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1.
J Oral Rehabil ; 48(1): 10-17, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32979854

RESUMO

BACKGROUND: The diagnosis of temporomandibular disorders (TMD) is based on patient history and physical examination, and may require medical imaging. Masticatory muscle palpation is essential to make a diagnosis of TMD. However, the response of masticatory muscles to mechanical pressure stimuli depends on many physical and psychological factors. OBJECTIVE: This study aimed at determining the impact of somatosensory amplification (SSA)-an estimate of somatic awareness and bodily hypervigilance-on pressure pain thresholds (PPTs) measured at both trigeminal and extra-trigeminal locations in healthy individuals. METHODS: PPTs were measured at the right anterior temporalis and superficial masseter, and the thenar eminence of the right hand in one hundred healhty individuals (69F, 31M), divided in three groups based on their SSA scores: low (N = 32), intermediate (N = 34) and high (N = 34). General linear models were used to test between-group differences in PPTs including sex as a covariate. The level of significance was set at P < .05. RESULTS: Individuals with high SSA had lower PPTs at the anterior temporalis than individuals with low (P = .006) and intermediate (P = .001) SSA. No significant between-group differences were found in PPTs measured at the masseter (P = .372). PPTs measured at the thenar eminence were significantly lower in the high than the low SSA group (P = .009). Females had lower PPTs at the masseter than males (P = .021) but not at other muscle locations (all P > .05). CONCLUSION: Increased somatosensory amplification is associated with decreased pressure pain thresholds at both trigeminal and extra-trigeminal locations in healthy individuals. SSA could be a potential confounder while diagnosing TMD and evaluating treatment outcomes.


Assuntos
Limiar da Dor , Transtornos da Articulação Temporomandibular , Feminino , Humanos , Masculino , Músculo Masseter , Músculos da Mastigação , Músculo Temporal
2.
Toxicol Lett ; 336: 1-10, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33166664

RESUMO

Lidocaine induces neurotoxicity in the spinal cord, but the underlying mechanisms remain unclear. In this study, we evaluated the effects of miR-199a-5p on 10 % lidocaine neurotoxicity. Increased expression of miR-199a-5p in the spinal cord of rats treated with 10 % lidocaine was assessed by qRT-PCR. Furthermore, after miR-199a-5p antagomir administration, the sensory dysfunction and myelin sheath lesions (evaluated by semithin sections stained with toluidine blue, electron microscopy, g-ratios and myelin thickness) induced by 10 % lidocaine were alleviated. Myelin regulatory factor (MYRF), a key molecule of myelin sheath development, was predicted to be a target gene of miR-199a-5p by the TargetScan and miRBase databases. MYRF and its downstream factors myelin basic protein (MBP), proteolipid protein (PLP) and myelin oligodendrocyte glycoprotein (MOG) were significantly decreased after intrathecal 10 % lidocaine administration. Moreover, these changes were reversed after miR-199a-5p antagomir administration. FISH-immunofluorescence showed coexpression of miR-199a-5p and MYRF in the spinal cord white matter of rats. A luciferase reporter assay further demonstrated the functional association between miR-199a-5p and MYRF. Overall, miR-199a-5p upregulation is involved in 10 % lidocaine-induced spinal cord toxicity through regulation of MYRF. Therefore, downregulating miR-199a-5p expression may be a potential strategy to ameliorate spinal cord neurotoxicity induced by 10 % lidocaine.


Assuntos
Antagomirs/administração & dosagem , MicroRNAs/metabolismo , Bainha de Mielina/metabolismo , Síndromes Neurotóxicas/terapia , Limiar da Dor , Transtornos das Sensações/terapia , Doenças da Medula Espinal/terapia , Medula Espinal/metabolismo , Animais , Modelos Animais de Doenças , Regulação para Baixo , Lidocaína , Masculino , MicroRNAs/genética , Bainha de Mielina/patologia , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/genética , Síndromes Neurotóxicas/metabolismo , Ratos Sprague-Dawley , Transtornos das Sensações/induzido quimicamente , Transtornos das Sensações/genética , Transtornos das Sensações/metabolismo , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Doenças da Medula Espinal/induzido quimicamente , Doenças da Medula Espinal/genética , Doenças da Medula Espinal/metabolismo , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo
3.
J Oral Facial Pain Headache ; 34(4): 311-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33290437

RESUMO

AIMS: To compare two pain models of myalgic TMD, delayed-onset muscle soreness (DOMS) and injections of nerve growth factor (NGF), in terms of pain-related and motor function outcomes, as well as activity-related temporal summation. METHODS: Fifty age- and gender-matched healthy participants were recruited and randomized into one of three groups: to a repeated eccentric contraction task to cause DOMS (n = 20), to receive NGF injections into the masseter muscle (n = 20), or to a control group (n = 10). Mechanical sensitivity of masticatory muscles, chewing parameters, jaw function limitation, maximum bite force, and activity-related temporal summation were assessed at baseline and at days 1, 2, and 7 following the intervention. RESULTS: Compared to baseline, both model groups showed increased mechanical sensitivity, jaw function limitation, pain on chewing, and decreased chewing efficiency, lasting longer in the NGF group than in the DOMS group (P < .05). Furthermore, also compared to baseline, the NGF group showed increased pain on maximum bite and decreased pain-free maximum opening (P < .05). No increases in activity-related temporal summation were shown for any of the model groups when compared to baseline or the control group (P > .05). CONCLUSION: Both models produced similar pain-related outcomes, with the NGF model having a longer effect. Furthermore, the NGF model showed a more substantial effect on motor function, which was not seen for the DOMS model. Finally, neither of the models were able to provoke activity-related temporal summation of pain.


