Nonpharmacological Management of Persistent Pain in Elite Athletes: Rationale and Recommendations.

Persistent pain is common in elite athletes. The current review arose from a consensus initiative by the International Olympic Committee to advance the development of a standardized, scientific, and evidence-informed approach to management. We suggest that optimal management of persistent pain in elite athletes requires an understanding of contemporary pain science, including the rationale behind and implementation of a biopsychosocial approach to care. We argue that athletes and clinicians need to understand the biopsychosocial model because it applies to both pain and the impact of pain with special reference to the sport setting. Management relies on thorough and precise assessment that considers contributing factors across nociceptive, inflammatory, neuropathic, and centrally acting domains; these can include contextual and psychosocial factors. Pain management seeks to remove contributing factors wherever possible through targeted education; adjustment of mechanical loading, training, and performance schedules; psychological therapies; and management of inflammation.

Pain in elite athletes-neurophysiological, biomechanical and psychosocial considerations: a narrative review.

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both injury and pain interfere with peak performance. Pain management should be based on the physiological, anatomical and psychosocial influences on the individual's pain and is not equivalent to injury management, which focuses on musculoskeletal recovery and return-to-play. This narrative review provides a foundation for understanding the differing causes and types of pain in elite athletes, thereby serving as a springboard for comprehensive pain management.

International Olympic Committee consensus statement on pain management in elite athletes.

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic.

Rescue of synaptosomal glutamate release defects in tau transgenic mice by the tau aggregation inhibitor hydromethylthionine.

Glutamatergic neurotransmission, important for learning and memory, is disrupted in different ways in patients with Alzheimer's disease (AD) and frontotemporal dementia (FTD) tauopathies. We have previously reported that two tau transgenic mouse models, L1 and L66, produce different phenotypes resembling AD and FTD, respectively. The AD-like L1 model expresses the truncated core aggregation domain of the AD paired helical filament (PHF) form of tau (tau296-390) whereas the FTD-like L66 model expresses full-length tau carrying two mutations at P301S/G335D. We have used synaptosomes isolated from these mice to investigate K+-evoked glutamate release and, if abnormal, to determine responsiveness to hydromethylthionine, a tau aggregation inhibitor previously shown to reduce tau pathology in these models. We report that the transgenes in these two mouse lines cause opposite abnormalities in glutamate release. Over-expression of the core tau unit in L1 produces a significant reduction in glutamate release and a loss of Ca2+-dependency compared with wild-type control mice. Full-length mutant tau produces an increase in glutamate release that retains normal Ca2+-dependency. Chronic pre-treatment with hydromethylthionine normalises both reduced (L1) and excessive glutamate (L66) and restores normal Ca2+-dependency in L1 mice. This implies that both patterns of impairment are the result of tau aggregation, but that the direction and Ca2+-dependency of the abnormality is determined by expression of the disease-specific transgene. Our results lead to the conclusion that the tauopathies need not be considered a single entity in terms of the downstream effects of pathological aggregation of tau protein. In this case, directionally opposite abnormalities in glutamate release resulting from different types of tau aggregation in the two mouse models can be corrected by hydromethylthionine. This may help to explain the activity of hydromethylthionine on cognitive decline and brain atrophy in both AD and behavioural-variant FTD.

[3H]OSIP339391, a selective, novel, and high affinity antagonist radioligand for adenosine A2B receptors.

Until recently, the characterization of adenosine A(2B) receptors has been hampered by the lack of high affinity radioligands. This study describes the synthesis and in vitro characterization of the radiolabeled derivative of OSIP339391, a novel, potent, and selective pyrrolopyrimidine A(2B) antagonist. OSIP339391 had a selectivity of greater than 70-fold for A(2B) receptors over other human adenosine receptor subtypes. The radiolabel was introduced by hydrogenation of the acetylenic precursor with tritium gas resulting in the incorporation (on average) of three tritium atoms in the molecule, yielding a ligand with specific activity of 87Ci/mmol (3.2TBq/mmol). Using membranes from HEK-293 cells expressing the human recombinant A(2B) receptor, [3H]OSIP339391 was characterized in kinetic, saturation, and competition binding experiments. From the association and dissociation rate studies, the affinity was 0.41nM and in close agreement with that found in saturation binding experiments (0.17nM). In competition, binding studies using 0.5nM [3H]OSIP339391, the affinity of a range of agonists and antagonists was consistent with previously reported data. Thus, [3H]OSIP339391 is a novel, selective, and high affinity radioligand that can be a useful tool in the further exploration and characterization of recombinant and endogenous adenosine A(2B) receptors.