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1.
J Occup Health ; 63(1): e12269, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34390307

RESUMO

OBJECTIVES: Musculoskeletal disorders (MSDs) in the neck and shoulder region may be associated with significant impairment of quality of life and well-being. The study was to determine the prevalence of painful MSDs in Chinese dentists and evaluate somatosensory function and neck mobility compared with non-dental professional controls. METHODS: One hundred dentists (age: 36.5 ± 9.8 years) and 102 controls (age: 36.2 ± 10.0 years) were recruited between September 2019 and December 2020. The Medical Outcome Study 36-item short-form health survey questionnaire and information of MSDs history were recorded. The cervical range of motion (CROM) with and without pain, and the pressure pain thresholds (PPTs) of the facial and neck muscles were tested. Chi-square test, Mann-Whitney U test and multiple linear regression analysis were used to analyze the data. The factors in the multiple linear regression analysis were occupation, working age, and gender. RESULTS: The prevalence rate of neck pain was significantly higher in dentists (73.0%) compared with the controls (52.0%) (P = .002). The regression models of cervical range of posterior extension, lateral flexion and rotation were statistically significant (P ≤ .001). The regression models of PPTs of the tested facial and neck muscles were statistically significant (P < .001). CONCLUSION: Dentists are at higher risk of neck pain. The bigger cervical range of left rotation of dentists could be related to the working posture. The lower PPTs in dentists may reflect a hypersensitivity in the facial and neck muscles. Preventive measures are needed to reduce occupational hazards in dentists.


Assuntos
Odontólogos/estatística & dados numéricos , Cervicalgia/epidemiologia , Doenças Profissionais/epidemiologia , Limiar da Dor/fisiologia , Postura/fisiologia , Amplitude de Movimento Articular/fisiologia , Adulto , China , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
2.
J Neurosci ; 41(43): 8991-9007, 2021 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-34446571

RESUMO

Different peripheral nerve injuries cause neuropathic pain through distinct mechanisms. Even the site of injury may impact underlying mechanisms, as indicated by the clinical finding that the antiseizure drug carbamazepine (CBZ) relieves pain because of compression injuries of trigeminal but not somatic nerves. We leveraged this observation in the present study hypothesizing that because CBZ blocks voltage-gated sodium channels (VGSCs), its therapeutic selectivity reflects differences between trigeminal and somatic nerves with respect to injury-induced changes in VGSCs. CBZ diminished ongoing and evoked pain behavior in rats with chronic constriction injury (CCI) to the infraorbital nerve (ION) but had minimal effect in rats with sciatic nerve CCI. This difference in behavior was associated with a selective increase in the potency of CBZ-induced inhibition of compound action potentials in the ION, an effect mirrored in human trigeminal versus somatic nerves. The increase in potency was associated with a selective increase in the efficacy of the NaV1.1 channel blocker ICA-121431 and NaV1.1 protein in the ION, but no change in NaV1.1 mRNA in trigeminal ganglia. Importantly, local ICA-121431 administration reversed ION CCI-induced hypersensitivity. Our results suggest a novel therapeutic target for the treatment of trigeminal neuropathic pain.SIGNIFICANCE STATEMENT This study is based on evidence of differences in pain and its treatment depending on whether the pain is above (trigeminal) or below (somatic) the neck, as well as evidence that voltage-gated sodium channels (VGSCs) may contribute to these differences. The focus of the present study was on channels underlying action potential propagation in peripheral nerves. There were differences between somatic and trigeminal nerves in VGSC subtypes underlying action potential propagation both in the absence and presence of injury. Importantly, because the local block of NaV1.1 in the trigeminal nerve reverses nerve injury-induced mechanical hypersensitivity, the selective upregulation of NaV1.1 in trigeminal nerves suggests a novel therapeutic target for the treatment of pain associated with trigeminal nerve injury.


Assuntos
Analgésicos não Narcóticos/uso terapêutico , Carbamazepina/uso terapêutico , Neuralgia/tratamento farmacológico , Medição da Dor/efeitos dos fármacos , Neuralgia do Trigêmeo/tratamento farmacológico , Analgésicos não Narcóticos/farmacologia , Animais , Carbamazepina/farmacologia , Feminino , Masculino , Canal de Sódio Disparado por Voltagem NAV1.1/biossíntese , Neuralgia/metabolismo , Medição da Dor/métodos , Limiar da Dor/efeitos dos fármacos , Limiar da Dor/fisiologia , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento , Neuralgia do Trigêmeo/metabolismo
3.
Sci Rep ; 11(1): 13783, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215798

