How does physical activity modulate pain?

Central aspects of pain associated with physical activity: results from the Investigating Musculoskeletal Health and Wellbeing cohort

Background

Knee pain reduces activity, while inactivity can increase pain. The central nervous system modulates both pain and activity. The 8-item Central Aspects of Pain (CAP) questionnaire measures self-reported symptoms associated with current and future knee pain severity and psychophysical evidence of central pain sensitivity. The objective was to explore associations between CAP and physical inactivity in people with knee pain.

Methods

Participants from the Investigating Musculoskeletal Health and Wellbeing cohort who reported their knee as their most troublesome joint with numerical rating scale pain severity ≥1/10 completed questionnaires at baseline and 12 months addressing demographic and clinical characteristics, CAP questionnaire, and physical inactivity (Frail Non-Disabled questionnaire item). Chi-squared, correlations and multivariable logistic regression were performed.

Results

Seven hundred twenty-two participants provided baseline data and 404 longitudinal data. Higher baseline CAP scores were associated with higher baseline pain severity {OR: 1.25 (95% confidence interval [CI]: 1.02-1.53); P = 0.032} and physical inactivity (OR: 1.18 [95% CI: 1.11-1.25]; P < 0.001). Increasing CAP scores over 12 months were associated with becoming physically inactive (OR: 1.16 [95% CI: 1.01-1.32]; P = 0.032). The effects of CAP on physical inactivity were not fully explained by pain severity nor by any single characteristic of widespread pain distribution, emotional or cognitive factors, sleep disturbance, or fatigue.

Conclusion

Central aspects of pain questionnaire displays cross-sectional and longitudinal associations with physical inactivity. Central nervous system manifestations of pain appear to link pain with physical activity and may be more important than pain severity.

Association Between Interoceptive Accuracy and Pain Perception: Insights From Trained Musicians and Athletes

BACKGROUND

The integration of concurrent endogenous and exogenous multisensory information throughout years of dedicated sensorimotor training is associated with enhanced interoceptive accuracy and altered pain perception in healthy individuals. However, this relationship remains inconclusive, with outcomes varying by training modality and pain stimulus. This study examines associations between distinct forms of sensorimotor training, interoception and pain perception.

METHODS

Two groups of individuals performing extensive sensorimotor training, 17 musicians and 15 athletes, and 14 non-musicians/athletes were recruited. Participants completed a cardiac interoceptive accuracy (IAcc) task and quantitative sensory tests, including mechanical and electrical detection thresholds (MDTs and EDTs), pressure and heat pain thresholds (PPTs and HPTs), as well as music-related perceptual discrimination and self-reported physical activity assessments.

RESULTS

Results revealed superior IAcc and PPTs in athletes compared to controls. Musicians exhibited increased heat pain sensitivity. While IAcc in musicians did not reach significance, training duration significantly predicted IAcc across both groups. PPTs correlated positively with both IAcc and accumulated training, but mediation analyses revealed that training effects on PPTs occurred independently of IAcc, suggesting distinct pathways for interoception and pain modulation. Additionally, physical activity levels correlated positively with both IAcc and PPTs across participants.

CONCLUSIONS

These findings support the emerging view that individuals engaging in sensorimotor training routines, which require embodied multisensory integration for optimal performance, enhance interoceptive accuracy. They also confirm that pain processing varies by training modality. Furthermore, they suggest that the type of acute pain stimulus may explain inconsistencies in the interoception-pain relationship in healthy populations.

SIGNIFICANCE STATEMENT

This study advances our understanding of the interoception-pain-training nexus by revealing two distinct pathways: one linking sensorimotor training, interoceptive accuracy and pressure pain perception and another showing that accumulated sensorimotor training independently elevates pain thresholds. By differentiating between pain modalities, the findings contribute to resolving previous contradictory results, refine our insights into interoception in healthy populations and inform about potential clinical interventions.

Longitudinal association between frailty and pain in three prospective cohorts of older population

BACKGROUND AND OBJECTIVES

As the global population ages, frailty and pain have become two significant health issues that impact the quality of life in older adults. Previous studies have not thoroughly explored the relationship between them. This study aims to investigate the longitudinal association between frailty and pain using data from prospective cohorts in China (CHARLS), the United Kingdom (ELSA), and the United States (HRS).

METHODS

This study utilized data from three prospective cohort studies: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study (HRS). Frailty status was assessed using the Rockwood frailty index and categorized into robust, pre-frail, and frail. Pain was evaluated by self-reports. Pain degrees were categorized into mild, moderate and severe. Pain areas were grouped into four main areas: head and neck, trunk, limbs, oral. Generalized linear mixed-effects models were employed to analyze the longitudinal relationship between frailty and pain while adjusting for covariates, including gender, age, marital status, education level, sleep quality, smoking, drinking, hypertension, and diabetes.

RESULTS

According to the inclusion and exclusion criteria, 10,624 participants from CHARLS (47% female, mean age: 60.76 years), 4945 participants from ELSA (52.2% female, mean age: 70.05 years), and 11,439 participants from HRS (55.8% female, mean age: 69.28 years) were included in the subsequent analysis. Compared to robust individuals, those in pre-frail and frail states showed a significantly increased risk of experiencing pain. In all three cohorts, pre-frail individuals had a 3.82-fold increased likelihood of pain compared to robust individuals (OR = 3.82, 95%CI = 3.51-4.15, p-value < 0.001, CHARLS), 4.29-fold (OR = 4.29, 95%CI = 3.74-4.93, p-value < 0.001, ELSA), and 4.17-fold (OR = 4.17, 95%CI = 3.81-4.57 p-value < 0.001, HRS). Frail individuals had a 10.44-fold increased likelihood of pain (OR = 10.44, 95%CI = 9.05-12.04, p-value < 0.001, CHARLS), 10.14-fold (OR = 10.14, 95%CI = 8.05-12.76, p-value < 0.001, ELSA), and 13.27-fold (OR = 13.27, 95%CI = 11.71-15.03, p-value < 0.001, HRS).

CONCLUSION

This study demonstrates that frailty significantly impacts the risk of pain, the degree of pain, and the areas of pain. And this association is consistently observed across older populations in different countries. Future pain management strategies should incorporate frailty assessments to mitigate the adverse effects of pain on the health of older adults.

How Do Peripheral Neurons and Glial Cells Participate in Pain Alleviation by Physical Activity?

Chronic pain is a global health problem with major socioeconomic implications. Drug therapy for chronic pain is limited, prompting search for non-pharmacological treatments. One such approach is physical exercise, which has been found to be beneficial for numerous health issues. Research in recent years has yielded considerable evidence for the analgesic actions of exercise in humans and experimental animals, but the underlying mechanisms are far from clear. It was proposed that exercise influences the pain pathways by interacting with the immune system, mainly by reducing inflammatory responses, but the release of endogenous analgesic mediators is another possibility. Exercise acts on neurons and glial cells in both the central and peripheral nervous systems. This review focuses on the periphery, with emphasis on possible glia-neuron interactions. Key topics include interactions of Schwann cells with axons (myelinated and unmyelinated), satellite glial cells in sensory ganglia, enteric glial cells, and the sympathetic nervous system. An attempt is made to highlight several neurological diseases that are associated with pain and the roles that glial cells may play in exercise-induced pain alleviation. Among the diseases are fibromyalgia and Charcot-Marie-Tooth disease. The hypothesis that active skeletal muscles exert their effects on the nervous system by releasing myokines is discussed.

The relationship between leisure time activities and chronic musculoskeletal pain in schoolteachers

BACKGROUND

Leisure activities (LAs) have a positive effect on well-being, healthy aging, cognitive functions, physical function, and mental health.

PURPOSE

To determine the prevalence of chronic musculoskeletal pain (CMSP) in schoolteachers and evaluate the relationship between different types of LAs and CMSP.

METHODS

A total of 433 in-service schoolteachers (303 female, 130 male) participated in this cross-sectional study between January 2023 and March 2023 using an online survey. Common LAs in Turkey, including reading books/magazines/newspapers or writing stories/letters, leisure physical activities (PAs), computer-based LAs, television viewing, LAs on smartphones, music listening, going to the cinema/theatre/opera/ballet/concert, gardening, cooking meal/pastry, meeting with friends, and painting/marbling/ceramic/knitting, and their durations were recorded.

RESULTS

The median age of the participants was 38.0 (IQR, 35.0-45.0) years. The prevalence of CMSP was 44.8%. Multiple logistic regression analysis including age, sex, body mass index, comorbidities, weekly standing duration at work, and LAs showed that there was an inverse relationship between CMSP and PAs (OR = 0.564, 95% CI: 0.357-0.890) and listening to music (OR = 0.555, 95% CI: 0.317-0.973). Moreover, LAs on smartphones (OR = 4.318, 95% CI: 2.004-9.308), gardening (OR = 1.827, 95% CI: 1.097-3.043), and having a thyroid disorder (OR = 2.212, 95% CI: 1.045-4.684) were predictive variables for CMSP.