Assuntos
Mialgia , Fator de Crescimento Neural , Humanos , Músculos da Mastigação , Modelos Teóricos , Mialgia/induzido quimicamente , Medição da Dor , Limiar da Dor
4.
J Oral Facial Pain Headache ; 34(4): 353-363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33290441

RESUMO

AIMS: To systematically review the literature to assess whether genetic polymorphisms affect orofacial pain sensitivity in healthy individuals and in patients with chronic orofacial pain disorders. METHODS: Electronic searches were conducted to identify observational studies and clinical trials investigating the association between genetic polymorphisms and orofacial pain sensitivity in healthy individuals and/or patients with chronic orofacial pain disorders. Searches were carried out in PubMed, Embase, and Scopus databases using Medical Subject Headings and free terms. RESULTS: Seven studies fulfilled the eligibility criteria: four analyzed healthy subjects, two included chronic orofacial pain patients, and one included samples of healthy subjects and patients with neuropathic pain. The results showed that genes associated with mechanical and thermal pain sensitivity were mostly related to opioid, catecholaminergic, inflammatory, and dopaminergic pathways. CONCLUSION: Genetic polymorphisms related to opioid, catecholaminergic, inflammatory, and dopaminergic pathways were associated with sensitivity to thermal and pressure stimuli in the orofacial region. Therefore, genetic factors should be taken into account for an accurate interpretation of orofacial pain sensitivity. These results will allow for a better understanding of the etiopathogenesis of chronic pain affecting the orofacial region, and consequently for finding new therapeutic targets.


Assuntos
Dor Crônica , Dor Facial , Dor Crônica/genética , Dor Facial/genética , Humanos , Limiar da Dor , Polimorfismo Genético , Sensibilidade e Especificidade
5.
J Headache Pain ; 21(1): 133, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198621

RESUMO

BACKGROUND: Pain sensitivity may determine the risk, severity, prognosis, and efficacy of treatment of clinical pain. Magnetic resonance imaging studies have linked thermal pain sensitivity to changes in brain structure. However, the neural correlates of mechanical pain sensitivity remain to be clarified through investigation of direct neural activities on the resting-state cortical oscillation and synchrony. METHODS: We recorded the resting-state magnetoencephalographic (MEG) activities of 27 healthy individuals and 30 patients with episodic migraine (EM) and analyzed the source-based oscillatory powers and functional connectivity at 2 to 59 Hz in pain-related cortical regions, which are the bilateral anterior cingulate cortex (ACC), medial orbitofrontal (MOF) cortex, lateral orbitofrontal (LOF) cortex, insula cortex, primary somatosensory cortex (SI), primary motor cortex (MI), and posterior cingulate cortex (PCC). The mechanical punctate pain threshold (MPPT) was obtained at the supraorbital area (the first branch of the trigeminal nerve dermatome, V1) and the forearm (the first thoracic nerve dermatome, T1) and further correlated with MEG measures. RESULTS: The MPPT is inversely correlated with the resting-state relative powers of gamma oscillation in healthy individuals (all corrected P < 0.05). Specifically, inverse correlation was noted between the MPPT at V1 and gamma powers in the bilateral insula (r = - 0.592 [left] and - 0.529 [right]), PCC (r = - 0.619 and - 0.541) and MI (r = - 0.497 and - 0.549) and between the MPPT at T1 and powers in the left PCC (r = - 0.561) and bilateral MI (r = - 0.509 and - 0.520). Furthermore, resting-state functional connectivity at the delta to beta bands, especially between frontal (MOF, ACC, LOF, and MI), parietal (PCC), and sensorimotor (bilateral SI and MI) regions, showed a positive correlation with the MPPT at V1 and T1 (all corrected P < 0.05). By contrast, in patients with EM, the MPPT was not associated with resting-state cortical activities. CONCLUSIONS: Pain sensitivity in healthy individuals is associated with the resting-state gamma oscillation and functional connectivity in pain-related cortical regions. Further studies must be conducted in a large population to confirm whether resting-state cortical activities can be an objective measurement of pain sensitivity in individuals without clinical pain.