RESUMO

Patients with cervicogenic headache (CeH) showed lower spinal postural variability (SPV). In a next step, the complex character of such SPV needs to be analysed. Therefore, variables influencing SPV need to be explored. A non-randomized repeated-measure design was applied to analyse relations between biopsychosocial variables and SPV within a CeH-group (n = 18), 29-51 years, and matched control-group (n = 18), 26-52 years. Spinal postural variability, expressed by standard deviations, was deducted from 3D-Vicon motion analysis of habitual spinal postures (degrees). Interactions between SPV and pain processing, lifestyle, psychosocial characteristics were analysed. Pain processing characteristics included symptoms of central sensitization (Central Sensitization Inventory), (extra)-cephalic pressure pain thresholds (kPa/cm2/s). Lifestyle characteristics included sleep quality (Pittsburgh Sleep Quality Index), physical activity, screen-time, sedentary-time (hours a week), position (cm) and inclination (degrees) of the laptop (= desk-setup). Psychosocial characteristics included degree of depression, anxiety and stress (Depression Anxiety Stress Scale-21), impact of headache on quality of life (Headache Impact Test-6). Spinal postural variability related significantly to intrinsic (stress, anxiety, extra-cephalic pressure pain thresholds, sleep-duration) and extrinsic (desk-setup, screen-time) variables in the CeH-group. In the control-group, SPV related significantly to extra-cephalic pressure pain thresholds. Spinal postural variability related to diverse variables in the CeH-group compared to the control-group. More research is needed into a possible causal relationship and its clinical implication.


Assuntos
Vértebras Cervicais/fisiopatologia , Cervicalgia/fisiopatologia , Cefaleia Pós-Traumática/fisiopatologia , Equilíbrio Postural/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/complicações , Cervicalgia/epidemiologia , Medição da Dor , Limiar da Dor/fisiologia , Cefaleia Pós-Traumática/complicações , Cefaleia Pós-Traumática/epidemiologia , Amplitude de Movimento Articular/fisiologia , Coluna Vertebral/fisiopatologia
4.
J Clin Invest ; 131(13)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196305

RESUMO

Fibromyalgia syndrome (FMS) is characterized by widespread pain and tenderness, and patients typically experience fatigue and emotional distress. The etiology and pathophysiology of fibromyalgia are not fully explained and there are no effective drug treatments. Here we show that IgG from FMS patients produced sensory hypersensitivity by sensitizing nociceptive neurons. Mice treated with IgG from FMS patients displayed increased sensitivity to noxious mechanical and cold stimulation, and nociceptive fibers in skin-nerve preparations from mice treated with FMS IgG displayed an increased responsiveness to cold and mechanical stimulation. These mice also displayed reduced locomotor activity, reduced paw grip strength, and a loss of intraepidermal innervation. In contrast, transfer of IgG-depleted serum from FMS patients or IgG from healthy control subjects had no effect. Patient IgG did not activate naive sensory neurons directly. IgG from FMS patients labeled satellite glial cells and neurons in vivo and in vitro, as well as myelinated fiber tracts and a small number of macrophages and endothelial cells in mouse dorsal root ganglia (DRG), but no cells in the spinal cord. Furthermore, FMS IgG bound to human DRG. Our results demonstrate that IgG from FMS patients produces painful sensory hypersensitivities by sensitizing peripheral nociceptive afferents and suggest that therapies reducing patient IgG titers may be effective for fibromyalgia.


Assuntos
Fibromialgia/imunologia , Fibromialgia/fisiopatologia , Animais , Estudos de Casos e Controles , Modelos Animais de Doenças , Feminino , Fibromialgia/etiologia , Gânglios Espinais/fisiopatologia , Humanos , Imunização Passiva , Imunoglobulina G/administração & dosagem , Imunoglobulina G/sangue , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Nociceptores/imunologia , Nociceptores/fisiologia , Dor/fisiopatologia , Limiar da Dor/fisiologia
5.
Clin Neurophysiol ; 132(9): 2163-2175, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34284252

RESUMO

OBJECTIVE: Many studies have examined the effectiveness of transcranial direct current stimulation (tDCS) on human pain perception in both healthy populations and pain patients. Nevertheless, studies have yielded conflicting results, likely due to differences in stimulation parameters, experimental paradigms, and outcome measures. Human experimental pain models that utilize indices of pain in response to well-controlled noxious stimuli can avoid many confounds present in clinical data. This study aimed to assess the robustness of tDCS effects on experimental pain perception among healthy populations. METHODS: We conducted three meta-analyses that analyzed tDCS effects on ratings of perceived pain intensity to suprathreshold noxious stimuli, pain threshold and tolerance. RESULTS: The meta-analyses showed a statically significant tDCS effect on attenuating pain-intensity ratings to suprathreshold noxious stimuli. In contrast, tDCS effects on pain threshold and pain tolerance were statistically non-significant. Moderator analysis further suggested that stimulation parameters (active electrode size and current density) and experimental pain modality moderated the effectiveness of tDCS in attenuating pain-intensity ratings. CONCLUSION: The effectiveness of tDCS on attenuating experimental pain perception depends on both stimulation parameters of tDCS and the modality of experimental pain. SIGNIFICANCE: This study provides some theoretical basis for the application of tDCS in pain management.


