One spinal manipulation session reduces local pain sensitivity but does not affect postural stability in individuals with chronic low back pain: a randomised, placebo-controlled trial.

BACKGROUND: Clinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity. METHODS: A two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant's perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes. RESULTS: Participants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants' perceived treatment allocation did not affect the outcomes. CONCLUSION: One spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant's belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.

Does the painDETECT questionnaire identify impaired conditioned pain modulation in people with musculoskeletal pain? - a diagnostic accuracy study.

BACKGROUND: People with neuropathic-like symptoms had more unfavourable pain features than people with nociceptive. Moreover, deficient conditioned pain modulation is common in people with neuropathic-like symptoms. PainDETECT questionnaire have been used to assess the central sensitisation sign and symptoms. However, whether the painDETECT questionnaire can identify the conditioned pain modulation's impairment is still unknown. Therefore, the current study aimed to evaluate the diagnostic accuracy of the painDETECT questionnaire in detecting the impairment of conditioned pain modulation in people with musculoskeletal pain. METHODS: We conducted a diagnostic accuracy comparing the painDETECT questionnaire (index method) with the cold pressor test, the psychophysical test used to assess the conditioned pain modulation (reference standard). We determined diagnostic accuracy by calculating sensitivity, specificity, predictive values, and likely hood ratios. RESULTS: We retrospectively enrolled 308 people with musculoskeletal pain in outpatient departments. Most participants were female (n 20 = 220, 71.4%) and had a mean age of 52.2 (± 15.0) years. One hundred seventy-three (56.1%) participants were classified as nociceptive pain, 69 (22.4%) as unclear, and 66 (21.4%) as neuropathic-like symptoms. According to the cold pressor test, 60 (19.4%) participants presented impairment of conditioned pain modulation. The cutoff point of 12 of the painDETECT questionnaire showed values of diagnostic accuracy below 70% compared to the cold pressor test, except for a negative predictive value [76.9 95% Confidence Interval (CI) 71.7 to 81.5]. The cutoff point 19 showed high specificity (78.6%, 95% CI 73.0 to 83.5), high negative predictive value (80.5%, 95% CI 78.1 to 82.7), and accuracy of 67.5% compared to the cold pressor test. CONCLUSION: The painDETECT questionnaire seems valuable for ruling out people with musculoskeletal pain and impairment of conditioned pain modulation.

Exploratory analysis of 5 supervised machine learning models for predicting the efficacy of the endogenous pain inhibitory pathway in patients with musculoskeletal pain.

OBJECTIVES: The identification of factors that influence the efficacy of endogenous pain inhibitory pathways remains challenging due to different protocols and populations. We explored five machine learning (ML) models to estimate the Conditioned Pain Modulation (CPM) efficacy. DESIGN: Exploratory, cross-sectional design. SETTING AND PARTICIPANTS: This study was conducted in an outpatient setting and included 311 patients with musculoskeletal pain. METHODS: Data collection included sociodemographic, lifestyle, and clinical characteristics. CPM efficacy was calculated by comparing the pressure pain thresholds before and after patients submerged their non-dominant hand in a bucket of cold water (cold-pressure test) (1-4 °C). We developed five ML models: decision tree, random forest, gradient-boosted trees, logistic regression, and support vector machine. MAIN OUTCOME MEASURES: Model performance were assessed using receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, recall, F1-score, and the Matthews Correlation Coefficient (MCC). To interpret and explain the predictions, we used SHapley Additive explanation values and Local Interpretable Model-Agnostic Explanations. RESULTS: The XGBoost model presented the highest performance with an accuracy of 0.81 (95% CI = 0.73 to 0.89), F1 score of 0.80 (95% CI = 0.74 to 0.87), AUC of 0.81 (95% CI: 0.74 to 0.88), MCC of 0.61, and Kappa of 0.61. The model was influenced by duration of pain, fatigue, physical activity, and the number of painful areas. CONCLUSIONS: XGBoost showed potential in predicting the CPM efficacy in patients with musculoskeletal pain on our dataset. Further research is needed to ensure the external validity and clinical utility of this model.