Assuntos
Magnetoencefalografia , Transtornos de Enxaqueca , Mapeamento Encefálico , Humanos , Imagem por Ressonância Magnética , Transtornos de Enxaqueca/diagnóstico por imagem , Dor , Limiar da Dor
6.
Neurology ; 95(19): e2697-e2706, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33055277

RESUMO

OBJECTIVE: To investigate small fiber innervation of the skin and its relationships with clinicometry of autism and peripheral afferents for contact heat-evoked potential (CHEP) and psychophysical measures of thermal thresholds. METHODS: We recruited 32 men with autism (26.5 ± 5.9 years) and conducted small fiber assessments of skin biopsy with quantifying intraepidermal nerve fiber (IENF) density, CHEP, quantitative sensory testing, and large fiber physiology of nerve conduction studies. Results were compared with age-matched controls and analyzed with clinical measures of autism. RESULTS: Patients with autism showed a lower IENF density than controls (5.53 ± 2.09 vs 11.13 ± 3.49 fibers/mm, p < 0.0001). The IENF density was reduced in 17 (53.1%) men with autism classified as skin denervation group. On psychophysics, 9 (28%) men with autism had elevated thermal thresholds, and the warm threshold of the big toe was negatively correlated with IENF density (p = 0.0073), indicating functional impairments of small fiber sensory nerves. IENF density was negatively correlated with CHEP amplitude in autism (p = 0.003), in contrast to the pattern of positive correlation in controls, indicating different processing of nociceptive afferent in autism. Clinically, IENF density was related to distinct tactile symptom patterns in the skin denervation vs normal innervation group, respectively. Furthermore, IENF density was associated with autistic symptoms measured by the Autism Spectrum Quotient in a U-shaped model (p = 0.014). CONCLUSIONS: These observations indicated that a substantial portion of individuals with autism had small fiber pathology, which was associated with tactile and autistic symptoms, providing structural and physiologic evidence for the involvement of peripheral sensory nerves in autism.


Assuntos
Transtorno Autístico/fisiopatologia , Epiderme/patologia , Potenciais Somatossensoriais Evocados/fisiologia , Temperatura Alta , Fibras Nervosas/patologia , Condução Nervosa/fisiologia , Nociceptividade/fisiologia , Adulto , Estudos de Casos e Controles , Eletrodiagnóstico , Epiderme/inervação , Humanos , Masculino , Limiar da Dor , Limiar Sensorial , Adulto Jovem
7.
J Pharmacol Exp Ther ; 375(2): 317-331, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32948647

RESUMO

Nerve growth factor (NGF) is the protein responsible for the development and maintenance of sensory skin innervation. Given the role of appropriate innervation in skin healing, NGF has been indicated as a possible prohealing treatment in pathologic conditions characterized by nerve-ending loss, such as chronic ulcers in diabetes; however, its use as a therapeutic agent is limited by its hyperalgesic effect. We tested the effect of topical application of the nonalgogenic NGF derivative hNGFP61S/R100E in two models of skin ulcer induced in dbdb diabetic mice, investigating healing time, skin histology, reinnervation, and angiogenesis using morphologic and molecular approaches. We showed that the topical administration of CHF6467, a recombinant human NGF in which an amino acid substitution (R100E) abolished the hyperalgesic effect usually associated with NGF, accelerated skin repair in experimental wounds (full-excision and pressure-ulcer) induced in diabetic mice (dbdb). CHF6467-induced acceleration of wound healing was accompanied by increased re-epithelization, reinnervation, and revascularization as assessed by histology, immunohistochemistry, and image analysis. Bioinformatic analysis of differentially expressed genes and signaling pathways in the wound tissues showed that protein kinase B-mammalian target of rapamycin was the most regulated pathway. In spite of the transdermal absorption leading to measurable, dose-dependent increases in CHF6467 plasma levels, no systemic thermal or local mechanical hyperalgesia was observed in treated mice. When tested in vitro in human cell lines, CHF6467 stimulated keratinocyte and fibroblast proliferation and tube formation by endothelial cells. Collectively, these results support a possible use of CHF6467 as a prohealing agent in skin lesions in diabetes. SIGNIFICANCE STATEMENT: Topical application of CHF6467 accelerates reinnervation, neoangiogenesis, and wound healing in diabetic mice in both full-thickness skin-excision and pressure-ulcer models through the protein kinase B/mammalian target of rapamycin pathway and does not induce hyperalgesia.


Assuntos
Diabetes Mellitus Experimental/fisiopatologia , Mutação , Fator de Crescimento Neural/genética , Fator de Crescimento Neural/farmacologia , Pele/efeitos dos fármacos , Pele/fisiopatologia , Cicatrização/efeitos dos fármacos , Administração Tópica , Animais , Células Endoteliais da Veia Umbilical Humana/citologia , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Humanos , Masculino , Camundongos , Fator de Crescimento Neural/administração & dosagem , Células PC12 , Limiar da Dor/efeitos dos fármacos , Ratos
8.
J Oral Facial Pain Headache ; 34: s43-s56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32975540

RESUMO

AIMS: To investigate associations between experimental pain sensitivity and five chronic pain conditions among 655 participants in the OPPERA study. METHODS: Quantitative sensory tests were used to measure sensitivity to three modalities of nociception: blunt pressure pain, mechanical pinprick pain, and thermal heat pain. Participants were also classified according to the presence or absence of five chronic pain conditions: temporomandibular disorders, headache, low back pain, irritable bowel syndrome, and fibromyalgia. RESULTS: Univariate analyses found each modality to be significantly associated with at least one pain condition, most consistently for pressure pain sensitivity (8 of 15 instances) and least consistently for heat pain sensitivity (5 of 35 instances). Yet, multivariable analyses that evaluated the independent contributions of all five pain conditions found few significant associations (12 of 75 instances). Instead, pain sensitivity consistently varied according to the total number of pain conditions a person experienced, implying that the combination of pain conditions influences each nociceptive modality. CONCLUSION: When evaluating nociceptive sensitivity in a chronic pain patient, comorbid pain conditions should be considered, as the more salient feature underlying sensitivity is likely the number rather than the type(s) of pain conditions.


