < .001) but similar number of latent TrPs (mean, 4 ± 2) than healthy women (mean, 4 ± 3; P = .613). A greater number of active TrPs were associated with higher intensity of ongoing pain (r = 0.605; P = .007). Higher intensity of ongoing knee pain was associated with lower physical function (P < .05). CONCLUSIONS: The referred pain elicited by active TrPs in the lower extremity muscles contributed to pain symptoms in painful knee OA. A higher number of active TrPs was associated with higher intensity of ongoing knee pain.

Effects of mobilization with movement on pain and range of motion in patients with unilateral shoulder impingement syndrome: a randomized controlled trial.

OBJECTIVE: The purpose of this study was to compare the immediate effects of mobilization with movement (MWM) to a sham technique in patients with shoulder impingement syndrome. METHODS: A randomized controlled trial was performed. Forty-two patients (mean ± SD age, 55 ± 9 years; 81% female) satisfied eligibility criteria, agreed to participate, and were randomized into an MWM group (n = 21) or sham manual contact (n = 21). The primary outcome measures including pain intensity, pain during active range of motion, and maximal active range of motion were assessed by a clinician blinded to group allocation. Outcomes were captured at baseline and after 2 weeks of MWM treatment or sham intervention. The primary analysis was the group × time interaction. RESULTS: The 2×2 analysis of variance revealed a significant group × time interaction for pain intensity during shoulder flexion (F = 7.054; P = .011), pain-free shoulder flexion (F = 32.853; P < .001), maximum shoulder flexion (F = 18.791; P < .01), and shoulder external rotation (F = 7.950; P < .01) in favor of the MWM group. No other significant differences were found. CONCLUSIONS: Patients with shoulder impingement syndrome who received 4 sessions of MWM exhibited significantly better outcomes for pain during shoulder flexion, pain-free range of shoulder flexion, maximal shoulder flexion, and maximal external rotation than those patients who were in the sham group.

Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain.

OBJECTIVE: To investigate the difference in the presence of trigger points (TrPs) between patients with chronic nonspecific low back pain (LBP) and healthy people, and to determine the relationship of TrPs with the intensity of ongoing pain, disability, and sleep quality. DESIGN: A cross-sectional study. SETTING: The role of TrPs in LBP has not been determined. PATIENTS: Forty-two patients with nonspecific LBP (50% women), aged 23-55 years old, and 42 age- and sex-matched controls participated. OUTCOME MEASURES: TrPs were bilaterally explored within the quadratus lumborum, iliocostalis lumborum, psoas, piriformis, gluteus minimus, and gluteus medius muscles in a blinded design. TrPs were considered active if the subject recognized the local and referred pain as familiar symptoms, and TrPs were considered latent if the pain was not recognized as a familiar symptom. Pain measures were collected with a numerical pain rate scale, disability was assessed with the Roland-Morris questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index. RESULTS: Patients with nonspecific LBP exhibited a greater disability and worse sleep quality than healthy controls (P < 0.001). Patients with nonspecific LBP exhibited a mean of 3.5 ± 2.3 active TrPs. Further, patients with nonspecific LBP showed a greater (P < 0.001) number of latent TrPs (mean: 2.0 ± 1.5) than healthy controls (mean: 1.0 ± 1.5). Active TrPs in the quadratus lumborum, iliocostalis lumborum, and gluteus medius muscles were the most prevalent in patients with nonspecific LBP. A greater number of active TrPs was associated with higher pain intensity (rs = 0.602; P < 0.001) and worse sleep quality (rs = 0.338; P = 0.03). CONCLUSIONS: The local and referred pain elicited by active TrPs in the back and hip muscles contributes to pain symptoms in nonspecific LBP. Patients had higher disability and worse sleep quality than controls. The number of active TrPs was associated with pain intensity and sleep quality. It is possible that a complex interaction among these factors is present in patients with nonspecific LBP.

Is Irritable Bowel Syndrome Considered as Comorbidity in Clinical Trials of Physical Therapy Interventions in Fibromyalgia? A Scoping Review.