Pain interference, neuropathic-like symptoms, pain intensity, and symptoms of central sensitization negatively impact individual's disability after Chikungunya fever: cross-sectional study / Interferência da dor, sintomas do tipo neuropático, intensidade da dor e sintomas de sensibilização central afetam negativamente a capacidade funcional dos indivíduos após a febre Chicungunha: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Particular pain features, such as pain interference, neuropathic-like symptoms, and central sensitization (CS) symptoms may be present in patients with Chikungunya fever and lead to functional limitations. The present study aimed to assess the association between pain characteristics and the disability in participants affected by Chikungunya fever in the chronic phase. METHODS: A cross-sectional study was conducted with 36 participants who filled out a sociodemographic, pain characteristics (pain interference - Brief Pain Inventory, neuropathic-like symptoms - PainDETECT Questionnaire, and CS-related signs and symptoms - Central Sensitization Inventory) and disability (Health Assessment Questionnaire) questionnaires. The Spearman correlation test (rho) verified the relationship between the outcomes. RESULTS: Most of the participants were female (77%), with a mean age of 43 years. Twenty-seven (75%) participants presented nociceptive pain and 11 (30%) had central sensitization symptoms. There was a high positive correlation between the presence of neuropathic-like symptoms and disability (rho=0.71; p<0.001) and pain intensity and disability (rho=0.76; p<0.001). A moderate positive correlation was found between the central sensitization symptoms and disability (rho=0.51; p=0.002). Moreover, there is a low positive correlation between pain interference in an individual's life and disability (rho=0.34; p=0.041). CONCLUSION: Patients in chronic phase of Chikungunya fever revealed mild pain intensity and predominance of nociceptive pain. Pain interference, neuropathic-like symptoms, and central sensitization symptoms negatively impact individual's disability after Chikungunya fever.

RESUMO JUSTIFICATIVA E OBJETIVOS: Características particulares da dor, como interferência da dor, sintomas do tipo neuropático e sintomas de sensibilização central (SC), podem estar presentes em pacientes com febre Chicungunha e levar a limitações funcionais. O presente estudo teve como objetivo avaliar a correlação entre as características da dor e a capacidade funcional em participantes acometidos pela febre Chicungunha na fase crônica. MÉTODOS: Foi realizado um estudo transversal com 36 participantes que preencheram questionários sociodemográficos, de características de dor (interferência da dor - Inventário Breve de Dor, sintomas do tipo neuropático - questionário PainDETECT, e sinais e sintomas relacionados à SC - Inventário de Sensibilização Central) e de capacidade funcional (Health Assessment Questionnaire). O teste de correlação de Spearman (rho) verificou a relação entre os desfechos. RESULTADOS: A maioria dos participantes era do sexo feminino (77%), com média de idade de 43 anos. Vinte e sete (75%) participantes apresentaram dor nociceptiva e 11 (30%) apresentaram sintomas de sensibilização central. Houve alta correlação positiva entre a presença de sintomas do tipo neuropático e capacidade funcional (rho=0,71; p<0,001) e intensidade da dor e capacidade funcional (rho=0,76; p<0,001). Foi encontrada uma correlação positiva moderada entre os sintomas de sensibilização central e a capacidade funcional (rho=0,51; p=0,002). Além disso, há uma correlação positiva baixa entre a interferência da dor na vida do indivíduo e a capacidade funcional (rho=0,34; p=0,041). CONCLUSÃO: Pacientes em fase crônica da febre Chicungunha apresentaram intensidade de dor leve e predominância de dor nociceptiva. A interferência da dor, os sintomas do tipo neuropático e os sintomas de sensibilização central afetam negativamente a capacidade funcional do indivíduo após a febre Chicungunha.

Neuropathic-like symptoms and central sensitization related signs and symptoms negatively affect the functional performance of patients with knee osteoarthritis - a cross-sectional study.

Objective: This study aimed to compare the functional performance among participants with a neuropathic-like symptoms (NS) and central sensitization related signs and symptoms (CS), and their knee osteoarthritis (OA) counterparts. Methods: A cross-sectional observational study was conducted with 125 participants with knee OA (94 females, mean age 63.1 â€‹± â€‹7.4 years). Participants completed a self-reported questionnaire with personal and clinical features and musculoskeletal pain characteristics, including NS (PainDETECT), CS (Central Sensitization Inventory, CSI), and conditioned pain modulation. Self-reported functional disability (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC) and functional mobility (Timed Up and Go, TUG) were compared among patients with NS, CS, and their knee OA counterparts using the one-way analysis of variance (ANOVA). Results: Thirty-three (26.4%) participants had NS and CS, eighteen (14.4%) had NS, twenty-seven (21.6%) participants had CS, and 47 (37.6%) had knee OA with no NS or CS. A one-way ANOVA revealed greater functional limitation in the group with NS and CS (mean â€‹= â€‹67.5 â€‹± â€‹12.0) or NS (mean â€‹= â€‹56.7 â€‹± â€‹17.5) than the group without these symptoms (mean â€‹= â€‹32.0 â€‹± â€‹20.7) with a statistical significance difference [F(3, 121) â€‹= â€‹29.434, p â€‹< â€‹0.001] in the WOMAC Total score. The group with NS and CS (mean â€‹= â€‹19.2 â€‹± â€‹7.4) or NS (mean â€‹= â€‹16.3 â€‹± â€‹6.3) had slower velocity than the group without these symptoms (mean â€‹= â€‹11.6 â€‹± â€‹3.5) with a statistical significance difference [F(3,121) â€‹= â€‹10.045, p â€‹< â€‹0.001] in the TUG test. Conclusion: Participants with knee osteoarthritis and NS or CS pain phenotype have greater functional limitations than their counterparts.