Assuntos
Dor Crônica , Fibromialgia , Transtornos da Articulação Temporomandibular , Humanos , Limiar da Dor , Estudos Prospectivos
9.
J Oral Rehabil ; 47(12): 1521-1529, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32898936

RESUMO

BACKGROUND: Clinical findings suggest that orthodontic treatment with clear aligners (clear aligner therapy/CAT) may cause masticatory muscle soreness in some patients. OBJECTIVE: This multi-site prospective study investigated tooth pain and masticatory muscle soreness and tenderness in patients undergoing CAT and explored whether psychological traits affected these outcomes. METHODS: Twenty-seven adults (22F, 5M; mean age ± SD=35.3 ± 17.6 years) about to start CAT were recruited at three clinics. During CAT, they reported on 100-mm visual analogue scales their tooth pain, masticatory muscle soreness and stress three times per day over 4 weeks (week 1 = baseline; week 2 = dummy aligner; week 3 = first active aligner; week 4 = second active aligner). Pressure pain thresholds (PPTs) were measured at the masseter and temporalis at baseline and after week 4. Mixed models were used to evaluate the outcome measures over time. RESULTS: Clear aligner therapy caused mild tooth pain, which was greater with the passive than the first and second active aligners (both P < .001). Mild and clinically not relevant masticatory muscle soreness was produced by all aligners (all P < .05), with the first active aligner producing less soreness than the dummy aligner (P < .001). PPTs did not change significantly after 4 weeks. Both tooth pain and masticatory muscle soreness were affected by stress and trait anxiety, whilst muscle soreness was affected also by oral behaviours. CONCLUSIONS: In the short term, CAT produces tooth pain and masticatory muscle soreness of limited significance. Frequent oral behaviours are related to increased masticatory muscle soreness during CAT. The medium- and long-term effects of CAT should be further explored.


Assuntos
Mialgia , Aparelhos Ortodônticos Removíveis , Adulto , Humanos , Músculo Masseter , Músculos da Mastigação , Mialgia/etiologia , Limiar da Dor , Estudos Prospectivos
10.
J Oral Facial Pain Headache ; 34(3): 281-290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870957

RESUMO

AIMS: To investigate pain sensitivity in the masseter muscle and index finger in response to acute psychologic stress in healthy participants. METHODS: Fifteen healthy women (23.7 ± 2.3 years) participated in two randomized sessions: in the experimental stress session, the Paced Auditory Serial Addition Task (PASAT) was used to induce acute stress, and in the control session, a control task was performed. Salivary cortisol, perceived stress levels, electrical and pressure pain thresholds (PTs), and pain tolerance levels (PTLs) were measured at baseline and after each task. Mixed-model analysis was used to test for significant interaction effects between time and session. RESULTS: An interaction effect between time and session occurred for perceived stress levels (P < .001); perceived stress was significantly higher after the experimental task than after the control task (P < .01). No interaction effects occurred for salivary cortisol levels, electrical PTs, or pressure PTLs. Although significant interactions did occur for electrical PTL (P < .05) and pressure PT (P < .001), the simple effects test could not identify significant differences between sessions at any time point. CONCLUSION: The PASAT evoked significant levels of perceived stress; however, pain sensitivity to mechanical or electrical stimuli was not significantly altered in response to the stress task, and the salivary cortisol levels were not altered in response to the PASAT. These results must be interpreted with caution, and more studies with larger study samples are needed to increase the clinical relevant understanding of the pain mechanisms and psychologic stress.


Assuntos
Hidrocortisona , Limiar da Dor , Estudos Cross-Over , Feminino , Humanos , Músculo Masseter , Projetos Piloto , Saliva , Estresse Psicológico
11.
Sci Rep ; 10(1): 15458, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32963266

RESUMO

The aim of this investigation was to evaluate the effects of local anaesthesia on nerve growth factor (NGF) induced masseter hyperalgesia. Healthy participants randomly received an injection into the right masseter muscle of either isotonic saline (IS) given as a single injection (n = 15) or an injection of NGF (n = 30) followed by a second injection of lidocaine (NGF + lidocaine; n = 15) or IS (NGF + IS; n = 15) in the same muscle 48 h later. Mechanical sensitivity scores of the right and left masseter, referred sensations and jaw pain intensity and jaw function were assessed at baseline, 48 h after the first injection, 5 min after the second injection and 72 h after the first injection. NGF caused significant jaw pain evoked by chewing at 48 and 72 h after the first injection when compared to the IS group, but without significant differences between the NGF + lidocaine and NGF + IS groups. However, the mechanical sensitivity of the right masseter 5 min after the second injection in the NGF + lidocaine group was significantly lower than the second injection in the NGF + IS and was similar to the IS group. There were no significant differences for the referred sensations. Local anaesthetics may provide relevant information regarding the contribution of peripheral mechanisms in the maintenance of persistent musculoskeletal pain.