Assuntos
Encéfalo/fisiopatologia , Manejo da Dor/métodos , Percepção da Dor/fisiologia , Limiar da Dor/fisiologia , Dor/fisiopatologia , Estimulação Transcraniana por Corrente Contínua/métodos , Humanos , Dor/diagnóstico , Manejo da Dor/psicologia , Limiar da Dor/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento
6.
Sci Rep ; 11(1): 14547, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34267302

RESUMO

The C-tactile (CLTM) peripheral nervous system is involved in social bonding in primates and humans through its capacity to trigger the brain's endorphin system. Since the mammalian cochlea has an unusually high density of similar neurons (type-II spiral ganglion neurons, SGNs), we hypothesise that their function may have been exploited for social bonding by co-opting head movements in response to music and other rhythmic movements of the head in social contexts. Music provides one of many cultural behavioural mechanisms for 'virtual grooming' in that it is used to trigger the endorphin system with many people simultaneously so as to bond both dyadic relationships and large groups. Changes in pain threshold across an activity are a convenient proxy assay for endorphin uptake in the brain, and we use this, in two experiments, to show that pain thresholds are higher when nodding the head than when sitting still.


Assuntos
Música , Limiar da Dor/fisiologia , Gânglio Espiral da Cóclea/citologia , Gânglio Espiral da Cóclea/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios , Adulto Jovem
7.
BMC Neurol ; 21(1): 272, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243742

RESUMO

BACKGROUND: Human hairy (not glabrous skin) is equipped with a subgroup of C-fibers, the C-tactile (CT) fibers. Those do not mediate pain but affective aspects of touch. CT-fiber-activation reduces experimental pain if they are intact. In this pilot study we investigated pain modulating capacities of CT-afferents in CRPS. METHODS: 10 CRPS-patients (mean age 33 years, SEM 3.3) and 11 healthy controls (mean age 43.2 years, SEM 3.9) participated. CT-targeted-touch (brush stroking, velocity: 3 cm/s) was applied on hairy and glabrous skin on the affected and contralateral limb. Patients rated pleasantness of CT-targeted-touch (anchors: 1 "not pleasant"-4 "very pleasant") twice daily on 10 days. Pain intensity (NRS: 0 "no pain" - 10 "worst pain imaginable") was assessed before, 0, 30, 60 and 120 min after each CT-stimulation. To assess sensory changes, quantitative-sensory-testing was performed at the beginning and the end of the trial period. RESULTS: CT-targeted-touch was felt more pleasant on the healthy compared to the affected limb on hairy (p < 0.001) and glabrous skin (p 0.002), independent of allodynia. In contrast to healthy controls patients felt no difference between stimulating glabrous and hairy skin on the affected limb. Thermal pain thresholds increased after CT-stimulation on the affected limb (cold-pain-threshold: p 0.016; heat-pain-threshold: p 0.033). CONCLUSIONS: CT-stimulation normalizes thermal pain thresholds but has no effect on the overall pain in CRPS. Therefore, pain modulating properties of CT-fibers might be too weak to alter chronic pain in CRPS. Moreover, CT-fibers appear to lose their ability to mediate pleasant aspects of touch in CRPS.


Assuntos
Síndromes da Dor Regional Complexa/fisiopatologia , Fibras Nervosas Amielínicas/fisiologia , Dor/fisiopatologia , Adulto , Humanos , Limiar da Dor/fisiologia , Projetos Piloto , Percepção do Tato/fisiologia
8.
Nutrients ; 13(5)2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-34063083

RESUMO

Chronic pain affects mental and physical health and alters brain structure and function. Interventions that reduce chronic pain are also associated with changes in the brain. A number of non-invasive strategies can promote improved learning and memory and increase neuroplasticity in older adults. Intermittent fasting and glucose administration represent two such strategies with the potential to optimize the neurobiological environment to increase responsiveness to recognized pain treatments. The purpose of the pilot study was to test the feasibility and acceptability of intermittent fasting and glucose administration paired with a recognized pain treatment activity, relaxation and guided imagery. A total of 32 adults (44% W, 56% M), 50 to 85 years of age, with chronic knee pain for three months or greater participated in the study. Four sessions were completed over an approximate two-week period. Findings indicate the ability to recruit, randomize, and retain participants in the protocol. The procedures and measures were reasonable and completed without incident. Participant adherence was high and exit interview feedback positive. In summary, the pilot study was feasible and acceptable, providing the evidence necessary to move forward with a larger clinical trial.