Pain-related interference and pain-related psychosocial factors of three different subgroups of patients with chronic low back pain.

BACKGROUND: Low back pain (LBP) subgroup identification and management are a research priority. The clarification of subgroup differences could assist clinicians in clinical decisions contributing to a tailored treatment. OBJECTIVES: To compare pain-related interference and pain-related psychosocial factors among subgroups of chronic low back pain (localised low back pain, peripheral neuropathic back pain, and widespread pain). DESIGN: Cross-sectional study. METHODS: A cross-sectional study was conducted on 444 participants with chronic low back pain. Pain-related interference was investigated by the Brief Pain Inventory and Patient-Specific Functional Scale. Pain-related psychosocial factors assessment included psychosocial factors from Brief Screening Questions and maladaptive beliefs from Back Beliefs Questionnaire, self-efficacy, and expectation questions. Participants' characteristics, pain-related interference, and pain-related psychosocial factors were compared among the three groups. RESULTS: A one-way ANCOVA presented statistically significant differences among the groups for current pain intensity [F(2,441) = 6.77, p = 0.001], pain duration [F(2,425) = 9.83, p < 0.001], pain-related interference by Brief Pain Inventory [F(2,441) = 11.97, p < 0.001], and pain-related psychosocial factors regarding symptoms of anxiety [F(2,441) = 3.85, p = 0.022], symptoms of depression [F(2,441) = 6.74, p = 0.001], social isolation [F(2,441) = 6.54, p = 0.002], catastrophising [F(2,441) = 9.72, p < 0.001], perceived stress [F(2,441) = 3.93, p = 0.020], maladaptive beliefs [F(2,441) = 6.89, p = 0.001], and expectation [F(2,441) = 6.66, p = 0.001]. CONCLUSION: Participants with widespread pain presented higher pain-related interference and pain-related psychosocial factors compared to the localised low back pain group. Participants with peripheral neuropathic back pain and widespread pain presented with similar characteristics.

Relationship between the Widespread Pain Index and the PainMAP software for pain sites measurement in patients with Widespread Pain / Relação entre o Índice de Dor Espalhada e o software PainMAP para medida de localização da dor em pacientes com dor espalhada