Assuntos
Anestésicos Locais/administração & dosagem , Dor Facial/tratamento farmacológico , Hiperalgesia/tratamento farmacológico , Lidocaína/administração & dosagem , Músculo Masseter/efeitos dos fármacos , Fator de Crescimento Neural/efeitos adversos , Adulto , Estudos de Casos e Controles , Método Duplo-Cego , Dor Facial/etiologia , Dor Facial/patologia , Feminino , Humanos , Hiperalgesia/etiologia , Hiperalgesia/patologia , Injeções Intramusculares , Masculino , Músculo Masseter/fisiopatologia , Limiar da Dor
12.
Arch Oral Biol ; 118: 104854, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32763472

RESUMO

OBJECTIVE: The aim of this study was to assess the correlation of inflammatory and pain genes polymorphisms with the presence of temporomandibular disorder (TMD) patients and with pressure pain sensitivity. DESIGN: Data was collected from 268 consecutive subjects at Bauru School of Dentistry. Subjects aged younger than 20 years, with dental and neuropathic pain, sinusitis, cognitive and neurologic disorder were excluded. Included subjects were evaluated using the Research Diagnostic Criteria for Temporomandibular disorders and divided into two groups: TMD cases and healthy controls. Groups were submitted to pressure pain threshold (PPT) test for the temporomandibular joint, anterior temporalis and masseter muscles and genotyped for Val158Met, IL6-174, IL-1ß-3954 and TNFA-308. Student's t-test and Pearson chi-square test were used to comparisons between groups. A linear multiple regression was used to evaluate the influence of genetics variables on the PPT and a bivariate analysis was used to assesses the influence of genetics variables on pain sensitivity below the PPT cut off of the structures in TMD group. RESULTS: TMD group showed significantly lower PPT values for all structures when compared with control group (p < 0.001). SNP IL6-174 predicted higher pain sensitivity in the temporomandibular joint (p < 0.005) and in anterior temporalis muscle (p < 0.044) and SNP Val158Met in the masseter muscle (p < 0.038); when TMD group was divided according to PPT cut-off values the SNP Val158Met influenced increase pain sensibility in the masseter muscle. CONCLUSION: TNFA-308 was associated with TMD and SNP IL6-174 and SNP Val158Met influenced pain sensitivity of patients with TMD.


Assuntos
Inflamação/genética , Limiar da Dor , Transtornos da Articulação Temporomandibular , Adulto , Genótipo , Humanos , Interleucina-6/genética , Músculo Masseter , Polimorfismo de Nucleotídeo Único , Pressão , Músculo Temporal , Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/genética , Adulto Jovem
13.
Fisioterapia (Madr., Ed. impr.) ; 42(4): 214-217, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193508

RESUMO

INTRODUCCIÓN: El dolor de hombro, específicamente el síndrome de impingement subacromial, es un problema que afecta a gran parte de la población, siendo el segundo más frecuente después del dolor lumbar. Se han obtenido resultados beneficiosos sobre la musculatura afecta con la utilización de la punción seca profunda en el tratamiento. OBJETIVO: Evaluar los cambios en intensidad de dolor (EVA), umbral de dolor a la presión (algometría), rango osteomuscular (goniometría) y funcionalidad (DASH) obtenidos con el tratamiento de punción seca profunda, combinado con liberación por presión y estiramiento local con espray frío, en un paciente con síndrome de impingement subacromial. Descripción del caso: Varón de 35 años con dolor, de 3 meses de evolución, en la cara anterior y lateral del hombro derecho que se irradia al miembro superior derecho, llegando hasta la mano y dedos. Intervención: Se realizan 4 sesiones de fisioterapia, con una duración de 60min cada una y una distancia temporal de 8 días entre ellas. Se evalúan las variables de intensidad del dolor, umbral del dolor a la presión, rango osteomuscular, puntos gatillo miofasciales y funcionalidad del hombro. Se exploran 9 músculos de la región del hombro para diagnosticar los puntos gatillo miofasciales existentes y tratarlos mediante técnicas de punción seca profunda, liberación por presión y estiramiento local con espray frío. RESULTADOS Y DISCUSIÓN: Los resultados muestran una disminución de la intensidad del dolor, aumento del rango osteomuscular, del umbral del dolor a la presión y de la funcionalidad. Por ello, el tratamiento se considera efectivo. Sin embargo, al tratarse de un estudio de caso no se pueden extrapolar los resultados al resto de población, siendo necesarias futuras investigaciones sobre esta patología y tipo de tratamiento para conseguir mejores resultados, así como incorporar otras técnicas como el ejercicio terapéutico o la electroestimulación