CONCLUSIONS

Considering that PAs and music listening are inversely associated with CMSP, it may be beneficial to make them a part of the lifestyle of both healthy individuals and individuals with CMSP. Physicians should also be aware that LAs on smartphones carry a greater risk for CMSP.

Do biopsychosocial factors predict the level of physical activity in individuals with persistent shoulder pain?

OBJECTIVE

The objective of this cross-sectional study was to compare the physical activity level between individuals with and without rotator cuff related shoulder pain (RCRSP), and, in individuals with RCRSP, investigate whether biopsychosocial factors are associated with the physical activity level.

METHODS

Seventy-four participants with and 84 participants without RCRSP wore a fitness tracking watch for seven consecutive days to assess physical activity (step count, moderate-to-vigorous physical activity (MVPA)-minutes). Additionally, participants with RCRSP completed questionnaires on their level of pain, disability, and physical activity (short version of the International Physical Activity Questionnaire [IPAQ]), as well as on biopsychosocial factors, including resilience, stress, catastrophizing, anxiety and depressive symptoms, self-efficacy, and social support. Statistical analysis included Mann-Whitney U tests and General Linear Models for group comparisons, as well as multiple regression analyses to explore predictors of physical activity.

RESULTS

No significant between-group difference was found concerning step count and MVPA-minutes. Age and depressive symptoms explained 14% of the variance in step count, while age and resilience explained 15% of MVPA-minutes variance. Additionally, resilience was associated with IPAQ (P < 0.05), indicating that higher resilience correlates with greater reported physical activity (odds ratio: 2.32 [1.27, 4.22]).

CONCLUSION

While individuals with RCRSP did not show lower physical activity levels compared to their healthy counterparts, greater physical activity was associated with younger age, lower depressive symptoms, and higher resilience in individuals with RCRSP. Future research should explore whether resilience and physical activity interventions can prevent the transition to persistent RCRSP.

Frequency of physical activity during leisure time and variables related to pain and pain medication use in Spanish adults: A cross-sectional study

BACKGROUND

Physical inactivity has been identified as a risk factor for pain.

OBJECTIVE

The main objective was to analyze the relationships between leisure time physical activity frequency (PAF) and pain prevalence, pain level, pain impairment, daily life pain impairment, and analgesic use in Spanish adults. In addition, risk factors such as sex, body mass index, marital status and social class were assessed for these pain variables in addition to PAF.

METHOD

Cross-sectional study based on data from the 2014 and 2020 European Health Surveys in Spain residents. The Chi-square test was used to analyze the relationship of dependence between the variables of interest. A correlation study calculating Spearman's rho and a multiple logistic regression were performed to assess risk factors for pain variables.

RESULTS

20,113 and 19,196 subjects with a median age of 49 and 52 years old in 2014 and 2020 European Health Surveys, respectively, were analyzed. Dependence relationships were found between PAF and pain variables (p<0.001). The prevalence of: pain, high levels of pain, pain impairment, high level of pain impairment and use analgesic were higher in the inactive population than in the rest of the PAF levels (36.7-53%) vs (18.6-44.3%), p<0.05. Weak correlations were found between PAF and pain variables (-0.177 ≤ Rho ≤ -0.107) (p<0.001). Logistics regression show that being active or very active reduces the odds of pain, the intensity of pain and being affected in daily activities due to pain by 0.524 to 0.776 times. Likewise, being active or very active reduces the odds of taking pain medication by 0.661 to 0.755 times. Also age, low social class, being a woman, and being obese increase of odds of pain, pain affectation and use of analgesics in both surveys by 1.008 to 2.202 times.

CONCLUSIONS

Physical inactivity was related to a higher prevalence of: pain, higher levels of pain, higher pain involvement and higher analgesic use. In addition, lower social class, being female, older age, and obesity were factors for higher odds of pain, pain involvement, and analgesic use in both surveys.

Joint effects of prescription opioid use and physical activity on depressive symptoms

OBJECTIVES

The possible interaction of prescription opioid use and physical activity with regard to depressive symptoms has not been well studied. This study aimed to investigate the joint effects of prescription opioid use and physical activity on depressive symptoms.

STUDY DESIGN

Cross-sectional study.

METHODS

This cross-sectional study included 29,542 participants from the National Health and Nutrition Examination Survey (2007 to March 2020). Depressive symptoms were evaluated using the Patient Health Questionnaire-9. Multivariable logistic regression models were used to examine the association.

RESULTS

Of the 29,542 adults, 2598 had depressive symptoms (weighted, 7.7%), 1845 used prescription opioids (weighted, 6.0%), and 18,373 (weighted 67.0%) achieved the recommended physical activity. After multivariable adjustment, the odds ratio (OR) of depressive symptoms was 4.06 (95% confidence interval [CI]: 3.28, 5.02) for both prescription opioid use and inactive physical activity compared to those without either condition. No multiplicative interaction was observed for prescription opioid use and inactive physical activity on depressive symptoms (OR = 1.26 [95% CI: 0.87, 1.81]). However, additive interaction was statistically significant between the 2 exposures (relative excess risk due to interaction = 1.34 [95% CI: 0.31, 2.36]; attributable proportion due to interaction = 0.33 [95% CI: 0.12, 0.54]; synergy index = 1.78 [95% CI: 1.12, 2.83]).

CONCLUSIONS

Prescription opioid use and inactive physical activity interacted synergistically to affect depressive symptoms.

Association of sedentary behavior and physical activity with occurrence of signs and symptoms in participants of a cardiac rehabilitation program

Sedentary behavior (SB) is associated with health impairments, while physical activity (PA) has been a protective factor. It is unclear whether SB and PA are associated with occurrence of signs and/or symptoms (SS) during cardiac rehabilitation program (CRP) exercise sessions. The objective was to evaluate the association between SB and PA with occurrence of SS. Was included 48 patients from a CRP program (64.7 ± 10.4 years-old). Daily time and % of time of SB and weekly time in moderate-to-vigorous-intensity [MVPA], % of MVPA time, steps/day, and steps/minute were accelerometer-measured. Patients were followed-up during 24 CRP sessions, for accompaniment of SS. Age, sex, and comorbidities (hypertension, diabetes, dyslipidemia, obesity) were covariates. Log-transformed values of SB, MVPA and steps/day were also analyzed. As results, 43.7% (n = 21) of participants presented occurrence of signs, 62.5% (n = 30) presented occurrence of symptoms, and 81.2% (n = 39) present occurrence of SS. In fully adjusted model, % of time in MVPA (β: -0.449,p = 0.045) and steps/minute (β: -0.244,p = 0.026) were inversely associated with occurrence of symptoms. No association was observed between SB and PA and occurrence of signs. The occurrence of symptoms and SS among CRP participants was directly associated with SB and inversely associated with variables of PA.

Insomnia among patients with chronic pain: A retrospective study

Insomnia can coexist with chronic pain and is a major cause of rapidly increasing medical expenses. However, insomnia has not been fully evaluated in patients with chronic pain. This retrospective study aimed to identify the risk factors for insomnia in patients with chronic non-cancer pain. A total of 301 patients with chronic non-cancer pain were enrolled. Patients with the Athens insomnia scale scores ≥ 6 and < 6 were classified into insomnia (+) and insomnia (-) groups, respectively. All patients completed self-report questionnaires as part of their chronic pain treatment approach. Univariate and multivariate analyses were performed to predict insomnia. We found that 219 of 301 (72.8%) patients met the AIS criteria for insomnia. Significant differences were depicted between patients with and without insomnia in terms of body mass index, numeric rating scale, pain catastrophizing scale, hospital anxiety, and depression scale (HADS), pain disability assessment scale, EuroQol 5 dimension (EQ5D), and pain self-efficacy questionnaire. Multiple regression analysis identified the numeric rating scale, HADS, and EQ5D scores as factors related to insomnia in patients with chronic non-cancer pain. Anxiety, depression, and disability were associated with a greater tendency toward insomnia. HADS and EQ5D scores are useful screening tools for preventing insomnia in patients with chronic non-cancer pain.

Nociceptive Processing of Elite Athletes Varies between Sport-Specific Loads: An EEG-Based Study Approach

INTRODUCTION

For the downstream nociceptive processing of elite athletes, recent studies indicate that athletes probably tolerate more pain as compared with a normally active population. Phenotyping the nociceptive processing of athletes in different types of endurance sports can provide insight into training-specific effects, which may help in understanding the long-term effects of specific exercise.