Assuntos
Dor Crônica/terapia , Jejum , Glucose/administração & dosagem , Imagens, Psicoterapia/métodos , Plasticidade Neuronal/fisiologia , Terapia de Relaxamento/métodos , Idoso , Idoso de 80 Anos ou mais , Artralgia/fisiopatologia , Artralgia/terapia , Dor Crônica/fisiopatologia , Terapia Combinada , Ingestão de Alimentos/fisiologia , Ingestão de Alimentos/psicologia , Estudos de Viabilidade , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor/métodos , Medição da Dor , Limiar da Dor/fisiologia , Limiar da Dor/psicologia , Projetos Piloto , Resultado do Tratamento
9.
Neurology ; 97(4): e389-e402, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34011572

RESUMO

OBJECTIVE: To test whether contralateral sensory abnormalities in the clinically unaffected area of patients with unilateral neuropathic pain are due to the neuropathy or pain mechanisms. METHODS: We analyzed the contralateral clinically unaffected side of patients with unilateral painful or painless neuropathy (peripheral nerve injury [PNI], postherpetic neuropathy [PHN], radiculopathy) by standardized quantitative sensory testing following a validated protocol. Primary outcome was the independent contribution of the following variables on the contralateral sensory function using generalized linear regression models: pain intensity, disease duration, etiology, body area, and sensory patterns in the most painful area. RESULTS: Among 424 patients (PNI n = 256, PHN n = 78, radiculopathy n = 90), contralateral sensory abnormalities were frequent in both painful (n = 383) and painless (n = 41) unilateral neuropathy, demonstrating sensory loss for thermal and mechanical nonpainful stimuli and both sensory loss and gain for painful test stimuli. Analysis by etiology revealed contralateral pinprick hyperalgesia in PHN and PNI. Analysis by ipsilateral sensory phenotype demonstrated mirror-image pinprick hyperalgesia in both mechanical and thermal hyperalgesia phenotypes. Pain intensity, etiology, and affected body region predicted changes in only single contralateral somatosensory parameters. Disease duration had no impact on the contralateral sensory function. CONCLUSION: Mechanisms of sensory loss seem to spread to the contralateral side in both painful and painless neuropathies. Contralateral spread of pinprick hyperalgesia was restricted to the 2 ipsilateral phenotypes that suggest sensitization; this suggest a contribution of descending net facilitation from supraspinal areas, which was reported in rodent models of neuropathic pain but not yet in human patients.


Assuntos
Hiperalgesia/fisiopatologia , Neuralgia/fisiopatologia , Percepção da Dor/fisiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Radiculopatia/fisiopatologia , Feminino , Humanos , Hiperalgesia/complicações , Masculino , Neuralgia/etiologia , Medição da Dor , Limiar da Dor/fisiologia , Traumatismos dos Nervos Periféricos/complicações , Estimulação Física , Radiculopatia/complicações
11.
Phys Ther ; 101(8)2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33989399

RESUMO

OBJECTIVE: The presence of altered nociceptive pain processing in patients with upper extremity tendinopathy/overuse injury is conflicting. Our aim was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas between patients with upper extremity tendinopathy/overuse injury and controls. METHODS: Five databases were searched from inception to October 15, 2020. The authors selected case-control studies comparing PPTs between individuals with upper extremity tendinopathy/overuse injury and pain-free controls. Data were extracted for population, diagnosis, sample size, outcome, and type of algometer. Results were extracted by 3 reviewers. The methodological quality/risk of bias (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development and Evaluation approach) were assessed. Meta-analyses of symptomatic, segment-related, and distant pain-free areas were compared. RESULTS: The search identified 807 publications with 19 studies (6 shoulder, 13 elbow) eligible for inclusion. The methodological quality ranged from fair (48%) to good (37%). Patients exhibited lower bilateral PPTs than controls at the symptomatic area (affected side: MD = -175.89 kPa [95% CI = -220.30 to -131.48 kPa]; nonaffected side: MD = -104.50 kPa [95% CI = -142.72 to -66.28 kPa]) and the segment-related area (affected side: MD = -150.63 kPa [95% CI = -212.05 to -89.21 kPa]; nonaffected side: MD = -170.34 kPa [95% CI = - 248.43 to -92.25]) than controls. No significant differences in PPTs over distant pain-free areas were observed. CONCLUSION: Low to moderate quality evidence suggests bilateral hypersensitivity to pressure pain at the symptomatic and contralateral/mirror areas in patients with upper extremity tendinopathies/overuse injury. Moderate quality of evidence supports bilateral pressure pain sensitivity in the segment-related area (neck) in lateral epicondylalgia, but not in subacromial impingement syndrome. No evidence of widespread pressure pain hyperalgesia was reported. IMPACT: Early identification of people with altered pain modulation could guide clinicians in treatment strategies. This review shows that there is a complex interplay between peripheral and central pain mechanisms in upper extremity tendinopathies/overuse injuries and that there likely are different subgroups of patients with upper extremity conditions.


