Sleep deprivation increases pain sensitivity following acute muscle soreness.

OBJECTIVE: The aim of this cross-sectional group comparison study was to investigate whether sleep disturbance facilitates pain sensitivity caused by an acute muscle injury. METHODS: Thirty-six healthy individuals were included and randomly assigned to one of three groups in a non-balanced manner: a control group (n = 11) and two groups who performed eccentric exercise for quadriceps to cause delayed onset of muscle soreness (DOMS). The difference between the DOMS groups was that one followed their habitual sleep pattern (Sleep group, n = 12) and the other had their sleep withdrawn for one night (No-Sleep group, n = 13). The level of DOMS was indicated using a 6-point Likert Scale and pain sensitivity was assessed using Pressure Pain Thresholds (PPT) at the lower legs and shoulder at baseline (Day-1) and after 48 h (Day-3). Additionally, pain distribution following suprathreshold pressure stimulation (STPS) on the quadriceps muscle was assessed on the same days. RESULTS: PPTs were significantly reduced at Day-3 compared with Day-1 in both DOMS groups. The relative change between days was larger in the No-Sleep group compared with controls (P<0.05) whilst no significant change was seen in the Sleep group compared with controls. Furthermore, no significant differences were found between groups nor days for the subjective perception of DOMS (Likert Scale) and the size of the area of STPS. CONCLUSIONS: The loss of sleep further increases pain sensitivity following an acute soft tissue injury, demonstrating a potential causative role of the lack of sleep on complex pain states following musculoskeletal injuries.

Análisis de la efectividad de la técnica de punción seca en cefaleas: revisión sistemática / Effectiveness of dry needling for headache: A systematic review

Introducción: El uso de tratamientos no farmacológicos en pacientes con cefalea, como la punción seca (PS), está asociado a una baja morbimortalidad y a un bajo coste sanitario. Algunos han demostrado utilidad en la práctica clínica. El objetivo de esta revisión fue analizar el grado de evidencia de la efectividad de la PS en la cefalea.MétodosRevisión sistemática de ensayos clínicos aleatorizados sobre cefalea y PS en las bases de datos biomédicas PubMed, Web of Science, Scopus y PEDro. Se evaluó la calidad de los estudios incluidos mediante la escala PEDro por 2 evaluadores de forma independiente.ResultadosDe un total de 136 estudios, se seleccionaron 8 ensayos clínicos publicados entre 1994 y 2019, incluyendo en total 577 pacientes. Dos estudios evaluaron pacientes con cefalea cervicogénica, otros 2, pacientes con cefalea tensional, y otro, pacientes con migraña. Los otros 3 estudios evaluaron pacientes con cefalea de características mixtas (tensional/migraña). La calidad de los estudios incluidos osciló entre «baja» (3/10) y «alta» (8/10). La eficacia de la PS sobre los episodios de cefalea fue similar a la de los tratamientos con los que se comparó. No obstante, obtuvo mejoras significativas respecto a variables funcionales y de sensibilidad.ConclusionesLa punción seca es una técnica a considerar para el tratamiento de las cefaleas en la consulta, pudiendo utilizarse de forma rutinaria, bien de forma aislada, bien en combinación con terapias farmacológicas. (AU)

Introduction: Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache.MethodsWe performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers.ResultsOf a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes.ConclusionsDry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments. (AU)

Effectiveness of dry needling for headache: A systematic review.

INTRODUCTION: Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache. METHODS: We performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers. RESULTS: Of a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes. CONCLUSIONS: Dry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.

Effectiveness of dry needling for headache: A systematic review. / Análisis de la efectividad de la técnica de punción seca en cefaleas: revisión sistemática.

INTRODUCTION: Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache. METHODS: We performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers. RESULTS: Of a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes. CONCLUSIONS: Dry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.

Effects of an anteroposterior mobilization of the glenohumeral joint in overhead athletes with chronic shoulder pain: A randomized controlled trial.

BACKGROUND: Passive oscillatory mobilizations are often employed by physiotherapists to reduce shoulder pain and increase function. However, there is little data about the neurophysiological effects of these mobilizations. OBJECTIVES: To investigate the initial effects of an anteroposterior (AP) shoulder joint mobilization on measures of pain and function in overhead athletes with chronic shoulder pain. DESIGN: Double-blind, controlled, within-subject, repeated-measures design. METHOD: Thirty-one overhead athletes with chronic shoulder pain participated. The effects of a 9-min, AP mobilization of the glenohumeral joint were compared with manual contact and no-contact interventions. Self-reported pain, pressure pain threshold (PPT), range of movement (ROM), muscle strength, and disability were measured immediately before and after each intervention. RESULTS/FINDINGS: No significant differences were found among the treatment conditions in any of the variables investigated. A significantly greater mean decrease in self-reported shoulder pain was observed following treatment condition [0.63 (0.12, 1.14); p = 0.01]. PPT at the affected shoulder increased significantly following both the treatment [0.23 (-0.43, 0.02); p = 0.02] and manual contact [0.28 (-0.51, 0.04); p = 0.01] conditions. Shoulder AP joint mobilization also increased PPT at a distal, non-painful site [0.42 (-0.85, 0.01); p = 0.04]. No changes were observed in shoulder ROM or muscle strength. CONCLUSIONS: This study found no superior effects in various pain or function-related outcome measures of a passive oscillatory anteroposterior mobilization applied to the glenohumeral joint compared to manual contact and no-contact interventions in overhead athletes with chronic shoulder pain. Some ability to modulate shoulder pain and local and widespread pain sensitivity was observed in the short term after the passive oscillatory anteroposterior mobilization.

Pressure-induced referred pain is expanded by persistent soreness.

Several chronic pain conditions are accompanied with enlarged referred pain areas. This study investigated a novel method for assessing referred pain. In 20 healthy subjects, pressure pain thresholds (PPTs) were recorded and pressure stimuli (120% PPT) were applied bilaterally for 5 and 60 seconds at the infraspinatus muscle to induce local and referred pain. Moreover, PPTs were measured bilaterally at the shoulder, neck, and leg before, during, and after hypertonic saline-induced referred pain in the dominant infraspinatus muscle. The pressure and saline-induced pain areas were assessed on drawings. Subsequently, delayed onset muscle soreness was induced using eccentric exercise of the dominant infraspinatus muscle. The day-1 assessments were repeated the following day (day 2). Suprathreshold pressure stimulations and saline injections into the infraspinatus muscle caused referred pain to the frontal aspect of the shoulder/arm in all subjects. The 60-second pressure stimulation caused larger referred pain areas compared with the 5-second stimulation (P < 0.01). Compared with pressure stimulation, the saline-induced referred pain area was larger (P < 0.02). After saline-induced pain, the PPTs at the infraspinatus and supraspinatus muscles were reduced (P < 0.05), and the 5-second pressure-induced referred pain area was larger than baseline. Pressure pain thresholds at the infraspinatus and supraspinatus muscles were reduced at day 2 in the delayed onset muscle soreness side (P < 0.05). Compared with day 1, larger pressure and saline-induced referred pain areas were observed on day 2 (P < 0.05). Referred pain to the shoulder/arm was consistently induced and enlarged after 1 day of muscle soreness, indicating that the referred pain area may be a sensitive biomarker for sensitization of the pain system.