METHODS

Twenty-six elite endurance athletes from the disciplines of rowing, triathlon, and running and 26 age- and sex-matched, recreationally active control subjects who participated in the subjective pain perception and processing of standardized noxious stimuli were investigated by EEG. This included standardized heat pain thresholds (HPT) and contact heat-evoked potentials from heat stimulation, measured with EEG as well as pinprick-evoked potentials from mechanical stimulation.

RESULTS

After noxious stimulation, athletes showed a higher activation of the event-related spectral perturbation (ERSP) patterns in the N2P2 EEG response at the Cz Electrode compared with the controls. After noxious contact heat stimulation, triathletes had a higher ERSP activation compared with the controls, whereas the rowers had a higher ERSP activation after noxious mechanical stimulation. Also, HPT in triathletes were increased despite their increased central activation after thermal stimulation. We found a correlation between increased HPT and training hours and years, although athletes did not differ within these variables.

CONCLUSIONS

Although we were able to identify differences between athletes of different endurance sports, the reasons and implications of these differences remain unclear. The study of sport-specific somatosensory profiles may help to understand the mechanisms of exercise-related long-term effects on pain processing and perception. Furthermore, sport-specific somatosensory effects may support the personalization of exercise interventions and identify risk factors for chronic pain in elite athletes.

Atlas of exercise-induced brain activation in mice

OBJECTIVES

There is significant interest in uncovering the mechanisms through which exercise enhances cognition, memory, and mood, and lowers the risk of neurodegenerative diseases. In this study, we utilize forced treadmill running and distance-matched voluntary wheel running, coupled with light sheet 3D brain imaging and c-Fos immunohistochemistry, to generate a comprehensive atlas of exercise-induced brain activation in mice.

METHODS

To investigate the effects of exercise on brain activity, we compared whole-brain activation profiles of mice subjected to treadmill running with mice subjected to distance-matched wheel running. Male mice were assigned to one of four groups: a) an acute bout of voluntary wheel running, b) confinement to a cage with a locked running wheel, c) forced treadmill running, or d) placement on an inactive treadmill. Immediately following each exercise or control intervention, blood samples were collected for plasma analysis, and brains were collected for whole-brain c-Fos quantification.

RESULTS

Our dataset reveals 255 brain regions activated by acute exercise in mice, the majority of which have not previously been linked to exercise. We find a broad response of 140 regulated brain regions that are shared between voluntary wheel running and treadmill running, while 32 brain regions are uniquely regulated by wheel running and 83 brain regions uniquely regulated by treadmill running. In contrast to voluntary wheel running, forced treadmill running triggers activity in brain regions associated with stress, fear, and pain.

CONCLUSIONS

Our findings demonstrate a significant overlap in neuronal activation signatures between voluntary wheel running and distance-matched forced treadmill running. However, our analysis also reveals notable differences and subtle nuances between these two widely used paradigms. The comprehensive dataset is accessible online at www.neuropedia.dk, with the aim of enabling future research directed towards unraveling the neurobiological response to exercise.

Constipation and pain in Parkinson's disease: a clinical analysis

Parkinson's Disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms (NMS). Among NMS, constipation and pain are both highly prevalent and debilitating affecting up to 80% of PD patients and impairing their quality of life. Here, we investigated the relationship between constipation and pain in PD patients. This is a retrospective study assessing the relationship between pain and constipation in a PD patient population from a clinical database of patients attending the outpatient clinic of the movement disorders division, Neurology Unit of Policlinico Tor Vergata, in Rome. Subjects were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS) part III, Hoehn and Yahr (H&Y) stage, King's Parkinson's Disease Pain Scale (KPPS), Brief Pain Inventory (BPI), Non-Motor Symptoms Scale (NMSS) and Beck Depression Inventory (BDI). Patients were further divided in two groups (Group 1, 32 patients with constipation and Group 2, 35 PD patients without constipation) ANOVA and ANCOVA analysis were used to compare the two groups. PD patients with constipation had significantly higher pain severity and pain interference, as measured by the BPI scale and higher total KPPS score, fluctuation-related pain, nocturnal pain, and radicular pain when compared to PD patients without constipation. This study highlights for the first time a possible interplay between constipation and pain in PD that deserves further investigations.

The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review

The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

Feasibility and acceptability of design and conduct of a registry-based randomised clinical trial evaluating eVIS as a digital support for physical activity in interdisciplinary pain rehabilitation programs: A randomised pilot study

Background

Patients with chronic pain often struggle to engage in physical activity despite its health benefits. The eVISualisation of physical activity and pain intervention (eVIS) was developed to support adherence to physical activity plans in Interdisciplinary Pain Rehabilitation Programs (IPRPs) by visualising activity, pain levels, pain interference, and pharmacological use. This pilot study assesses the feasibility and acceptability of trial design and trial conduct of a registry-based randomised clinical trial (R-RCT).

Method

This randomised clinical pilot study included the first 10% (n = 39, mean age 43.5, 74.4% females) of the R-RCT sample (n≈400). Participants with non-cancer chronic pain from six IPRP units were randomly assigned to either the intervention group (IPRP + eVIS, n = 19) or the control group (IPRP, n = 20). Feasibility and acceptability were evaluated using pre-defined criteria on recruitment- and data collection procedures (e.g., inclusion rates, representativeness, adverse events), physiotherapists' ratings of trial design and conduct (e.g., acceptability, feasibility), and outcome data characteristics and completeness (e.g., adherence, data accessibility).

Results

Recruitment was largely feasible, though attrition differences and the need for refined eligibility screening were noted. Physiotherapists cited time and implementation challenges. Both groups had satisfactory data completeness, but the control group showed lower adherence to daily reporting in the final third of the study. The intervention group had greater improvements in physical health, with 19.5% more participants achieving the minimum clinically important difference (≥3) on the physical component summary scale (PCS). No adverse events occurred.

Conclusion

With minor adjustments, the R-RCT design is mostly feasible, though some challenges to feasibility were identified and addressed.

Physical activity, sitting time, and thermal quantitative sensory testing responses in African Americans

Introduction

Prior research suggests that African Americans (AAs) have more frequent, intense, and debilitating pain and functional disability compared with non-Hispanic Whites (NHWs). Potential contributing factors to this disparity are physical activity and sedentary behavior, given that AAs are less physically active, and physical activity is associated with antinociception (whereas sedentary behavior is linked to pronociception). However, impact of these factors on pain processing has largely been unexplored in AAs, especially before chronic pain onset.

Objective

This study examined relationships between physical activity, sedentary behavior (sitting time), and laboratory measures of pain and pain modulation in adult AAs. These included heat pain threshold and tolerance, temporal summation of pain (TSP, a marker of central sensitization), and conditioned pain modulation (CPM, a marker of descending pain inhibition).

Methods

Multiple regressions were conducted to examine the effects of physical activity and sitting time on heat threshold and tolerance. Multilevel models were conducted to assess the relationship between physical activity, sitting time, and temporal summation of pain. Additional multilevel models were conducted to assess the relationship between physical activity, sitting time, and conditioned pain modulation.

Results

Higher level of physical activity, but not sitting time, was associated with reduced TSP slopes. Neither physical activity nor sitting time was associated with CPM slopes. No significant relationships between physical activity or sitting time and heat pain threshold or tolerance were detected.

Conclusions

These findings suggest that physical activity is associated with reduced TSP, an effect which may be driven by reduced spinal hyperexcitability in more active individuals. Thus, structural and individual interventions designed to increase physical activity in healthy, young AAs may be able to promote antinociceptive processes (ie, reduced TSP/reduced pain facilitation) potentially protective against chronic pain.

Sleep characteristics and pain in middle-aged and older adults: Sex-specific impact of physical and sitting activity

OBJECTIVES

The relationship between poor sleep health and worse pain is established. Physical activity has been successful in reducing chronic pain and improving sleep in aging adults. Despite known sex differences (more women than men experiencing chronic pain and insomnia), sex-specific patterns of interactive associations between physical activity, sleep, and pain remain unexplored. This study tested whether physical and sitting activity moderated associations between sleep characteristics and pain intensity, and whether sex further moderated these relationships.

METHODS

Participants aged 50+ (N = 170, Mage = 64.34, 72 women) completed an online survey measuring pre-sleep arousal (Pre-sleep Arousal Scale), sleep (Pittsburgh Sleep Quality Index), past month average pain intensity, and physical activity (International Physical Activity Questionnaire). Multiple regressions evaluated whether minutes of physical activity (total, vigorous, moderate, walking) or sitting activity, pre-sleep arousal, sleep, sex, or their interaction was associated with pain. Analyses controlled for education, difficulty walking, body mass index, total medical conditions, pain medication, and depressive/anxiety symptoms.