ABSTRACT BACKGROUND AND OBJECTIVES: Identifying pain sites is essential to managing patients with Widespread Pain. Several instruments have been developed, including pain drawings, a grid system and computerized methods. However, it is not yet known whether the Widespread Pain Index matches an automated method (painMAP) for quantifying the number of pain areas. Therefore, this study aimed to identify the relationship between the Widespread Pain Index and the painMAP software to measure pain sites in participants with Widespread Pain. METHODS: A pre-planned secondary analysis of data collected from 311 patients with musculoskeletal pain was conducted. The Widespread Pain Index and the painMAP software assessed pain sites. Spearman's correlation coefficient investigated the correlation between the Widespread Pain Index and the painMAP software. RESULTS: A total of 98 participants with Widespread Pain were included in this study. Most participants were female (67; 83.7%), with a mean age of 57,7±11,5 years, mean height of 1.6 (0.1) meters and mean weight of 73.2 (11.8) kilograms. The mean pain intensity was 6.7 (2.0), and the pain duration was 92.3 (96.3) months. The mean number of pain sites in the Widespread Pain Index was 10.1 (3.7), and in the painMAP software, it was 11.7 (8.8). A weak positive correlation (rho = 0.26, 95% CI 0.45 to 0.04, p = 0.022) between the Widespread Pain Index and the painMAP software was found. CONCLUSION: The Widespread Pain Index and the painMAP software showed a weak correlation for assessing pain sites in participants with Widespread Pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: A identificação dos locais de dor é um aspecto essencial no manejo de pacientes com Dor Espalhada. Vários instrumentos foram desenvolvidos, incluindo desenhos de dor, um sistema de grade e métodos computadorizados. No entanto, ainda não se sabe se o Índice de Dor Espalhada coincide com um método automatizado (painMAP) para quantificar o número de áreas de dor. Portanto, este estudo teve como objetivo identificar a relação entre o Índice de Dor Espalhada e o painMAP para medir as áreas doloridas em participantes com esse quadro de dor. MÉTODOS: Uma análise secundária pré-planejada de dados coletados de 311 pacientes com dor musculoesquelética foi realizada. O Índice de Dor Espalhada e o painMAP avaliaram as áreas de dor. O coeficiente de correlação de Spearman foi utilizado para investigar a correlação entre o Índice de Dor Espalhada e o software painMAP. RESULTADOS: Um total de 98 participantes com Dor Espalhada foram incluídos neste estudo. A maioria dos participantes era do sexo feminino (67;83,7%), com média de idade de 57,7±11,5 anos, média de altura de 1,6 (0,1) metros e média de peso de 73,2 (11,8) quilogramas. A média de intensidade da dor foi de 6,7 (2,0) e da duração da dor de 92,3 (96,3) meses. O número médio de áreas de dor no Índice de Dor Espalhada foi de 10,1(3,7) e no software painMAP foi de 11,7 (8,8). Uma correlação positiva fraca (rho=0,26, IC de 95% 0,45-0,04, p=0,022) entre o Índice de Dor Espalhada e o painMAP foi encontrada. CONCLUSÃO: O Índice de Dor Espalhada e o painMAP mostraram correlação positiva fraca para avaliar as áreas de dor em participantes com dor espalhada.

Health literacy, pain-related interference and pain-related distress of patients with musculoskeletal pain.

The present study aimed to compare pain-related interference and pain-related distress in patients with musculoskeletal pain and differing levels of health literacy. A cross-sectional study was conducted among 243 patients with chronic musculoskeletal pain. Short Test of Functional Health Literacy in Adults classified the level of health literacy. Outcome measures included pain-related interference (pain intensity and functional limitation) and pain-related distress (psychosocial factors). Analysis of variance methods were used. One hundred twenty-three (50.62%) participants were classified as adequate, 24 (9.88%) as marginal and 96 (39.50%) as inadequate health literacy. Patients with inadequate health literacy had higher values of pain severity compared to the other groups, when controlled for age. The group adequate health literacy showed less kinesiophobia compared to their counterparts. Functional limitations and other psychosocial factors were similar among groups. Pain severity and kinesiophobia had disadvantageous findings in participants with inadequate health literacy. Still, the results of pain severity must be approached cautiously because the differences were observed when controlled for age solely.

Patients with fibromyalgia present different pain phenotypes compared to patients with generalized pain / Pacientes com fibromialgia apresentam fenótipos de dor diferentes em comparação com pacientes com dor generalizada

ABSTRACT BACKGROUND AND OBJECTIVES Fibromyalgia and generalized pain represent a global health problem and are distinct musculoskeletal disorders, but there is an overlap in the clinical presentation between these conditions. However, no study has compared pain characteristics between patients with fibromyalgia and patients with generalized pain. Therefore, the present study aimed to compare pain characteristics and functional limitation of patients with fibromyalgia and patients with generalized pain. METHODS A pre-planned secondary analysis of data collected from 311 patients with musculoskeletal pain was performed. Pain characteristics included pain intensity, pain duration, pain area, symptoms of central sensitization, presence of neuropathic-like symptoms, and the conditioned pain modulation. The Patient-Specific Functional Scale assessed functional limitation. RESULTS 98 patients with generalized pain were identified, being 58 (59.18%) classified in the fibromyalgia group and 40 (40.82%) classified in the generalized pain group. Significant differences were found between groups for Widespread Pain Index, Symptom Severity Scale, and Polysymptomatic Distress Scale. Participants with fibromyalgia presented higher values of pain intensity (fibromyalgia = 7.29±2.07, generalized pain = 6.05±2.47; p=0.008), neuropathic-like symptoms (fibromyalgia = 17.74±7.62, generalized pain = 12.17±6.41; p=0.005), and symptoms of central sensitization (fibromyalgia = 51.32±14.26, generalized pain = 33.97±14.65; p<0.001), when compared with generalized pain. There was no significant difference in conditioned pain modulation and functional limitation between groups. CONCLUSION Patients with fibromyalgia exhibited unfavorable pain characteristics, including pain intensity, neuropathic-like symptoms, and symptoms of central sensitization compared to patients with generalized pain. However, pain duration, functional limitation, and conditioned pain modulation did not present meaningful differences between groups.