INTRODUCTION: Shoulder pain, specifically subacromial impingement syndrome, is a problem that affects many people, being the second most common after low back pain. Beneficial results have been obtained on the musculature effects by using deep dry needling in the treatment. OBJECTIVE: To evaluate changes in pain intensity using a visual analogue scale (VAS), pressure pain threshold (algometry), range of motion (goniometry), and functionality (DASH), obtained with the treatment of deep dry needling, combined with local pressure release and stretching with cold spray on the myofascial trigger points of the musculature involved in the shoulder area. Case description: 35-year-old male patient, with pain in the anterior and lateral side of the right shoulder that radiated to the upper right limb reaching the hand and fingers, of 3 months of onset. Intervention: Four physiotherapy sessions were performed, each one lasting 60min, and spaced 8 days apart. Pain variables, pressure pain threshold, range of motion, myofascial trigger points, and shoulder functionality were evaluated. Nine muscles of the shoulder region were explored to diagnose existing trigger points and to treat them using deep dry needling techniques, local pressure release, and local stretching with cold spray. RESULTS AND DISCUSSION: The results showed a decrease in pain intensity and an increase in range of motion, algometry values, and functionality. Therefore, deep dry needling treatment of myofascial trigger point is considered effective. However, the results cannot be generalised due to the small sample size of the study. Further studies are needed on this disorder, as well as the type of treatment to obtain better results, and to incorporate other techniques besides deep dry needling, such us therapeutic exercise or electrostimulation


Assuntos
Humanos , Masculino , Adulto , Síndrome de Colisão do Ombro/terapia , Terapia por Acupuntura/instrumentação , Pontos-Gatilho , Dor de Ombro/reabilitação , Agulhas , Medição da Dor , Limiar da Dor , Acrômio/diagnóstico por imagem , Acrômio/lesões , Inquéritos e Questionários
14.
J Stroke Cerebrovasc Dis ; 29(9): 105030, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807443

RESUMO

PURPOSE: Spinal epidural hematoma is a rare but important disease as it can be a stroke mimic. Our aim was to investigate the clinical characteristics of patients with an activated stroke code and spinal epidural hematoma. METHODS: Patients with an activated stroke code were examined retrospectively. Patients with spinal epidural hematoma were evaluated with further neurological examinations and neuroimaging. RESULTS: Of 2866 patients with an activated stroke code, spinal epidural hematoma was detected in 5 (0.2%, 63-79 years, 2 men). In all 5 cases, hematoma was located in the unilateral dorsal region of the spinal canal and spread to 5-9 vertebral segments at the C1-T3 level. None of the patients had a medical history of head or neck injury, coagulopathy, or use of anti-thrombotic agents. All of the patients had occipital, neck, and/or back pain, and their hemiparesis occurred simultaneously or within 1 h after the onset of pain. Hyperalgesia ipsilateral to the hematoma was observed in 1 patient, hypoalgesia contralateral to the hematoma was observed in 1, and quadriparesis and bilateral hypoalgesia were observed in 1. The hematomas spontaneously decreased in size in 4 patients, and cervical laminectomy was performed in the other patient. In the 1860 patients with an activated stroke code and spontaneous eye opening, the sensitivity of pain as a predictor of spinal epidural hematoma was 100%, with a specificity of 88.7%, and positive predictive value of 2.3%. CONCLUSION: Patients with spinal epidural hematoma could present with clinical characteristics mimicking ischemic stroke. Spinal epidural hematoma should be differentiated in patients treated under stroke code activation.


Assuntos
Avaliação da Deficiência , Hematoma Epidural Espinal/diagnóstico , Imagem por Ressonância Magnética , Medição da Dor , Acidente Vascular Cerebral/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Hematoma Epidural Espinal/complicações , Hematoma Epidural Espinal/fisiopatologia , Hematoma Epidural Espinal/cirurgia , Humanos , Hiperalgesia/etiologia , Hiperalgesia/fisiopatologia , Laminectomia , Masculino , Pessoa de Meia-Idade , Limiar da Dor , Paresia/etiologia , Paresia/fisiopatologia , Valor Preditivo dos Testes , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia
15.
Arthritis Rheumatol ; 72(12): 2017-2024, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32683800

RESUMO

OBJECTIVE: To determine the association between dysregulated central pain processing and treatment response in rheumatoid arthritis (RA). METHODS: One hundred eighty-two participants with active RA were followed up for 12 weeks after starting a disease-modifying antirheumatic drug (DMARD). To assess central pain processing, participants underwent quantitative sensory testing (QST), including assessment of pressure pain thresholds (PPTs) at the trapezius muscles, temporal summation, and conditioned pain modulation (CPM). QST measures were categorized as high central dysregulation versus low central dysregulation. The association between baseline central dysregulation and treatment response, as defined by the European League Against Rheumatism (EULAR) response criteria, was assessed using multiple logistic regression adjusted for demographic characteristics, RA-related variables, and psychosocial variables. RESULTS: A good EULAR response was achieved in fewer participants with high CPM dysregulation than participants with low CPM dysregulation (22.5% versus 40.3%; P = 0.01). A similar trend, though not significant, was noted when central dysregulation was assessed with PPT and temporal summation. The adjusted odds ratios (ORs) for the association between high central dysregulation and good EULAR response were 0.59 for PPTs (95% confidence interval [95% CI] 0.28-1.23), 0.60 for temporal summation (95% CI 0.27-1.34), and 0.40 for CPM (95% CI 0.19-0.83). In a model examining the combined effects of dysregulated temporal summation and CPM, dysregulation of both measures was associated with lower odds of achieving a good EULAR response (OR 0.23 [95% CI 0.07-0.73]). CONCLUSION: Low CPM was significantly associated with lower odds of achieving a good EULAR response, suggesting that inefficient descending inhibitory mechanisms may be a potential treatment target for further study.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Sensibilização do Sistema Nervoso Central/efeitos dos fármacos , Limiar da Dor/efeitos dos fármacos , Dor/tratamento farmacológico , Adulto , Idoso , Antirreumáticos/administração & dosagem , Artrite Reumatoide/fisiopatologia , Sensibilização do Sistema Nervoso Central/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Medição da Dor , Limiar da Dor/fisiologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-32708600