RESULTS

In women, vigorous activity interacted with total pre-sleep arousal and somatic pre-sleep arousal in its association with pain. Higher total arousal and somatic arousal were associated with worse pain intensity only for women who reported highest levels of vigorous activity. No such associations were observed for men or for other physical or sitting activity levels.

CONCLUSIONS

Vigorous physical activity may exacerbate the association between more pre-sleep arousal and worse pain in middle-aged and older women. Research should explore potential sex-specific mechanisms (e.g., inflammatory cytokines, arousal neural networks) underlying these results.

Associations between Physical Activity and Kyphosis and Lumbar Lordosis Abnormalities, Pain, and Quality of Life in Healthy Older Adults: A Cross-Sectional Study

Significant evidence suggests that regular physical activity (PA) leads to numerous physical and psychological outcomes in the elderly. This cross-sectional study was designed to further explore this issue by investigating the associations between PA (measured by accelerometer) and kyphosis and lumbar lordosis abnormalities, pain, and quality of life (QoL) in the elderly. In this cross-sectional study, 163 older adults (73 women) over 65 years of age (mean age: 68.70 ± 3.09) from Russia acted as participants. The following instruments were used to measure research variables: ActiGraph wGT3X-BT for measuring PA, spinal-mouse for measuring kyphosis and lumbar lordosis abnormalities, and the World Health Organization Quality of Life Scale (WHOQOL-BREF) questionnaire for measuring QoL. Pain was measured using two questions. The Independent t-test and a regression analysis were used to analyze data. The results showed that our sample participated on average in 15.8 min of moderate PA (MPA) per day, which is lower than the recommended guidelines. Men were significantly more physically active than women. In addition, MPA was significantly associated with lower kyphosis and lumbar lordosis abnormalities and pain in older adults. Finally, MPA was significantly associated with higher QoL. These findings indicate that PA is a critical concern for the elderly. Accordingly, physical educators and fitness instructors should adopt appropriate strategies to promote an active lifestyle among older adults.

Bodily Pain in Physical Function and the Role of Physical Activity Among Community-Dwelling Adults Aged 50-69 Years in Ghana

BACKGROUND

Older adults who experience pain are likely to report higher functional limitations (FL) and lower physical activity (PA) levels. However, the extent to which PA explains the association of pain with FL is largely unknown, particularly in low- and middle-income countries. This study estimates whether and how much pain in FL is mediated by PA engagement.

METHODS

We used cross-sectional data from 770 adults aged 50-69 years who participated in the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana. FL and pain characteristics were defined using the Medical Outcomes Study Short Form-36. PA was assessed by the International Physical Activity Questionnaire-Short Form. Bootstrapped mediation analyses estimated the direct and indirect hypothesized associations. The control variables included age, sex, residential type, level of education, monthly income, social isolation, emotional distress, multimorbidity, and self-rated health.

RESULTS

After adjusting for potential confounders, higher pain interference (β = 0.091, p < .05) and higher pain severity (β = 0.075, p < .05) were associated with greater FL. The bootstrapping analyses showed that PA mediated the pain interference-FL association, accounting for approximately 58% (β = 0.124, Boots 95% confidence interval (CI): 0.078-0.175) of the total effect (β = 0.215, Boots 95% CI: 0.095-0.335). Similarly, PA mediated the association between pain severity with FL, accounting for approximately 37% (β = 0.044, Boots 95% CI: 0.001-0.094) of the overall effect (β = 0.119, Boots 95% CI: -0.011 to 0.249).

CONCLUSIONS

Our data suggest that the higher pain severity and pain interference may lead to higher FL in middle and old age, and the associations are partially explained by PA. Effective and low-cost PA participation could be targeted in efforts to reduce the effect of pain on physical functioning among middle-aged and older adults.

Acute exercise of painful muscles does not reduce the hypoalgesic response in young healthy women - a randomized crossover study

OBJECTIVES

Exercise-induced hypoalgesia (EIH) is characterized by an increase in pain threshold following acute exercise. EIH is reduced in some individuals with chronic musculoskeletal pain, although the mechanisms are unknown. It has been hypothesized that this may relate to whether exercises are performed in painful or non-painful body regions. The primary aim of this randomized experimental crossover study was to investigate whether the presence of pain per se in the exercising muscles reduced the local EIH response. The secondary aim was to investigate if EIH responses were also reduced in non-exercising remote muscles.

METHODS

Pain-free women (n=34) participated in three separate sessions. In session 1, the maximal voluntary contraction (MVC) for a single legged isometric knee extension exercise was determined. In sessions 2 and 3, pressure pain thresholds (PPT) were assessed at the thigh and shoulder muscles before and after a 3-min exercise at 30 % of MVC. Exercises were performed with or without thigh muscle pain, which was induced by either a painful injection (hypertonic saline, 5.8 %) or a non-painful injection (isotonic saline, 0.9 %) into the thigh muscle. Muscle pain intensity was assessed with an 11-point numerical rating scale (NRS) at baseline, after injections, during and after exercises.

RESULTS

PPTs increased at thigh and shoulder muscles after exercise with painful (14.0-24.9 %) and non-painful (14.3-19.5 %) injections and no significant between-injection EIH differences were observed (p>0.30). Muscle pain intensity was significantly higher following the painful injection compared to the non-painful injection (p<0.001).

CONCLUSIONS

Exercising painful muscles did not reduce the local or remote hypoalgesic responses, suggesting that the pain-relieving effects of isometric exercises are not reduced by exercising painful body regions.

ETHICAL COMMITTEE NUMBER

S-20210184.

TRIAL REGISTRATION NUMBER

NCT05299268.

Validity and reliability of the short form brief pain inventory in older adults with nociceptive, neuropathic and nociplastic pain

OBJECTIVE

The aim of this study was to evaluate the validity and reliability of the Short Form Brief Pain Inventory (SF-BPI) for community-dwelling Brazilian older adults with chronic neuropathic, nociceptive and nociplastic pain.

METHODS

Cross-sectional psychometric testing was conducted in a convenience sample, n=114 (66.5 ± 4.9 years).

RESULTS

The 2-factor structure of the SF-BPI was ratified by confirmatory factor analysis. Convergent validity was found between the SF-BPI and the Present Pain Intensity (PPI). There was good overall internal consistency (Cronbach's α: 0.87). Test-retest reliability was excellent for pain intensity and interference scores of the SF-BPI (ICC: 0.90 and 0.96, respectively), as well as inter-rater reliability for both dimensions (ICC: 0.77).

CONCLUSION

The findings support the validity and reliability of the SF-BPI for community-dwelling older adults with chronic pain and may contribute to health professionals having a brief multidimensional assessment for more effective therapeutic approaches in this population.

Association between Pain and Frequent Physical Exercise among Adults in the United States: A Cross-Sectional Database Study

Pain affects over 20% of United States adults, and less than 50% of United States adults participate in frequent physical exercise. This cross-sectional database study included 13,758 United States adults aged >18 years from the 2020 Medical Expenditure Panel Survey (MEPS) and analyzed the association between severity of pain (independent variable) and frequent physical exercise (dependent variable), adjusting for demographic, economic, limitation, and health variables using multivariable logistic regression. The study showed 50.3% of adults report frequently exercising. Only 37.1% of adults reported experiencing pain of any degree, with a majority of them experiencing little pain. In the adjusted model, extreme pain vs. none, quite a bit of pain vs. none, Hispanic vs. non-Hispanic ethnicity, having a functional limitation vs. no limitation, and being overweight/obese vs. not being obese/overweight were associated with lower odds of reporting doing frequent physical exercise. Meanwhile, being ≥65 or 40-64 vs. 18-39 years of age, male vs. female, white vs. not white race, private or public vs. no health coverage, and good vs. poor general health were associated with greater odds of reporting doing frequent physical exercise. These variables associated with frequent physical exercise should be considered in future work when designing health interventions.

The Association of Pain with Incident Falls in People with Chronic Obstructive Pulmonary Disease: Evidence from the English Longitudinal Study of Ageing

People with chronic obstructive pulmonary disease (COPD) have a higher prevalence of pain and a greater risk of falls than their healthy peers. As pain has been associated with an increased risk of falls in older adults, this study investigated the association between pain and falls in people with COPD compared to healthy controls. Data from the English Longitudinal Study of Ageing were used to establish an association between pain and falls when modelled with a generalised ordinal logistic regression and adjusted for sex, age, wealth, and education (complete case analysis only; n = 806 COPD, n = 3898 healthy controls). The odds were then converted to the predicted probabilities of falling. The predicted probability of falling for people with COPD was greater across all pain categories than for healthy controls; for COPD with (predicted probability % [95%CI]), no pain was 20% [17 to 25], with mild pain was 28% [18 to 38], with moderate pain was 28% [22 to 34] with severe pain was 39% [30 to 47] and for healthy controls with no pain was 17% [16 to 18], mild pain 22% [18 to 27], moderate pain 25% [20 to 29] and severe pain 27% [20 to 35]. The probability of falling increased across pain categories in individuals with COPD, with the most severe pain category at a nearly 40% probability of falling, indicating a potential interaction between COPD and pain.