Assuntos
Transtornos Traumáticos Cumulativos/fisiopatologia , Hiperalgesia/fisiopatologia , Limiar da Dor/fisiologia , Tendinopatia/fisiopatologia , Extremidade Superior/fisiopatologia , Humanos
12.
J Manipulative Physiol Ther ; 44(3): 244-254, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33879352

RESUMO

OBJECTIVE: The objective of this study was to compare the hypoalgesic effects of isolated or combined use of transcutaneous electrical nerve stimulation (TENS) and cervical joint manipulation (JM) in asymptomatic participants. METHODS: One hundred and forty-four healthy participants aged 18 to 30 years old were randomly assigned to 1 of 4 groups (n = 36 per group): active TENS + active JM, active TENS + placebo JM, placebo TENS + active JM, and placebo TENS + placebo JM. Active or placebo TENS was applied to the dominant forearm. JM was applied to the C6-7 segments. The pressure pain threshold was measured pre- and postintervention and after 20 minutes on the forearm and tibialis anterior of the dominant side. RESULTS: Segmental hypoalgesia was greater in the group active TENS + active JM compared with active TENS + placebo JM (P = .002), placebo TENS + active JM (P < .0001), and placebo TENS + placebo JM (P < .0001). For the extrasegmental hypoalgesia, active TENS + active JM had greater hypoalgesic effect compared with active TENS + placebo JM (P = .033), placebo TENS + active JM (P = .002), and placebo TENS + placebo JM (P < .0001). CONCLUSION: TENS and JM produced hypoalgesia when used alone and, when the treatments were combined, a higher segmental and extrasegmental hypoalgesic effect was obtained in asymptomatic participants.


Assuntos
Vértebras Cervicais/fisiologia , Manipulação da Coluna/métodos , Amplitude de Movimento Articular/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adolescente , Adulto , Terapia Combinada , Humanos , Masculino , Manejo da Dor , Medição da Dor/métodos , Limiar da Dor/fisiologia , Adulto Jovem
13.
PLoS One ; 16(3): e0245410, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33711031

RESUMO

The present study presents a non-surgical approach to assess colonic mechanical sensitivity in mice using colonometry, a technique in which colonic stretch-reflex contractions are measured by recording intracolonic pressures during saline infusion into the distal colon in a constant rate. Colonometrical recording has been used to assess colonic function in healthy individuals and patients with neurological disorders. Here we found that colonometry can also be implemented in mice, with an optimal saline infusion rate of 1.2 mL/h. Colonometrograms showed intermittent pressure rises that was caused by periodical colonic contractions. In the sceneries of colonic hypersensitivity that was generated post 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colonic inflammation, following chemogenetic activation of primary afferent neurons, or immediately after noxious stimulation of the colon by colorectal distension (CRD), the amplitude of intracolonic pressure (AICP) was markedly elevated which was accompanied by a faster pressure rising (ΔP/Δt). Colonic hypersensitivity-associated AICP elevation was a result of the enhanced strength of colonic stretch-reflex contraction which reflected the heightened activity of the colonic sensory reflex pathways. The increased value of ΔP/Δt in colonic hypersensitivity indicated a lower threshold of colonic mechanical sensation by which colonic stretch-reflex contraction was elicited by a smaller saline infusion volume during a shorter period of infusion time. Chemogenetic inhibition of primary afferent pathway that was governed by Nav1.8-expressing cells attenuated TNBS-induced up-regulations of AICP, ΔP/Δt, and colonic pain behavior in response to CRD. These findings support that colonometrograms can be used for analysis of colonic pain in mice.