RESUMO JUSTIFICATIVA E OBJETIVOS Fibromialgia e dor generalizada representam um problema de saúde global e são distúrbios musculoesqueléticos distintos, mas há uma sobreposição na apresentação clínica entre essas condições. Entretanto, nenhum estudo comparou as características da dor entre os pacientes com estas condições. Portanto, o presente estudo teve como objetivo comparar as características da dor e a limitação funcional de pacientes com fibromialgia e dor generalizada. MÉTODOS Realizou-se uma análise secundária pré-planejada de dados coletados de 311 pacientes com dor musculoesquelética. As características da dor incluíram: intensidade da dor, duração da dor, área da dor, sintomas de sensibilização central, presença de sintomas neuropáticos e a modulação condicionada da dor. A escala de funcionalidade específica do paciente avaliou a limitação funcional. RESULTADOS Identificou-se 98 pacientes com dor generalizada, sendo 58 (59,18%) classificados no grupo de fibromialgia e 40 (40,82%) no grupo de dor generalizada. Diferenças significativas foram encontradas entre os grupos para o índice de dor generalizada, escala de severidade de sintomas e escala polissintomática de sofrimento. Os participantes com fibromialgia apresentaram maiores valores de intensidade da dor (fibromialgia = 7,29±2,07, dor generalizada = 6,05 ± 2,47; p=0,008), sintomas neuropáticos (fibromialgia = 17,74±7,62, dor generalizada = 12,17 ± 6,41; p=0,005) e sintomas de sensibilização central (fibromialgia = 51,32±14,26, dor generalizada = 33,97±14,65; p<0,001), quando comparados à dor generalizada. Não houve diferença significativa na modulação condicionada da dor e na limitação funcional entre os grupos. CONCLUSÃO Pacientes com fibromialgia exibiram características de dor desfavoráveis, incluindo intensidade de dor, sintomas neuropáticos e sintomas de sensibilização central, quando comparados a pacientes com dor generalizada. Entretanto, a duração da dor, a limitação funcional e a modulação condicionada da dor não apresentaram diferença significativa entre os grupos.

Immediate effects of spinal manipulation on painful sensitivity and postural stability in patients with chronic nonspecific low back pain: study protocol for a controlled randomised clinical trial.

BACKGROUND: Low back pain is one of the main public health concerns. Chronic low back pain (cLBP) reduces functional capacity and affects postural stability. Although health professionals widely use spinal manipulation, its immediate effect on painful sensitivity and postural stability is lacking. This study aims to verify the immediate effects of lumbar spinal manipulation on the pressure pain threshold and postural stability in individuals with cLBP. METHODS: A two-arm, placebo-controlled clinical trial with parallel groups and examiner-blinded will be conducted with 80 participants with cLBP from an outpatient physical therapy department, randomly allocated at a 1:1 distribution. The experimental group will receive a lumbar spinal manipulation technique, and the placebo group will receive a simulated lumbar spinal manipulation. Both groups will receive one session of treatment and will be evaluated before and immediately after the intervention. The primary outcomes will be the pressure pain threshold and postural stability. Pain intensity and patient's expectation will be assessed as a secondary outcome. The pressure pain threshold will be assessed using a pressure algometer in 6 different anatomical regions. The evaluation of postural stability will be performed in a baropodometry exam by displacing the centre of pressure. The pain intensity will be measured using the Numeric Pain Rating Scale. A Likert scale will be used for the patient's expectation about the treatment. A two-way analysis of variance will compare the effect of the interventions between groups. DISCUSSION: This study will provide insights regarding the immediate effects of spinal manipulation in patients with cLBP against a simulated spinal manipulation using objective outcomes and considering patients' expectations regarding the treatment. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-3ksq2c . Registered on 13 July 2020.

Concurrent validity of the inertial sensors for assessment of balance control during quiet standing in patients with chronic low back pain and asymptomatic individuals.