Exploring the Association of Burning Mouth Syndrome with Depressive and Anxiety Disorders in Middle-Aged and Older Adults: A Systematic Review

BACKGROUND

Burning Mouth Syndrome (BMS) is an idiopathic condition mainly affecting middle-aged and older individuals with hormonal disturbances or psychiatric disorders and is characterized by chronic pain. The etiopathogenesis of this multifactorial syndrome is largely unknown. The objective of the present systematic review was therefore to evaluate the relationship of BMS with depressive and anxiety disorders in middle-aged and older individuals.

METHODS

We selected studies evaluating BMS and depressive and anxiety disorders assessed with validated tools, published from their inception up to April 2023, using PubMed, MEDLINE, EMBASE, Scopus, Ovid, and Google Scholar databases and adhering to the PRISMA 2020 guidelines/PRISMA 2020 27-item checklist. This study is registered on PROSPERO (CRD42023409595). The National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies were used to examine the risk of bias.

RESULTS

Two independent investigators rated 4322 records against the primary endpoint and found 7 records meeting the eligibility requirements. Anxiety disorders were found to be the most common psychiatric disorders related to BMS (63.7%), followed by depressive disorders (36.3%). We found a moderate association of BMS with anxiety disorders, with multiple studies included (n = 7). Moreover, we found a low association of BMS with depressive disorders (included studies, n = 4). The role of pain appeared to be controversial in explaining these associations.

CONCLUSIONS

In middle-aged and older subjects, anxiety and depressive disorders may be potentially related to the development of BMS. Furthermore, also in these age groups, females showed higher risk of developing BMS than males, even when taking into account multimorbidity such as sleep disorders, personality traits, and biopsychosocial changes as suggested by study-specific findings.

Neighbourhood greenness moderates the association between physical activity and geriatric-relevant health outcomes: an analysis of the CLSA

BACKGROUND

The purpose of this analysis was to evaluate the relationship between baseline physical activity levels of older adults and geriatric-relevant health outcomes at 3-year follow-up, and to determine whether baseline neighbourhood characteristics alter this association.

METHODS

Data from the Canadian Longitudinal Study on Aging (CLSA) were used to assess geriatric-relevant outcomes of physical impairment, medication use, severity of daily pain, and depressive symptoms. Data from the Canadian Active Living Environments (Can-ALE) and the Normalized Difference Vegetative Index (NDVI) were used to determine neighbourhood walkability and greenness, respectively. The analytic sample included adults who were 65 years or older at baseline [Formula: see text]. Adjusted odds ratios and 95% confidence intervals for the base relationships were calculated using proportional odds logistic regression (physical impairment, pain, medication use), and linear regression (depressive symptoms). Moderation effects of environmental factors were assessed using greenness and walkability.

RESULTS

The base relationships showed protective associations between each additional hour per week of total physical activity and physical impairment [Formula: see text] daily pain severity [Formula: see text] medication use [Formula: see text], and depressive symptoms [Formula: see text]. Additive moderation effects were seen when greenness was added to physical impairment [Formula: see text], daily pain severity [Formula: see text], and depressive symptoms [Formula: see text] but no moderation was seen with walkability. Sex differences were observed. For example, greenness moderation was found in severity of daily pain in males but not in females.

CONCLUSION

Future research investigating geriatric-relevant health outcomes and physical activity should consider neighbourhood greenness as a potential moderator.

Consistent pattern between physical activity measures and chronic pain levels: the Tromsø Study 2015 to 2016

ABSTRACT

Epidemiological literature on the relationship between physical activity and chronic pain is scarce and inconsistent. Hence, our aim was to assess the relationship applying comprehensive methodology, including self-reported and accelerometer measures of physical activity and different severity levels of chronic pain. We used data from the Tromsø Study (2015-2016). All residents in the municipality, aged 40 years and older were invited to participate (n = 32,591, 51% women). A total of 21,083 (53%) women reported on questionnaires. Additionally, 6778 participants (54% women) were invited to wear accelerometers (6125 with complete measurements). Our exposure measures were self-reported leisure time physical activity, exercise frequency, duration, and intensity and 2 accelerometer measures (steps per day and minutes of moderate to vigorous physical activity per day). Outcome measurements were chronic pain and moderate-to-severe chronic pain. We used Poisson regression to estimate chronic pain prevalence and prevalence ratios for each physical activity measure, with adjustments for sex, age, education level, smoking history, and occupational physical activity. Our main analyses showed an inverse dose-response relationship between all physical activity measures and both severity measures of chronic pain, except that the dose-response relationship with exercise duration was only found for moderate-to-severe pain. All findings were stronger for the moderate-to-severe pain outcomes than for chronic pain. Robustness analyses gave similar results as the main analyses. We conclude that an inverse dose-response association between physical activity and chronic pain is consistent across measures. To summarize, higher levels of physical activity is associated with less chronic pain and moderate-to-severe chronic pain.

A pilot study using pre-treatment physical activity level to predict long-term health-related quality of life in patients with head and neck cancer

BACKGROUND

Pre-treatment levels of physical activity (PA) in head and neck cancer (HNC) are rarely evaluated using accelerometry. This study aimed to investigate whether pre-treatment PA level in HNC predicts aspects of long-term health-related quality of life (HRQL) at 12 months after end of treatment.

METHODS

This pilot study included 48 patients diagnosed with HNC, 41 participants remaining at 12 months post-treatment. Pre-treatment PA was objectively assessed by an accelerometer. Self-perceived PA and HRQL were assessed pre-treatment and at 6- and 12-months post-treatment.

RESULTS

Patients with a higher pre-treatment PA level scored higher on physical function and role function and less fatigue and pain at the 12 months follow-up compared to patients with a lower pre-treatment PA. At 6 months the groups differed only on physical functioning. When comparing changes over time, there were statistically significant differences comparing high and low pre-treatment PA in the fatigue and pain domains between 6 and 12 months. Exploratory multiple regression analyses also indicated that higher pre-treatment PA levels were associated with greater favorable change in the four HRQL measures.

CONCLUSIONS

Higher levels of PA assessed with accelerometer before oncologic treatment associated favorably with aspects of self-perceived HRQL and PA over time in patients with HNC.

Relationship between Physical Activity and Pain in U.S. Adults

PURPOSE

We sought to assess the relationship between physical activity (PA) and pain within the available sample, with secondary aims to assess prevalence of pain, PA levels, health care seeking behaviors, and impact of pain on daily activities and work.

METHODS

We conducted an epidemiological cross-sectional observational study utilizing National Health Interview Survey data from 2020. We examined the self-reported adherence to current PA guidelines and the prevalence of pain. We hypothesized those dealing with pain were less likely to meet PA guidelines. The PA levels, pain prevalence, frequency, and intensity were assessed via the survey and relationships explored via modeling.

RESULTS

Of 31,568, 46% were men and 53.99% women with mean age of 52.27 yr (±17.31 yr). There were 12,429 (39.37%) participants that reported pain on some days, 2761 (8.75%) on most days, and 4661 (14.76%) every day. The odds of engaging in PA decreased in a stepwise fashion based on frequency and intensity of pain reporting when compared with no pain. Importantly, PA is a significant correlate affecting pain reporting, with individuals engaging in PA (strength and aerobic) demonstrating two times lower odds of reporting pain when compared with those not meeting the PA guidelines.

CONCLUSIONS

There is a significant correlation between meeting PA guidelines and pain. Meeting both criteria of PA guidelines resulted in lower odds of reporting pain. In addition, the odds of participating in PA decreased based on pain frequency reporting. These are important findings for clinicians, highlighting the need for assessing PA not only for those dealing with pain but also as a potential risk factor for minimizing development of chronic pain.