Assuntos
Doenças do Colo/patologia , Medição da Dor/métodos , Dor/patologia , Animais , Gânglios Espinais/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Limiar da Dor/fisiologia , Ácido Trinitrobenzenossulfônico/efeitos adversos
14.
J Manipulative Physiol Ther ; 44(2): 103-112, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33715788

RESUMO

OBJECTIVE: The purpose of this study was to investigate the effects of ischemic pressure (IP) vs postisometric relaxation (PIR) on rhomboid-muscle latent trigger points (LTrPs). METHODS: Forty-five participants with rhomboid-muscle LTrPs were randomly assigned into 3 groups and received 3 weeks of treatment-group A: IP and traditional treatment (infrared radiation, ultrasonic therapy, and transcutaneous electrical nerve stimulation); group B: PIR and traditional treatment; and group C: traditional treatment. Shoulder pain and disability, neck pain and disability, and pressure pain threshold (PPT) of 3 points on each side were measured before and after treatment. RESULTS: Multivariate analysis of variance indicated a statistically significant Group × Time interaction (P = .005). The PPT for the right lower point was increased in group A more than in groups B or C. Neck pain was reduced in group B more than in group C. Moreover, shoulder and neck disability were reduced in both groups A and B more than in group C. The PPTs of the left lower and middle points were increased in group B compared with groups A and C. The PPT of the left upper point was increased in group A more than in group C. There were significant changes in all outcomes in the 2 experimental groups (P < .05). No changes were found in the control group except in pain intensity, shoulder disability, and PPT of the left lower point. CONCLUSION: This study found that IP may be more effective than PIR regarding PPT, but both techniques showed changes in the treatment of rhomboid-muscle LTrPs.


Assuntos
Síndromes da Dor Miofascial/reabilitação , Cervicalgia/reabilitação , Músculos Superficiais do Dorso/fisiologia , Pontos-Gatilho/fisiologia , Adulto , Músculos do Dorso/fisiologia , Humanos , Masculino , Medição da Dor , Limiar da Dor/fisiologia , Dor de Ombro , Estimulação Elétrica Nervosa Transcutânea
15.
J Back Musculoskelet Rehabil ; 34(4): 623-630, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33682694

RESUMO

BACKGROUND: Although studies examined kinesiological taping (KT) and extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome (MPS), no study has yet compared these two treatments. OBJECTIVE: This study aimed to compare the efficacy of KT and ESWT on pain, pain threshold, functional level and neck movements in the treatment of MPS, which is an important cause of disability and constitutes 50-80% of chronic painful diseases. METHODS: Two hundred and sixty-two patients diagnosed with MPS in the upper part of the unilateral trapeze muscle were included in the study. The patients were divided into three groups according to the treatment they received: Group 1 (n= 75): ESWT + exercise, Group 2 (n= 82): KT + exercise, Group 3 (n= 105) and the latter receiving only exercise therapy (control group). Visual analog scale (VAS), pain threshold with algometer, Neck Disability Index (NDI), and neck contralateral lateral flexion angle were assessed before and three months after treatment. RESULTS: VAS, pain threshold, NDI and contralateral flexion angle values after treatment improved significantly in the ESWT and KT groups (p< 0.05) compared to the control group. The level of improvement in the ESWT group was higher (p< 0.05) than in the KT group in terms of VAS, pain threshold and NDI scores. CONCLUSION: Exercise, KT and ESWT applications in MPS were effective in all of the parameters examined. However, the ESWT + exercise therapy was more effective in terms of pain, pain threshold and disability.


Assuntos
Fita Atlética , Terapia por Exercício , Tratamento por Ondas de Choque Extracorpóreas , Síndromes da Dor Miofascial/terapia , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes da Dor Miofascial/fisiopatologia , Medição da Dor , Limiar da Dor/fisiologia , Amplitude de Movimento Articular/fisiologia , Músculos Superficiais do Dorso/fisiopatologia , Resultado do Tratamento , Adulto Jovem
16.
Mol Pain ; 17: 17448069211002009, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33765896

RESUMO

Pain sensitivity differs individually, but the mechanisms and genetic factors that underlie these differences are not fully understood. To investigate genetic factors that are involved in sensing cold pain, we applied a cold-induced pain test and evaluated protease-activated receptor 2 (PAR2/F2RL1) and transient receptor potential melastatin 8 (TRPM8), which are related to pain. We statistically investigated the associations between genetic polymorphisms and cold pain sensitivity in 461 healthy patients who were scheduled to undergo cosmetic orthognathic surgery for mandibular prognathism. We found an association between cold pain sensitivity and the rs2243057 polymorphism of the PAR2 gene. We also found a significant association between cold pain sensitivity and the rs12992084 polymorphism of the TRPM8 gene. Carriers of the minor A allele of the rs2243057 polymorphism of PAR2 and minor C allele of the rs12992084 polymorphism of TRPM8 exhibited a longer latency to pain perception in the cold-induced pain test, reflecting a decrease in cold pain sensitivity. These results suggest that genetic polymorphisms of both PAR2 and TRPM8 are involved in individual differences in cold pain sensitivity.