Evidence supports the presence of comorbid conditions, e.g., irritable bowel syndrome (IBS), in individuals with fibromyalgia (FM). Physical therapy plays an essential role in the treatment of FM; however, it is not currently known whether the IBS comorbidity is considered in the selection criteria for clinical trials evaluating physiotherapy in FM. Thus, the aim of the review was to identify whether the presence of IBS was considered in the selection criteria for study subjects for those clinical trials that have been highly cited or published in the high-impact journals investigating the effects of physical therapy in FM. A literature search in the Web of Science database for clinical trials that were highly cited or published in high-impact journals, i.e., first second quartile (Q1) of any category of the Journal Citation Report (JCR), investigating the effects of physical therapy in FM was conducted. The methodological quality of the selected trials was assessed with the Physiotherapy Evidence Database (PEDro) scale. Authors, affiliations, number of citations, objectives, sex/gender, age, and eligibility criteria of each article were extracted and analyzed independently by two authors. From a total of the 412 identified articles, 20 and 61 clinical trials were included according to the citation criterion or JCR criterion, respectively. The PEDro score ranged from 2 to 8 (mean: 5.9, SD: 0.1). The comorbidity between FM and IBS was not considered within the eligibility criteria of the participants in any of the clinical trials. The improvement of the eligibility criteria is required in clinical trials on physical therapy that include FM patients to avoid selection bias.

Has the Phase of the Menstrual Cycle Been Considered in Studies Investigating Pressure Pain Sensitivity in Migraine and Tension-Type Headache: A Scoping Review.

OBJECTIVE: The aim of this scoping review was to identify if the phase of the menstrual cycle was considered in observational studies comparing pressure pain sensitivity between women with migraine or tension-type headache (TTH) and headache-free women. METHODS: A systematic electronic literature search in PubMed, Medline, Web of Science, Scopus, and CINAHL databases was conducted. Observational studies including one or more groups with TTH and/or migraine comparing pressure pain thresholds (PPTs) were included. The methodological quality (risk of bias) was assessed with the Newcastle-Ottawa Scale. Authors, objectives, inclusion/exclusion criteria, size sample, female sample, tool to assess PPTs, mean age, and the use of any medication were extracted and analyzed independently by two authors. RESULTS: From a total of 1404 and 1832 identified articles for TTH and migraine, 30 and 18 studies satisfied the criteria and were included. Nineteen (63.4%) studies assessing TTH patients and eleven (61.1%) assessing migraine patients showed a high risk of bias. The most common flaws were attributed to improper selection of control and control over other additional factors. Based on the systematic review, just one study including TTH and one including migraine patients considered the menstrual cycle. CONCLUSION: The results of this scoping review identified that the phase of the menstrual cycle has been rarely considered in studies investigating sensitivity to pressure pain in primary headaches, such as TTH or migraine, although there is evidence showing the relevance of the phase of the menstrual cycle in pain perception.

Mechanical Properties of Lumbar and Cervical Paravertebral Muscles in Patients with Axial Spondyloarthritis: A Case-Control Study.

BACKGROUND: Axial spondyloarthritis (axSpA) affects spinal muscles, due to inflammation and structural damage. The mechanical properties of the muscles, such as tone or stiffness, could be altered in axSpA. The aim of this work is to analyze the mechanical properties of cervical and lumbar spine muscles in axSpA patients and their relationship with metrology measures, function, disease activity, structural damage and quality of life. METHODS: axSpA patients and age/gender/BMI matched healthy controls were recruited. The muscle mechanical properties (MMPs), such as tone or frequency, stiffness, decrement (linear elastic properties), relaxation and creep (viscoelastic properties), of cervical (semispinalis capitis) and lumbar (erector spinae) muscles were bilaterally measured at rest using myotonometry. Additionally, conventional metrology, BASMI (metrology index), BASDAI (disease activity index), mSASSS (radiological structural damage index) and SF-12 (health-related quality of life questionnaire) were used in the axSpA group. Between-groups comparison, intra-group correlations and multivariable regression analyses were performed to achieve the study aims. RESULTS: Thirty-four axSpA patients (mean age: 46.21 ± 8.53 y) and 34 healthy volunteers (mean age: 43.97 ± 8.49 y) were recruited. Both in cervical and lumbar spine, linear elastic parameters were significantly higher in axSpA patients in comparison with controls, while viscoelastic parameters were significantly lower. Lumbar muscle frequency, stiffness, relaxation, creep and cervical muscle elasticity were fair to strongly correlated (|0.346| < r < |0.774|) with age, functional status, activity of disease, structural damage and quality of life in axSpA patients. Furthermore, moderate to good fitted multivariate models (0.328 < R2 < 0.697) were obtained combining age, conventional metrology, activity of the disease and function for the estimation of cervical and lumbar MMPs. CONCLUSION: Mechanical properties of spinal muscles of axSpA patients differ from controls. Lumbar and cervical muscles exhibit greater linear elastic properties and lower viscoelastic properties, which are related with age, clinical and psychophysiological features of axSpA.