Analgesic efficacy of sleep-promoting pharmacotherapy in patients with chronic pain: a systematic review and meta-analysis

Dysregulation of sleep heightens pain sensitivity and may contribute to pain chronification. Interventions which consolidate and lengthen sleep have the potential to improve pain control. The main objective of this systematic review was to examine the effects of sleep-promoting pharmacotherapy on pain intensity in patients with chronic pain. Multiple electronic databases were searched from inception to January 2022 to identify relevant randomized controlled trials (RCTs). Two independent reviewers screened titles, abstracts, and full-text articles; extracted data; and assessed risk of bias for each included study. The GRADE approach was used to determine the strength of evidence. The search identified 624 articles. After full-text screening, 10 RCTs (n = 574 randomized participants) involving 3 pharmacologic interventions (melatonin, zopiclone, and eszopiclone) and 7 different chronic pain populations were included. Minimum clinically significant pain reduction ≥30% was reported in 4 studies. There is low-quality evidence (downgraded due to inconsistency and imprecision) that 2 to 8 weeks treatment with a sleep-promoting medication alone or in combination with an analgesic (6 trials, n = 397) decreases pain intensity compared with placebo or the same analgesic treatment alone (SMD -0.58 [95% confidence interval -1.00, -0.17], P = 0.006). Analyses of associations between changes in sleep and pain outcomes were only provided in 2 articles, with inconsistent findings. Notably, pain-relieving effects were most consistent in melatonin trials. Only 3 studies implemented polysomnography to obtain objective sleep measures. Low-quality evidence indicates that pharmacologic sleep promotion may decrease pain intensity in chronic pain populations. More research is needed to fully understand the influence of sleep-targeting interventions on pain control.

The mediating role of physical activity and sedentary behavior in the association between working from home and musculoskeletal pain during the COVID-19 pandemic

Introduction

Working from home during the COVID-19 pandemic has been associated both with physical inactivity and musculoskeletal pain. However, it has not been examined whether physical activity and sedentary behavior are underlying mechanisms in the association between working from home and musculoskeletal pain. Therefore, we examined their mediating role in this association.

Methods

Data were used from 24 questionnaire rounds of the Lifelines COVID-19 cohort (March 2020-January 2022). Longitudinal information on work situation (location, home, hybrid), physical activity, sedentary behavior, and musculoskeletal pain was collected among 28,586 workers. Analysis of physical activity/sedentary behavior as mediators of the association between working from home and musculoskeletal pain was performed using multilevel structural equation modeling.

Results

Home workers more often had pain in the upper back [odds ratio (OR) = 1.17, 95%-confidence interval (CI) = 1.02-1.34] and arm, neck, and/or shoulder (ANS) (OR = 1.32, 95%-CI = 1.19-1.47) than location workers. Furthermore, home workers were more often sedentary for >9 h per work day than location workers (OR = 2.82, 95%-CI = 2.56-3.09), and being more sedentary was associated with musculoskeletal pain (upper back: OR = 1.17, 95%-CI = 1.06-1.30; ANS: OR = 1.25, 95%-CI = 1.16-1.34). Corresponding indirect effects were OR = 1.18 (95%-CI = 1.04-1.33) and OR = 1.26 (95%-CI = 1.12-1.35). No indirect effect was found for physical activity. Similar indirect effects were observed for hybrid workers.

Conclusion

Home and hybrid workers were more likely to have pain in the upper musculoskeletal system during the COVID-19 pandemic than location workers, which was partly mediated by increased sedentary behavior, but not by reduced physical activity. Measures to reduce sedentary time in home workers may contribute to preventing musculoskeletal pain.

Television-viewing time and bodily pain in Australian adults with and without type 2 diabetes: 12-year prospective relationships

BACKGROUND

Bodily pain is a common presentation in several chronic diseases, yet the influence of sedentary behaviour, common in ageing adults, is unclear. Television-viewing (TV) time is a ubiquitous leisure-time sedentary behaviour, with a potential contribution to the development of bodily pain. We examined bodily pain trajectories and the longitudinal relationships of TV time with the bodily pain severity; and further, the potential moderation of the relationships by type 2 diabetes (T2D) status.

METHOD

Data were from 4099 participants (aged 35 to 65 years at baseline) in the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), who took part in the follow-ups at 5 years, 12 years, or both. Bodily pain (from SF36 questionnaire: a 0 to 100 scale, where lower scores indicate more-severe pain), TV time, and T2D status [normal glucose metabolism (NGM), prediabetes, and T2D] were assessed at all three time points. Multilevel growth curve modelling used age (centred at 50 years) as the time metric, adjusting for potential confounders, including physical activity and waist circumference.

RESULTS

Mean TV time increased, and bodily pain worsened (i.e., mean bodily pain score decreased) across the three time points. Those with T2D had higher TV time and more-severe bodily pain than those without T2D at all time points. In a fully adjusted model, the mean bodily pain score for those aged 50 years at baseline was 76.9(SE: 2.2) and worsened (i.e., bodily pain score decreased) significantly by 0.3(SE: 0.03) units every additional year (p <0.001). Those with initially more-severe pain had a higher rate of increase in pain severity. At any given time point, a one-hour increase in daily TV time was significantly associated with an increase in pain severity [bodily pain score decreased by 0.69 (SE: 0.17) units each additional hour; p <0.001], accounting for the growth factor (age) and confounders' effects. The association was more-pronounced in those with T2D than in those without (prediabetes or NGM), with the effect of T2D on bodily pain severity becoming more apparent as TV time increases, significantly so when TV time increased above 2.5 hours per day.

CONCLUSION

Bodily pain severity increased with age in middle-aged and older Australian adults over a 12-year period, and increments in TV time predicted increased bodily pain severity at any given period, which was more pronounced in those with T2D. While increasing physical activity is a mainstay of the prevention and management of chronic health problems, these new findings highlight the potential of reducing sedentary behaviours in this context.

Fitbit Activity, Quota-Based Pacing, and Physical and Emotional Functioning Among Adults With Chronic Pain

Physical activity can improve function in patients with chronic pain, however, adherence is low, in part due to inconsistent activity patterns. Smart wearable activity trackers, such as Fitbits, may help promote activity. In our program for chronic pain, we examined: 1) Fitbit activity patterns (ie, step count, moderate-to-vigorous physical activity (MVPA), sedentary behavior), and 2) whether achievement of weekly, individualized Fitbit step goals was associated with functional outcomes. We conducted a secondary analysis of Fitbit data from our 10-week mind-body activity program for chronic pain (GetActive-Fitbit arm, N = 41). Participants self-reported emotional and physical function and completed performance-based and accelerometer-based assessments. From week 1 to week 10, 30% of participants increased >800 steps; 32.5% increased MVPA; and 30% decreased sedentary behavior. Only step count significantly changed across time with mean steps peaking at week 8 (M = +1897.60, SD = 467.67). Fitbit step goal achievement was associated with improvements in anxiety (ß = -.35, CI [-2.80, -.43]), self-reported physical function (ß = -.34, CI [-5.17, 8.05]), and performance-based physical function (ß = .29, CI [-71.93, 28.38]), but not accelerometer-based physical function or depression. Adhering to individualized Fitbit step goals in the context of a mind-body activity program may improve anxiety and self-reported and performance-based physical function. PERSPECTIVE: We examine Fitbit activity patterns and the association between quota-based pacing and functional outcomes within a mind-body activity program for adults with chronic pain. Complementing quota-based pacing and coping skills with Fitbits may be a useful approach to promote activity engagement and behavior change in chronic pain populations.

Combined effects of lifestyle and psychosocial factors on central sensitization in patients with chronic low back pain: A cross-sectional study

BACKGROUND

Central sensitization is one cause of chronic low back pain. Lifestyle and psychosocial factors are involved in the exacerbation of central sensitization. However, the combined effects of these factors on central sensitization in patients with chronic low back pain are unclear. The objective of this study was to investigate the combined effects of lifestyle and psychosocial factors on central sensitization in patients with chronic low back pain.

METHODS

This was a cross-sectional study. The participants were recruited from three orthopedic clinics for a total of 70 patients with chronic low back pain. Data were analyzed using hierarchical multiple regression analysis. In Model 1, lifestyle factors such as sleep quality, physical activity, sitting time, and perceived stress were included. Model 2 included psychosocial factors (pain catastrophizing, anxiety, and depression).

RESULTS

The data showed that sleep (b = 0.30) and perceived stress (b = 0.47) were significantly correlated in Model 1, and anxiety (b = 0.41) and perceived stress (b = 0.27) were significantly correlated in Model 2. Furthermore, contributions from sleep (b = 0.14) decreased, and no significant correlations were observed. The coefficient of determination increased significantly from Model 1 to Model 2 (ΔR ² = 0.12, p < 0.05).

CONCLUSIONS

In this study, we clarified that perceived stress and anxiety were correlated with central sensitization in patients with chronic low back pain. In addition, sleep quality mediates anxiety and may be associated with central sensitization.