The objective was to investigate the concurrent validity of inertial sensors for measuring balance control in patients with chronic low back pain and asymptomatic individuals. Thirty-nine patients with chronic low back and 39 age- and sex-matched asymptomatic individuals were included. Balance control analysis was performed in quiet standing with two inertial sensors positioned at the lumbar region and the sternum and compared to the results of a force plate. The variables analysed with either device were Root Mean Square (RMS), index of smoothness (JERK), trajectory length (PATH) and area (AREA). Spearman's correlation coefficient investigated the correlation. Patients with chronic low back pain showed moderate correlation with the inertial sensor positioned on the lumbar for RMS (rs = 0.59; p < 0.01), PATH (rs = 0.42, p = 0.01) and AREA (rs = 0.59; p < 0.01) and weak correlation with the inertial sensor positioned on the sternum for PATH (rs = 0.36, p = 0.04). The asymptomatic group showed statistically significant correlations for RMS for the lumbar (rs = 0.38; p = 0.03) and sternum inertial sensor (rs = 0.42; p = 0.02). Inertial sensors showed weak to moderate correlations compared to data obtained from a force plate.

Are craniocervical flexion test and the pectoralis minor index useful tests for patients with subacromial pain syndrome? / Are craniocervical flexion test and the pectoralis minor index useful tests for patients with subacromial pain syndrome?

Cervical disorders and the shortening of the pectoralis minor are advocated to play an important role in patients with subacromial pain syndrome, despite the absence of evidence. This study aimed to compare the deep cervical flexor muscle function and the shortening of the pectoralis minor between patients with subacromial pain syndrome and controls. Secondarily, this study aimed to analyze the relationship of clinical tests with pain and disability among patients. This is a case-control study with 32 patients with subacromial pain syndrome [mean age: 33 ± 6.9 years; sex: 22 (65.6%) men; right dominance: 31 (96.9%)] and 32 controls matched for age, sex, handedness, and affected side. Participants filled the Numerical Pain Rating Scale, the Shoulder Pain and Disability Index; and performed the clinical tests which were compared between patients and controls. Pectoralis minor length of the patient's group (median = 9.0) was similar to the controls (median = 9.7) (U = 421.5; p = 0.22). The deep neck muscle function presented no statistical difference between patients and controls (χ2 = 4.319; p = 0.504). There was no statistically significant correlation between clinical tests and patient self-reported measures. Therefore, deep cervical flexor muscle and the pectoralis minor muscle were not impaired in patients with subacromial pain syndrome and did not show a relationship with self-reported measures.

Distúrbios cervicais e o encurtamento do músculo peitoral menor são apontados como tendo um papel importante em pacientes com síndrome da dor subacromial, apesar da ausência de evidências. Este estudo teve como objetivo comparar a função dos músculos flexores cervicais profundos e o encurtamento do músculo peitoral menor entre pacientes com síndrome da dor subacromial e controles. Secundariamente, este estudo objetivou analisar a relação dos testes clínicos com a dor e incapacidade entre os pacientes com síndrome da dor subacromial. Trata-se de um estudo caso-controle com 32 pacientes com síndrome da dor subacromial [idade: 33 ± 6,9 anos; sexo: 22 (65,6%) homens; dominância direita: 31 (96,9%)] e 32 controles pareados por idade, sexo, lateralidade e lado afetado. Os participantes preencheram a Numerical Pain Rating Scale, o Shoulder Pain and Disability Index, realizaram os testes clínicos e os resultados dos pacientes e controles foram comparados. O comprimento do músculo peitoral menor no grupo de pacientes (mediana = 9,0) foi semelhante ao grupo controle (mediana = 9,7) (U = 421,5; p = 0,22). A função do músculo flexor cervical profundo não apresentou diferença estatística entre pacientes e controles (χ2 = 4,319; p = 0,504). Não houve correlação estatisticamente significativa entre os testes clínicos e as medidas relatadas pelos pacientes. Portanto, o músculo flexor cervical profundo e o músculo peitoral menor não foram prejudicados em pacientes com síndrome da dor subacromial e não mostraram relação com medidas autorreferidas.

Neural management plus advice to stay active on clinical measures and sciatic neurodynamic for patients with chronic sciatica: Study protocol for a controlled randomised clinical trial.