Is Irritable Bowel Syndrome Considered in Clinical Trials on Physical Therapy Applied to Patients with Temporo-Mandibular Disorders? A Scoping Review.

The aim of the current scoping review was to identify if the presence of irritable bowel syndrome was included as eligibility criteria of participants included in clinical trials investigating the effects of physical therapy in individuals with temporomandibular pain disorders (TMDs). A systematic electronic literature search in the Web of Science database was conducted. Scientifically relevant, randomized clinical trials (those cited in other studies at least 5 times, or clinical trials published in high-impact journals, i.e., first and second quartiles (Q1-Q2) of any category of the Journal Citation Report (JCR)) evaluating the effects of any physical therapy intervention in patients with TMDs were included. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the selected trials. Authors affiliated to a clinical or non-clinical institution, total number of citations, objective, sex/gender, age, and eligibility criteria in each article were extracted and analyzed independently by two authors. From a total of 98 identified articles, 12 and 19 clinical trials were included according to the journal citation criterion or JCR criterion, respectively. After removing duplicates, a total of 23 trials were included. The PEDro score ranged from 4 to 8 (mean: 6.26, SD: 1.48). Based on the eligibility criteria of the trials systematically reviewed, none considered the presence of comorbid irritable bowel syndrome in patients with TMDs. The comorbidity between TMDs and irritable bowel syndrome is not considered within the eligibility criteria of participants in highly cited clinical trials, or published in a high-impact journal, investigating the effects of physical therapy in TMDs.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain.

BACKGROUND: Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. OBJECTIVE: To determine differences in pain perception between individuals with LBP living in Brazil and Spain. METHOD: Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. RESULTS: A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. CONCLUSION: The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

[Myofascial trigger points, pain, disability and quality of sleep in patients with chronic tension-type headache: a pilot study]. / Puntos gatillo miofasciales, dolor, discapacidad y calidad del sueno en pacientes con cefalea de tension cronica: estudio piloto.

INTRODUCTION. The referred pain induced by myofascial trigger points (MTP) and sleep disorders can be factors that contribute to chronic tension-type headache. AIM. To determine the relationship between MTP, intensity of pain, disability and quality of sleep in people with chronic tension-type headache. SUBJECTS AND METHODS. Participants in the study consisted of 16 patients with chronic tension-type headache and 15 healthy controls. A visual analogue scale was used to measure the intensity of the pain, and the neck disability questionnaire and the Pittsburgh (quality of sleep) questionnaire were also employed. MTP were explored in the temporal, masseter, upper trapezius, suboccipital, sternocleidomastoid, splenius capitis, semispinalis capitis and anterior digastric muscles by a blind evaluator. RESULTS. The subjects with chronic tension-type headache had greater cervical disability (p < 0.001) than the controls, whereas the quality of sleep showed a tendency (p = 0.092). A positive correlation was found between the worst pain last week with the Pittsburgh questionnaire (r = 0.631; p = 0.009) and disability (r = 0.521; p = 0.046), as well as a positive correlation between disability and quality of sleep (r = 0.815; p < 0.001). The patients with headache displayed a higher number of MTP than the healthy controls (p < 0.001), the presence of active MTP being found exclusively in the patients. No association was found between the number of MTP and intensity of pain, disability or quality of sleep. CONCLUSIONS. Quality of sleep and active MTP can be different factors contributing to chronic tension-type headache. Nevertheless, the presence of MTP could also be an epiphenomenon of the pain.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain

ABSTRACT Background Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. Objective To determine differences in pain perception between individuals with LBP living in Brazil and Spain. Method Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. Results A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. Conclusion The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

Puntos gatillo miofasciales, dolor, discapacidad y calidad del sueño en pacientes con cefalea de tensión crónica: estudio piloto / Myofascial trigger points, pain, disability and quality of sleep in patients with chronic tension-type headache: a pilot study

Introducción. El dolor referido inducido por puntos gatillo miofasciales (PGM) y las alteraciones del sueño pueden serfactores contribuyentes en la cefalea tensional crónica. Objetivo. Determinar la relación entre los PGM, intensidad del dolor, discapacidad y calidad del sueño en personas con cefalea tensional crónica. Sujetos y métodos. Participaron 16 pacientes con cefalea tensional crónica y 15 controles sanos. Se utilizó una escala analógica visual para la intensidad del dolor, el cuestionario de discapacidad de cuello y el cuestionario de calidad del sueñode Pittsburgh. Se exploraron PGM en los músculos temporal, masetero, trapecio superior, suboccipitales, esternocleidomastoideo, esplenio de la cabeza, semiespinoso de la cabeza y digástrico anterior por un evaluador ciego. Resultados. Los sujetos con cefalea tensional crónica tenían mayor discapacidad cervical (p < 0,001) que los controles, mientras que la calidad del sueño mostró una tendencia (p = 0,092). Se encontró una correlación positiva entre peor dolorde la semana pasada con el cuestionario de Pittsburgh (r = 0,631; p = 0,009) y la discapacidad (r = 0,521; p = 0,046), y una correlación positiva entre la discapacidad y calidad del sueño (r = 0,815; p < 0,001). Los pacientes con cefalea mostraron mayor número de PGM que los sujetos sanos (p < 0,001), siendo la presencia de PGM activos exclusiva en los pacientes. No se encontró asociación entre el número de PGM con la intensidad del dolor, discapacidad o calidad del sueño.Conclusiones. La calidad del sueño y los PGM activos pueden ser diferentes factores contribuyentes en la cefalea tensional crónica. No obstante, la presencia de PGM podría ser también un epifenómeno del dolor (AU)

Introduction. The referred pain induced by myofascial trigger points (MTP) and sleep disorders can be factors that contributeto chronic tension-type headache.Aim. To determine the relationship between MTP, intensity of pain, disability and quality of sleep in people with chronic tension-type headache. subjects and methods. Participants in the study consisted of 16 patients with chronic tension-type headache and 15 healthy controls. A visual analogue scale was used to measure the intensity of the pain, and the neck disability questionnaire and thePittsburgh (quality of sleep) questionnaire were also employed. MTP were explored in the temporal, masseter, upper trapezius,suboccipital, sternocleidomastoid, splenius capitis, semispinalis capitis and anterior digastric muscles by a blind evaluator. Results. The subjects with chronic tension-type headache had greater cervical disability (p < 0.001) than the controls, whereas the quality of sleep showed a tendency (p = 0.092). A positive correlation was found between the worst pain lastweek with the Pittsburgh cuestionnaire (r = 0.631; p = 0.009) and disability (r = 0.521; p = 0.046), as well as a positive correlation between disability and quality of sleep (r = 0.815; p < 0.001). The patients with headache displayed a higher number of MTP than the healthy controls (p < 0.001), the presence of active MTP being found exclusively in the patients. No association was found between the number of MTP and intensity of pain, disability or quality of sleep.Conclusions. Quality of sleep and active MTP can be different factors contributing to chronic tension-type headache. Nevertheless, the presence of MTP could also be an epiphenomenon of the pain (AU)