An exploration of low back pain beliefs in a Northern America based general population

BACKGROUND

Prior research has demonstrated that people across different populations hold beliefs about low back pain (LBP) that are inconsistent with current evidence. Qualitative research is needed to explore current LBP beliefs in Northern America (NA).

OBJECTIVES

We conducted a primarily qualitative cross-sectional online survey to assess LBP beliefs in a NA population (USA and Canada).

METHODS

Participants were recruited online using social media advertisements targeting individuals in NA over the age of 18 with English speaking and reading comprehension. Participants answered questions regarding the cause of LBP, reasons for reoccurrence or persistence of LBP, and sources of these beliefs. Responses were analyzed using conventional (inductive) content analysis.

RESULTS/FINDINGS

62 participants were included with a mean age of 47.6 years. Most participants reported multiple causes for LBP as well as its persistence and reoccurrence, however, these were biomedically focused with minimal to no regard for psychological or environmental influences. The primary cited source of participants' beliefs was healthcare professionals.

CONCLUSIONS

Our findings align with prior research from other regions, demonstrating a need for updating clinical education and public messaging about the biopsychosocial nature of LBP.

Relationships between Physical Activity Level and Pain in the Spanish Population: A Cross-Sectional Study

Introduction. One third of the world’s population suffers from some form of pain. Physical inactivity is one of the causes that reduces physical fitness and may lead to an increase in the prevalence of pain in the population. Aims. To analyse the relationships between the level of physical activity (PAL) and the prevalence and degree of pain, the limitations and impact of pain on daily activities and the use of pain medication in the Spanish population. Hypothesis. PAL is related to pain among Spaniards. Methodology. A cross-sectional study design was used, based on data obtained from the Spanish National Health Survey 2017 with 17,777 participants. A descriptive analysis was performed. Nonparametric statistical tests were used: chi-square statistic to analyse intergroup differences in ordinal variables; Mann−Whitney U test to analyse intergroup differences in continuous variables. A correlation study was also performed between the variables of interest, using Spearman’s rho. Results. Relationships were found between PAL and: prevalence of pain, degree of pain, limitations due to pain in usual activities, level of impact in daily activities and use of pain medication in the Spanish population (p < 0.001). Performing moderate and intense PA was related to lower prevalence and degree of pain in the population that performed it, compared to those who only walked or were inactive. Weak correlations were found between the level of PA and the study variables (p < 0.001). Conclusions. High PALs in the population are related to better indicators of pain among Spaniards, appearing to reduce the prevalence and degree of pain, as well as the limitations and impact caused by pain in the daily activities of citizens, and could reduce the use of pain medication in the adult Spanish population.

Bidirectional Associations Between Physical Activity and Pain Among Older Adults: An Ecological Momentary Assessment Study

This paper examines the within-day, bidirectional associations between physical activity and self-reported pain among older adults. Older adults (N = 104; range: 60-98 years) participated in a 10-day Ecological Momentary Assessment (EMA) study. Participants received six EMA prompts/day with a single item assessing pain. Participants wore an activPAL monitor measuring step counts. At the within-person level, on occasions when participants took more steps than usual in the 30 min before the EMA prompt, they were more likely to experience pain at the prompt (β^02=0.0003, p < .03). At the between-person level, greater step counts in the 30 min before the EMA prompt, on average, were associated with less pain on occasions when pain was experienced (β^01=-0.0005, p < .04). Pain was not related to subsequent stepping. Bidirectional associations between physical activity and pain were not documented, but physical activity did appear to be related to subsequent pain.

Specific versus non-specific exercises for the neck extensor muscles in women with chronic idiopathic neck pain: A randomized controlled trial

BACKGROUND

Structural and functional impairments of the cervical extensor muscles have been demonstrated in people with neck pain. A global exercise approach targeting all neck extensor muscles has shown positive effects in this population. However, to date, the efficacy of exercises specifically targeting the deep neck extensors has neither been tested nor compared to global exercises for the neck extensors.

OBJECTIVES

To compare the effects on pain and disability of a specific lower deep neck extensors (SLDNE) versus a general neck extensor (GNE) exercise program in women with chronic idiopathic neck pain.

METHODS

Fourty-three women with chronic idiopathic neck pain were randomly allocated to either a six-week SLDNE or a GNE exercise program. As primary outcome, neck disability was measured with the Neck Disability Index (NDI). Secondarily, pain intensity (VAS), cervical ROM, pressure pain thresholds (PPTs), cervical and thoracic posture and self-perceived benefit of treatment (GROC) were also measured. Every outcome was measured at baseline and immediately after treatment, except NDI, which was also measured at 6-months follow-up. The GROC was only assessed post-intervention.

RESULTS

Both exercise programs lead to reduced neck disability immediately post-intervention (within-group mean difference [MD] = -6.09; 95% Confidence Interval [CI]: 7.75, -4.42 and -4.73; 95%CI: 6.57, -2.91 respectively) and at the 6-months follow-up (-4.47; 95%CI: 6.41, -2.53 and -4.74; 95%CI: 6.50, -2.97), but with no between group differences. Similar results were found for pain intensity post-intervention, with no between group interaction (within-group MD = -20.87 mm; 95% CI: 28.55, -13.19 and -18.00 mm; 95%CI: (-26.24, -9.76) for SLDNE and GNE groups, respectively). GROC improved after both interventions without any between-group difference.

CONCLUSIONS

A six-week exercise program specifically targeting the lower deep neck extensors lead to comparable outcomes as a general neck extensor exercise program in women with chronic idiopathic neck pain.

Preoperative frailty and chronic pain after cardiac surgery: a prospective observational study

BACKGROUND

Chronic pain after cardiac surgery, whether or not related to the operation, is common and has negative impact on health related quality of life (HRQL). Frailty is a risk factor for adverse surgical outcomes, but its relationship with chronic pain after cardiac surgery is unknown. This study aimed to address the association between frailty and chronic pain following cardiac surgery.

METHODS

This sub-study of the Anesthesia Geriatric Evaluation study included 518 patients ≥ 70 years undergoing elective cardiac surgery. Pain was evaluated with the Short-Form 36 questionnaire prior to and one year after surgery. Associations between chronic postoperative pain and frailty domains, including medication use, nutritional status, mobility, physical functioning, cognition, HRQL, living situation and educational level, were investigated with multivariable regression analysis.

RESULTS

Chronic pain one year after cardiac surgery was reported in 182 patients (35%). Medication use, living situation, mobility, gait speed, Nagi's physical functioning and preoperative HRQL were frailty domains associated with chronic pain after surgery. For patients with chronic pain physical HRQL after one year was worse compared to patients without chronic pain (β -10.37, 99% CI -12.57 - -8.17).

CONCLUSIONS

Preoperative polypharmacy, living alone, physical frailty and lower mental HRQL are associated with chronic pain following cardiac surgery. Chronic postoperative pain is related to worse physical HRQL one year after cardiac surgery. These findings may guide future preoperative interventions to reduce chronic pain and poor HRQL after cardiac surgery in older patients.

TRIAL REGISTRATION

This trial has been registered before initiation under number NCT02535728 at clinicaltrials.gov.

A Cross-Sectional Study on Self-Perceived Health and Physical Activity Level in the Spanish Population

One-third of the Spanish population over 15 years of age did not achieve a reasonable amount of physical activity (PA) before the COVID-19 pandemic. We aim to analyse the associations between the PA level (PAL) and self-perceived health (SPH) in the Spanish population aged 15−69 years during the pre-pandemic period. A cross-sectional study was conducted using the Spanish National Health Survey 2017 (ENSE 2017) data, with 17,777 participants. We carried out a descriptive analysis, analysed intergroup differences with non-parametric statistical tests, and calculated the Odds Ratio (OR) and Relative Risk (RR) of having a negative SPH according to PAL. In addition, correlations between PAL and SPH were studied, finding associations between them (p < 0.001). Thus, performing moderate and intense PA was related to better SPH than just walking or inactive. Weak and moderate correlations were found between PAL and SPH (p < 0.001). We also found high ORs and RRs of negative SPH as PAL decreased. Moderate and intense PA were related to positive SPH, while the risk of negative perception in inactive people was higher.

Adding Physical Activity Coaching and an Activity Monitor Was No More Effective Than Adding an Attention Control Intervention to Group Exercise for Patients With Chronic Nonspecific Low Back Pain (PAyBACK Trial): A Randomized Trial

OBJECTIVE

To investigate whether adding physical activity coaching and an activity monitor enhanced the effects of a group exercise program on pain intensity and disability for people with chronic nonspecific low back pain.

DESIGN

Randomized controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors.