Advice to stay active is the primary management strategy for sciatica. Other conservative treatments such as neural management techniques may also contribute to sciatica recovery, but currently, the effects have not been robustly assessed. Thus, the aim of this study is to compare the effects of adding neural management to advice to stay active versus advice to stay active alone in improving pain intensity and functional limitation. Secondarily, to compare the effects of the experimental intervention in the sciatic neurodynamic, pain modulation, and psychosocial factors. A parallel-group, controlled, examiner-blinded superiority clinical trial randomised at a 1:1 allocation will be conducted in 210 participants with chronic sciatica. Patients will be recruited from outpatient physiotherapy clinics and community advertisements. The experimental group will receive neural mobilisation techniques and soft tissue mobilisation techniques for 30 minutes per session, 10 weekly sessions, plus advice to stay active on their activities of daily living, information on physical activity, imaging tests, and sciatica for 5 biweekly sessions lasting 25-30 minutes. The control group will receive advice to stay active only. The re-evaluation will be performed out after 5 weeks, 10 weeks, and 26 weeks after randomisation and primary endpoints will be pain intensity and functional limitation at 10 weeks. Secondary outcomes will include neuropathic symptoms, sciatic neurodynamic, pain modulation, and psychosocial factors. Adverse events and patient satisfaction will be assessed. Ethical approval has been granted from an Institutional Human Research Ethics Committee. Trial registration: Trial was prospectively registered in the Brazilian Registry of Clinical Trials (number: RBR-3db643c).

Use of the painDETECT to discriminate musculoskeletal pain phenotypes.

BACKGROUND: Musculoskeletal pain patients present similar pain characteristics regardless of the clinical diagnosis. PainDETECT questionnaire is useful for screening neuropathic-like symptoms in many musculoskeletal conditions. However, no previous studies compared pain phenotypes of patients with musculoskeletal pain using the painDETECT. Therefore, the current study aimed to compare the pain characteristics of patients with musculoskeletal pain classified according to the painDETECT as nociceptive pain, unclear, and neuropathic-like symptoms. METHODS: A cross-sectional study was conducted in 308 participants with musculoskeletal pain. Demographic and clinical characteristics of the participants were examined. Neuropathic-like symptoms, pain intensity, pain area, Central Sensitization-related sign and symptoms, functional limitation, and conditioned pain modulation were assessed in patients with musculoskeletal pain. Independent one-way analysis of variance (ANOVA) was used to test for between-group differences for the outcome measures with continuous variables and Pearson chi-square test verified between-group differences on the efficiency of the conditioned pain modulation. RESULTS: Participants had a mean age of 52.21 (±15.01) years old and 220 (71.42%) were females. One hundred seventy-three (56.16%) participants present nociceptive pain, 69 (22.40%) unclear, and 66 (21.42%) neuropathic-like symptoms. A one-way ANOVA showed differences for the pain intensity [F (2,305) = 20.097; p < .001], pain area [F (2,305) = 28.525; p < .001], Central Sensitization-related sign and symptoms [F (2,305) = 54.186; p < .001], and functional limitation [F (2,256) = 8.061; p < .001]. However, conditioned pain modulation was similarly impaired among the three groups (X2 = 0.333, p = 0.847). CONCLUSION: Patients with neuropathic-like symptoms revealed unfavorable pain characteristics compared to their counterparts, including pain intensity, generalized pain, Central Sensitization-related sign and symptoms, and functional limitation.

Cross-cultural adaptation of the painDETECT questionnaire into Brazilian Portuguese.

BACKGROUND AND OBJECTIVES: Neuropathic pain is common in the general population worldwide and Brazil. The painDETECT questionnaire is a notable instrument for screening on neuropathic pain. A Brazilian version of the painDETECT is necessary to broaden the possibilities of identification of neuropathic pain in the Brazilian population for the proper diagnosis and treatment. The current study aimed to perform the translation and cross-cultural adaptation of the painDETECT into the Portuguese language of Brazil. METHODS: A cross-cultural adaptation study was conducted in 11 stages according to standard procedures. Descriptive statistics were performed. The internal consistency of the questionnaire was assessed using Cronbach's Alpha test (α). RESULTS: Four translators, 10 experts, and 30 patients participated in the study. The expert committee adapted five out of nine items (item 2, 3, 6, 8, and 10) to the Brazilian context. The pretesting phase showed good internal consistency (α = 0.74) for the nine items, including the pain pattern and the body chart domains. The Cronbach's α of the instrument with seven descriptor items of pain was 0.83. CONCLUSIONS: The painDETECT was cross-culturally adapted into a Brazilian context and can be used to identify neuropathic components in pain of Brazilian patients. CLINICAL IMPLICATIONS: PainDETECT is available for Brazilians to identify neuropathic components in pain.

Is it possible to discriminate workers with a higher prevalence of low back pain considering daily exposure time in a work-related lumbar posture? A diagnostic accuracy study.