Assuntos
Temperatura Baixa , Dor/genética , Receptor PAR-2/metabolismo , Canais de Cátion TRPM/metabolismo , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/metabolismo , Dor/fisiopatologia , Percepção da Dor/fisiologia , Limiar da Dor/fisiologia , Receptor PAR-2/genética , Canais de Cátion TRPM/genética , Sensação Térmica/fisiologia , Adulto Jovem
17.
Chiropr Man Therap ; 29(1): 10, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33627163

RESUMO

BACKGROUND: Pain hypersensitivity can be assessed using Quantitative Sensory Testing (QST) and is associated with persistent low back pain. Spinal manipulation appears to modify pain hypersensitivity, and this could function as one mechanism leading to clinical improvements. In the current study, we applied a comprehensive QST battery to assess pain sensitivity in a cohort of low back pain patients before and after spinal manipulation to improve our understanding of the association between QST and clinical improvements. This study addresses two questions: Are clinical improvements following spinal manipulation in low back pain patients contingent on pain hypersensitivity, and does pain sensitivity change following spinal manipulation? METHODS: We performed a secondary analysis of data from a randomized clinical trial. One hundred and thirty-two participants with persistent LBP were treated with spinal manipulation four times over two weeks. Patient-reported outcomes and QST were assessed at baseline, after the fourth spinal manipulation session, and 14-days later. The clinical outcomes were changes in low back pain intensity and disability. Using latent profile analysis, we categorized the participants into clusters depending on their baseline QST scores. We used linear mixed models to examine the association between clusters and changes in patient-reported outcomes and QST. RESULTS: Two clusters emerged: a Sensitized and a Not sensitized. The former had significantly lower regional pressure and thermal pain thresholds, remote pressure pain tolerance, and lower inhibitory conditioned pain modulation than the Not sensitized group. However, we only found between-cluster differences for regional pressure pain threshold following spinal manipulation. Thus, the clusters were not associated with patient-reported pain and disability changes or the remaining QST outcomes. CONCLUSIONS: We report that the baseline QST profile was not associated with clinical improvements following spinal manipulation. We did observe a substantial change for regional pressure pain threshold, which suggests that any effect of spinal manipulation on pain sensitivity is most likely to be observed as changes in regional, mechanical pain threshold. However, the mechanism that invokes clinical improvement and pain sensitivity changes appear distinct. Due to methodological caveats, we advise caution when interpreting the results. TRIAL REGISTRATION: Clinical.Trial.gov identifier: NCT04086667 , registered 11 September 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04086667.


Assuntos
Dor Lombar/fisiopatologia , Dor Lombar/terapia , Manipulação da Coluna/métodos , Limiar da Dor/fisiologia , Adulto , Análise por Conglomerados , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente
18.
J Sport Rehabil ; 30(5): 812-817, 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33596547

RESUMO

Clinical Scenario: Plantar heel pain is a common condition frequently associated with persistent symptoms and functional limitations affecting both the athletic and nonathletic populations. Common interventions target impairments at the foot and ankle and local drivers of symptoms. If symptoms are predominantly perpetuated by alterations in central pain processing, addressing peripheral impairments alone may not be sufficient. Clinical Question: Do individuals with chronic plantar heel pain demonstrate signs potentially associated with altered central pain processing? Summary of Key Findings: After searching 6 electronic databases (PubMed, CINAHL, Scopus, SportDiscus, Cochrane, and PEDro) and filtering titles based on predetermined inclusion and exclusion criteria, 4 case-control studies were included. All studies scored highly on the Newcastle-Ottawa Scale for quality assessment. Using pressure pain thresholds, each study found decreased pressure pain hypersensitivity locally and at a remote site compared to control groups, suggesting the presence, to some extent, of altered nociceptive pain processing. Clinical Bottom Line: In the studies reviewed, reported results suggest a possible presence of centrally mediated symptoms in persons with plantar heel pain. However, despite findings from these studies, limitations in appropriate matching based on body mass index and measures used suggest additional investigation is warranted. Strength of Recommendation: According to the Oxford Centre for Evidence-Based Medicine, there is evidence level C to suggest chronic plantar heel pain is associated with alterations in central pain processing.