RESUMO

Due to the occurrence among musicians of musculoskeletal problems associated with playing a musical instrument, it is necessary to use prophylaxis. The aim of the study was to compare the effectiveness of two physioprophylaxis methods: chair massage and an original set of exercises. The study lasted four weeks and consisted of eight 15-min meetings (chair massage/exercises). The study was conducted on 44 music students assigned to three groups (chair massage/exercise program/control group). The algometric measurements and questionnaire were conducted. Health problems associated with playing an instrument was reported by 86.4% of the participants. The largest changes in pain threshold concerned the trigger points of the muscles with the highest pain sensitivity, i.e., upper part of trapezius ones, and reached 25-34% in relation to the initial values. For the trigger points of the levator scapulae and lower part of trapezius, the increase in the pain threshold was between 20 and 28%. Raising the pain threshold was observed both after each session and meeting by meeting, and these differences were most visible in the massage group. This effect was particularly visible from the fourth treatment. Chair massage and exercise should be used regularly, and significant results can be obtained after two weeks.


Assuntos
Dor Musculoesquelética , Música , Doenças Profissionais , Terapia por Exercício , Humanos , Massagem , Dor Musculoesquelética/prevenção & controle , Doenças Profissionais/prevenção & controle , Limiar da Dor , Adulto Jovem
17.
Pain Physician ; 23(4): E353-E362, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709181

RESUMO

BACKGROUND: Fibromyalgia (FM) syndrome is characterized by widespread pain, fatigue, and generalized increased pain sensitivity. Appropriate and simple pain models are methods employed to assess pain mechanisms that can potentially lead to improved treatments. Pressure pain thresholds (PPTs) or mapping the referred pain area produced by pressure stimulation at suprathreshold intensities are used to assess pain mechanisms. The optimal suprathreshold stimulation intensity to elicit referred pain with minimal discomfort for patients with FM has yet to be determined. OBJECTIVES: The aim of this study was to compare the area and intensity of pressure-induced referred pain in patients with FM as elicited by systematic increases in PPTs, compared with controls. STUDY DESIGN: Observational, crossed-section study. SETTING: Research laboratory. METHODS: Twenty-six patients with FM and 26 healthy controls, age- and gender-matched, were included. Suprathreshold stimulation was applied to the infraspinatus muscle of the dominant side at 4 different intensities (PPT +20%, +30%, +40%, and +50%), after which referred pain was evaluated by measuring the area of pain in pixels using a digital body chart and its intensity on a Visual Analog Scale. Factors related to anxiety condition, pain catastrophizing, depression, and quality of life were recorded. RESULTS: The referred pain areas were larger in the FM group compared with healthy individuals at 120% (P = 0.024), 130% (P = 0.001), 140% (P = 0.001), and 150% (P = 0.001) PPT, however, within the FM group no differences were found between the intensity of suprathreshold stimulation and the size of the referred pain areas (P = 0.135) or pain intensity (P > 0.05). There was a positive correlation between the size of referred pain areas and pain catastrophizing in the FM group (r = 0.457, P = 0.032). LIMITATIONS: This study presents some limitations, among which is the variability found in the referred pain areas. CONCLUSIONS: These findings show that referred pain induced by applying a suprathreshold pressure of 120% PPT can be a useful biomarker to assess sensitized pain mechanisms in patients suffering from FM. KEY WORDS: Referred pain, pain sensitivity, fibromyalgia, central sensitization, suprathreshold, pressure pain threshold, biomarker, facilitated pain mechanisms.


Assuntos
Fibromialgia/diagnóstico , Fibromialgia/psicologia , Medição da Dor/métodos , Limiar da Dor/psicologia , Dor Referida/diagnóstico , Dor Referida/psicologia , Adulto , Idoso , Catastrofização/diagnóstico , Catastrofização/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limiar da Dor/fisiologia , Qualidade de Vida/psicologia , Adulto Jovem
18.
Occup Ther Int ; 2020: 5168457, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32684869