The study aimed to develop and validate a cut-off for daily postures to discriminate workers with low back pain. The self-reported episode of low back pain in the last year and during the previous week and the total spent time in occupational postures of 529 workers were used to screen workers who more likely would report low back pain. The receiver operating characteristics curve verified the ability of daily time in each posture in discriminating workers with low back pain in a training sample. Then, the chi-squared test and measurements of the diagnostic accuracy were performed in the testing sample. The daily time spent in a given posture was not able to accurately discriminate against workers with low back pain. Total time spent walking was the only daily posture that discriminated workers with low back pain in the last year in the testing sample, albeit with low accuracy. Practitioner Summary: The daily time spent in a given posture was not able to accurately distinguish workers with low back pain. Total spent time in walking presented modest diagnostic accuracy and should be interpreted cautiously. The spent time in a particular posture did not detect workers with LBP in the last week.

Diagnostic accuracy of the clinical indicators to identify central sensitization pain in patients with musculoskeletal pain.

BACKGROUND: The identification of central sensitization (CS) is an important aspect in the management of patients with chronic musculoskeletal pain. Several methods have been developed, including clinical indicators and psychophysical measures. However, whether clinical indicators coincide with the psychophysical test of CS-related sign and symptoms is still unknown. Therefore, the present study aimed to analyze the diagnostic accuracy of the clinical indicators in identifying CS-related sign and symptoms in patients with musculoskeletal pain. METHODS: One-hundred consecutive patients with musculoskeletal pain were included. Clinical indicators (index method) based on a combination of patient self-report pain characteristics and physical examination were used to identify the phenotype of patients with musculoskeletal pain and the predominance of the CS-related sign and symptoms. Conditioned pain modulation (CPM) was assessed by the Cold Pressor Test (reference standard), which is a psychophysical test used to detect impairment of CPM. Measurements of the diagnostic accuracy were performed. RESULTS: Twenty-seven patients presented predominance of CS-related sign and symptoms in the assessment of the clinical indicators, and 20 had impairment of CPM. Clinical indicators showed high accuracy (75.0%; 95% confidence interval = 65.3 to 83.1), high specificity (80.0%; 95% confidence interval = 69.6 to 88.1), high negative predictive value (87.7%; 95% confidence interval = 81.2 to 92.1), and a relevant positive likelihood ratio (2.8, 95% confidence interval = 1.5 to 5.0) when compared to the Cold Pressor Test. CONCLUSION: Clinical indicators demonstrated a valuable tool for detecting the impaired CPM, which is a remarkable feature of the CS-related sign and symptoms. Clinicians are encouraged to use the clinical indicators in the management of patients with musculoskeletal pain.

The Reliability and Concurrent Validity of PainMAP Software for Automated Quantification of Pain Drawings on Body Charts of Patients With Low Back Pain.

BACKGROUND: The assessment of painful areas through printed body charts is a simple way for clinicians to identify patients with widespread pain in primary care. However, there is a lack in the literature about a simple and automated method designed to analyze pain drawings in body charts in clinical practice. PURPOSE: To test the inter- and intra-rater reliabilities and concurrent validity of software (PainMAP) for quantification of pain drawings in patients with low back pain. METHODS: Thirty-eight participants (16 [42.10%] female; mean age 50.24 [11.54] years; mean body mass index 27.90 [5.42] kg/m2 ; duration of pain of 94.35 [96.11] months) with a current episode of low back pain were recruited from a pool of physiotherapy outpatients. Participants were instructed to shade all their painful areas on a body chart using a red pen. The body charts were digitized by separate raters using smartphone cameras and twice for one rater to analyze the intra-rater reliability. Both the number of pain sites and the pain area were calculated using ImageJ software (reference method). The PainMAP software used image processing methods to automatically quantify the data from the same digitized body charts. RESULTS: The reliability analyses revealed that PainMAP has excellent inter- and intra-rater reliabilities to quantify the number of pain sites (intraclass correlation coefficient [ICC]2,1 : 0.998 [95% confidence interval (CI) 0.996 to 0.999]; ICC2,1 : 0.995 [95% CI 0.991 to 0.998]) and the pain area [ICC2,1 : 0.998 (95% CI 0.995 to 0.999); ICC2,1 : 0.975 (95% CI 0.951 to 0.987)], respectively. The standard error of the measurement was 0.22 (4%) for the number of pain sites and 0.03 cm2 (4%) for the pain area. The Bland-Altman analyses revealed no substantive differences between the 2 methods for the pain area (mean difference = 0.007 [95% CI -0.053 to 0.067]). CONCLUSION: PainMAP software is reliable and valid for quantification of the number of pain sites and the pain area in patients with low back pain.