Assuntos
Sistema Nervoso Central/fisiopatologia , Dor Crônica/fisiopatologia , Doenças do Pé/fisiopatologia , Dor Nociceptiva/fisiopatologia , Limiar da Dor/fisiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Calcanhar , Humanos , Pressão
19.
J Sport Rehabil ; 30(5): 804-811, 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33596548

RESUMO

CONTEXT: Localized and widespread hyperalgesia has been observed in patients with patellofemoral pain. Diacutaneous fibrolysis (DF) has shown to be effective in reducing pain in several musculoskeletal conditions including patellofemoral pain syndrome, but no studies have evaluated the effects of this technique in reducing localized and widespread hyperalgesia. OBJECTIVE: To assess the effect of DF on the pressure pain threshold and muscle length tests in patients with patellofemoral pain syndrome. DESIGN: A single-group, pretest-posttest clinical trial. SETTING: University of Zaragoza. PARTICIPANTS: Forty-six subjects with patellofemoral pain (20 males and 26 females: age 27.8 [6.9] y). INTERVENTION: Three sessions of DF. MAIN OUTCOME MEASURES: Pressure pain threshold using a handheld pressure algometer (4 sites around the knee, on tibialis anterior muscle, and one remote site on the upper contralateral limb); muscle length test of the iliotibial band, rectus femoris, and hamstring muscles; and patient-perceived treatment effect score. RESULTS: The application of 3 sessions of DF significantly increased the pressure pain threshold in all sites at posttreatment evaluation (P < .001) and at a 1-week follow-up (P < .001). A significant increase in muscle length was also observed at the posttreatment evaluation (P < .001) and 1-week follow-up (P < .001). Ninety-seven percent of the patients reported subjective improvement at posttreatment and at 1-week follow-up. CONCLUSION: This study found that local and widespread hyperalgesia was significantly reduced after 3 sessions of diacutaneous fibrolysis and at the 1-week follow-up. A significant improvement on muscle length tests was also observed, with high clinical satisfaction among patients.


Assuntos
Hiperalgesia/terapia , Manipulações Musculoesqueléticas/métodos , Limiar da Dor/fisiologia , Síndrome da Dor Patelofemoral/terapia , Adulto , Feminino , Músculos Isquiossurais/anatomia & histologia , Músculos Isquiossurais/fisiopatologia , Humanos , Hiperalgesia/fisiopatologia , Joelho/fisiopatologia , Masculino , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/fisiopatologia , Tamanho do Órgão , Síndrome da Dor Patelofemoral/fisiopatologia , Posicionamento do Paciente/métodos , Pressão , Músculo Quadríceps/anatomia & histologia , Músculo Quadríceps/fisiopatologia
20.
Phys Ther Sport ; 49: 51-61, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33601254

RESUMO

OBJECTIVE: The aim of this review was to investigate if exercise induced hypoalgesia (EIH) occurs following isometric muscle contraction in people with local musculoskeletal symptoms. DESIGN: Systematic review. DATA SOURCES: MEDLINE, EMBASE, CINAHL & SportDiscus electronic databases were searched (inception to April 2020). ELIGIBILITY CRITERIA: Two authors independently evaluated eligibility. Randomised controlled and crossover (repeated measures) trials that measured the effects of isometric exercise in participants with localised musculoskeletal pain during, and up to 2 hours after isometric exercise were included. Other inclusion criteria included comparison to another intervention, or comparison to healthy controls. Primary outcomes were experimentally induced pain thresholds and secondary outcomes included measures of pain sensitivity from clinical testing. RESULTS: 13 studies with data from 346 participants were included for narrative synthesis. EIH was reported in some upper and lower limb studies but there were no consistent data to show isometric exercises were superior to comparison interventions. CONCLUSION: There was no consistent evidence for EIH following isometric exercise in people with musculoskeletal pain. These findings are different to those reported in asymptomatic populations (where EIH is consistently demonstrated) as well as conditions associated with widespread symptoms such as fibromyalgia (where isometric exercise may induce hyperalgesia). Although well tolerated when prescribed, isometric exercise did not induce EIH consistently for people seeking care for local musculoskeletal symptoms. The variance in the dose, location of contraction and intensity of protocols included in this review may explain the inconsistent findings. Further work is required to better understand endogenous analgesia in musculoskeletal pain conditions.


Assuntos
Exercício Físico/fisiologia , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/terapia , Limiar da Dor/fisiologia , Humanos , Contração Isométrica/fisiologia , Manejo da Dor
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