RESUMO

Objectives: The pressure pain threshold (PPT) may be an efficient approach to screen and evaluate orofacial pain. However, the results of previous PPT studies have varied greatly. The aim of this paper was to determine whether the PPT is an efficient approach for screening and evaluating orofacial pain. Methods: The search yielded 123 articles. After removal of duplicates and screening of abstracts, 32 articles were selected for further evaluation. The Cochrane Collaboration tool for assessing the risk of bias was used for the evaluation of the studies. Results: The studies covered a total of 4403 adult patients, aged 16-62, and 30 children. The studies investigated the reliability and validity of the PPT (measured by a pressure algometer) in TMD patients. The PPT was investigated in relation to headache, menstrual cycle, oral contraception, occlusal interference, and occlusal appliances. Generally, the risk of bias was low to unclear. Some structural limitations were inherent in the studies, such as small samples and short duration of the testing involved. Also, the analyzed studies lacked consistency in study design and patient management. Pressure increase values differed from 20 kPa/s to 50 kPa/s and from 0.5 kg/cm2/s to 2 kg/cm2/s. Descriptions of the PPT examination points also varied, from very precise and repeatable to a simple listing of anatomical points. The number of measurements varied from 1 to 5 at each visit. The intervals ranged from 5 seconds to 15 minutes. However, some studies confirmed that the pressure algometer is an effective tool for determining the source of orofacial pain. Conclusions: Based on the analyzed articles, the authors argue that the PPT is not an efficient approach for screening and evaluating orofacial pain. What is more, it should not be used as the only diagnostics tool for patients with orofacial pain. Importantly, however, additional factors should be considered in the future for the evaluation of the PPT, including body symmetry and posture, hormone levels and the menstrual phase in women, and the use of medications and its influence on the PPT. Further clinical trials should also be performed on the PPT, examining head and neck pain patients, with more precise study design and larger samples.


Assuntos
Dor Facial/diagnóstico , Dor Facial/terapia , Medição da Dor/instrumentação , Humanos , Terapia Ocupacional , Medição da Dor/métodos , Limiar da Dor , Pressão , Reprodutibilidade dos Testes
19.
Pain Res Manag ; 2020: 3939757, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32676135

RESUMO

Aim: Orofacial chronic neuropathic pain commonly occurs following trigeminal nerve injuries. We investigated whether swimming exercise can reduce trigeminal neuropathic pain through improving antioxidant capacity. Materials and Methods: Twenty-eight Wistar rats of either sex and 180-220 grams were divided into 4 groups as sham, neuropathy, neuropathy + single bout exercise, and neuropathy + 2 weeks of exercise. Trigeminal neuropathy was carried out through chronic constriction injury (CCI) of infraorbital nerve. Protocols of exercise were included a single bout session (45 minutes) and a 2-week (45 minutes/day/6 days a week) swimming exercise. Mechanical allodynia was detected using Von Frey filaments. The activity of the serum antioxidant enzymes glutathione peroxidase and superoxides dismutase was assayed using ELISA kits. Results: We found that CCI significantly reduced facial pain threshold in both sexes (P < 0.05). Both swimming exercise protocols significantly reduced mechanical allodynia in female rats compared to the sham group; however, only 2 weeks of exercise were significantly effective in male rats. The activity of antioxidant enzyme glutathione peroxidase significantly (P < 0.05) decreased following CCI in female rats against that in the sham group and 2-week exercise significantly (P < 0.05) increased it toward the control level. The levels of glutathione peroxidase in male rats and superoxidase dismutase in both sexes were not significantly different compared to their sham groups. Conclusion: Swimming exercise alleviates trigeminal neuropathic pain in both sexes. Oxidative stress as a possible mechanism was involved in the effect of exercise on female rat trigeminal neuropathy.


Assuntos
Condicionamento Físico Animal/métodos , Caracteres Sexuais , Neuralgia do Trigêmeo , Animais , Modelos Animais de Doenças , Feminino , Hiperalgesia , Masculino , Estresse Oxidativo/fisiologia , Limiar da Dor/fisiologia , Ratos , Ratos Wistar , Neuralgia do Trigêmeo/metabolismo
20.
Sci Rep ; 10(1): 10782, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32612194

RESUMO

Physical exercise has been shown to alter sensory functions, such as sensory detection or perceived pain. However, most contributing studies rely on the assessment of single thresholds, and a systematic testing of the sensory system is missing. This randomised, controlled cross-over study aims to determine the sensory phenotype of healthy young participants and to assess if sub-maximal endurance exercise can impact it. We investigated the effects of a single bout of sub-maximal running exercise (30 min at 80% heart rate reserve) compared to a resting control in 20 healthy participants. The sensory profile was assessed applying quantitative sensory testing (QST) according to the protocol of the German Research Network on Neuropathic Pain. QST comprises a broad spectrum of thermal and mechanical detection and pain thresholds. It was applied to the forehead of study participants prior and immediately after the intervention. Time between cross-over sessions was one week. Sub-maximal endurance exercise did not significantly alter thermal or mechanical sensory function (time × group analysis) in terms of detection and pain thresholds. The sensory phenotypes did not indicate any clinically meaningful deviation of sensory function. The alteration of sensory thresholds needs to be carefully interpreted, and only systematic testing allows an improved understanding of mechanism. In this context, sub-maximal endurance exercise is not followed by a change of thermal and mechanical sensory function at the forehead in healthy volunteers.


Assuntos
Treino Aeróbico , Limiar da Dor/fisiologia , Adolescente , Adulto , Estudos Cross-Over , Feminino , Humanos , Masculino
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