METHODS

One hundred sixty participants with chronic nonspecific low back pain who were aged between 18 and 60 years and seeking care at an outpatient physiotherapy clinic participated. Both groups received supervised group exercise therapy. The intervention group also received physical activity coaching sessions aimed at improving physical activity, and physical activity electronic feedback delivered by an activity monitor. The attention control group received modified approaches of coaching sessions and an activity monitor. Disability was measured using the Roland Morris Disability Questionnaire (0-24), and pain intensity was measured using the 11-point Numerical Rating Scale (0-10). Linear mixed models were performed to test for differences between groups.

RESULTS

There were no differences between groups for reductions in disability (mean difference [MD] = -0.5 out of 24 points; 95% confidence interval [CI]: -2.2, 1.1) and pain intensity (MD = -0.4 out of 10 points; 95% CI: -1.3, 0.5) at 3-month follow-up. There were no between-groups differences at 6- and 12-month follow-up assessments.

CONCLUSION

Adding targeted physical activity coaching and an activity monitor did not reduce pain intensity or disability more than an attention control approach in participants with chronic low back pain who were undertaking a group exercise program. J Orthop Sports Phys Ther 2022;52(5):287-299. doi:10.2519/jospt.2022.10874.

The effect-modification of physical activity on the association of pain with impaired physical function in aging adults

OBJECTIVES

Pain is prevalent among older adults and may result in impairment in physical function. However, little is known about the effect-modification of this relationship by physical activity (PA) participation. This large and representative study sought to estimate the effect of pain on physical function among older adults in Ghana and evaluate whether PA modifies this association.

METHODS

Data came from 1201 adults aged ≥50 years participating in the AgeHeaPsyWel-HeaSeeB Study in Ghana. Pain constructs were defined using the Medical Outcomes Study Short Form-36 (MOS SF-36). PA was assessed using the International Physical Activity Questionnaire short form (IPAQ-SF) and physical function impairment was measured by seven-item domains based on the activities of daily living (ADL) and instrumental ADL (IADL). Adjusted hierarchical OLS regressions were fitted to estimate the direct and moderating relationships between pain facets, PA, and impaired physical function.

RESULTS

The relationships of pain severity (β = 0.348, p < .001), and pain interference (β = 0.424, p < .001) with impaired physical function were robust after full adjustment for confounding variables. Persons with pain experiences had significantly increased impaired physical function risks. PA significantly modified the association between pain severity (β = -0.232, p < .001) and pain interference (β = -0.143, p < .001) with impaired physical function.

CONCLUSIONS

Our data indicate that the relationships of pain with physical function impairment are modified by PA intensity. Future studies are warranted to understand the indirect effect of pain on functional limitations and how PA promotion could manage pain and improve functional ability in aging adults.

Elevating Subjective Well-Being Through Physical Exercises: An Intervention Study

Background: Physical activity is associated with higher levels of subjective well-being. However, little research has been conducted in naturalistic conditions with a longitudinal design. In the current study, we aimed to examine whether regular activity initiation can impact happiness, life satisfaction, and self-esteem 4 weeks later. Methods: The sample (N = 217, 124 women) was divided into three groups based on level of physical activity (active people, beginners, and inactive people). The participants completed measures of happiness, satisfaction with life, self-esteem, and a survey on physical activity. Ninety-five of participants who completed the same set of measures sent by email after 4 weeks were included in the analyses. Results: The study showed a strong relationship between subjective well-being and physical activity. Active people showed higher levels of happiness and self-esteem compared to beginners and inactive people and a higher level of life satisfaction than inactive people. Furthermore, after 4 weeks of exercising, beginners revealed greater life satisfaction and happiness compared to the baseline. Conclusion: These findings confirm that regular physical activity leads to higher levels of well-being. It seems that even a short engagement in physical activity (4 weeks) may contribute to an increase in subjective well-being.

Chronic Pain and Associated Factors Related to Depression among Older Patients in Hanoi, Vietnam

The interaction of chronic pain and depression among older people has been studied for many years. This study aimed to investigate the frequency of chronic pain and depression among older patients and correlated factors. A cross-sectional study was conducted in 921 older patients at the National Geriatric Hospital from November 2019 to March 2020. We used the Charlson Comorbidity Index (CCI) to assess the comorbid condition, a numerical rating scale (NRS) to examine pain severity, and Geriatric Depression Scale-15 items (GDS-15) to measure depression among participants. A chi-square test and Tobit regression were used to analyze the relationships. A total of 921 older patients participated in the study. The proportion of depression accounted for 55.8%. The mean Charlson score and number of diseases were 1.2 and 4.7, respectively. A positive correlation was found between comorbidity and chronic pain and depression. Moreover, socio-demographic variables such as occupation, education, and income were associated with pain and depressive symptoms. This study highlights the issue of mental health in older people with chronic pain. The results indicate the necessity of frequent depression screening, pain management, and social activity programs for older people to enhance their health.

Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial

BACKGROUND

Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults' chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program's scalability and potential efficacy.

OBJECTIVE

The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial.

METHODS

The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory-based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools.

RESULTS

Recruitment is ongoing as of January 2021.

CONCLUSIONS

Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/29013.

Functional health and symptoms in Spain before and during the COVID-19 pandemic

BACKGROUND

The impact of the coronavirus disease (COVID-19) pandemic on wellbeing and health has so far been studied using mostly cross-sectional designs. To place recent findings into context, we compared symptoms and functional health status in two independent samples assessed before and during the COVID-19 pandemic.

METHODS

Participants were recruited via an online panel using quota sampling. We assessed symptoms, functional health, and global quality of life with the EORTC QLQ-C30 in two general population samples in Spain (collected in July 2019 and April 2020). We also assessed several COVID-19 related variables, such as adherence to social distancing.

RESULTS

Data from N = 1010 participants before the pandemic (mean age 47.1 years, 50.5% female) were compared with data from N = 504 participants during the pandemic (mean age 47.1 years, 50.8% female). Participants during the pandemic (vs. before the pandemic) reported lower role functioning and emotional functioning, as well as less symptom burden. A lower degree of social distancing was associated with better functional health and lower symptom burden.

CONCLUSION

Our findings indicate an impact of the COVID-19 pandemic on functional health and symptom burden in the Spanish general population. The comparison of before and during the pandemic can be used to benchmark results raised only during the pandemic.

Tension-type headache

Tension-type headache (TTH) is the most prevalent neurological disorder worldwide and is characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity. Diagnosis is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition. Although the biological underpinnings remain unresolved, it seems likely that peripheral mechanisms are responsible for the genesis of pain in TTH, whereas central sensitization may be involved in transformation from episodic to chronic TTH. Pharmacological therapy is the mainstay of clinical management and can be divided into acute and preventive treatments. Simple analgesics have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH. Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and if simple analgesics are ineffective, poorly tolerated or contraindicated. Recommended preventive treatments include amitriptyline, venlafaxine and mirtazapine, as well as some selected non-pharmacological therapies. Despite the widespread prevalence and associated disability of TTH, little progress has been made since the early 2000s owing to a lack of attention and resource allocation by scientists, funding bodies and the pharmaceutical industry.

Comparison of murine behavioural and physiological responses after forced exercise by electrical shock versus manual prodding

NEW FINDINGS

What is the central question of this study? Forced treadmill exercise using electrical shock is the most common technique in rodent exercise studies. Here, we examined how the use of electrical shock during forced treadmill exercise affects behavioural and physiological responses in comparison to a novel non-electrical shock technique. What is the main finding and its importance? In comparison to mice that underwent traditional treadmill running induced by electrical shock, mice that underwent forced running using a novel technique involving gentle prodding to induce running showed: (i) higher locomotor activity; (ii) less anxiety-like behaviour; and (iii) altered exercise-induced muscle pain immediately after exercise.

ABSTRACT

Animal models of exercise have been useful to understand underlying cellular and molecular mechanisms. Many studies have used methods of exercise that are unduly stressful (e.g., electrical shock to force running), potentially skewing results. Here, we compared physiological and behavioural responses of mice after exercise induced using a prodding technique that avoids electrical shock versus a traditional protocol using electrical shock. We found that exercise performance was similar for both techniques; however, the shock group demonstrated significantly lower locomotor activity and higher anxiety-like behaviour. We also observed divergent effects on muscle pain; the prodding group showed hyperalgesia immediately after exercise, whereas the shock group showed hypoalgesia. Corticosterone concentrations were elevated to a similar extent for both groups. In conclusion, mice that were exercised without shock generated similar maximal exercise performance, but postexercise these mice showed an increase in locomotor activity, less anxiety-like behaviour and altered muscle pain in comparison to mice that exercised with shock. Our data suggest that running of mice without the use of electrical shock is potentially less stressful and might be a better technique to study the physiological and behavioural responses to exercise.

Differences in personality, perceived stress and physical activity in women with burning mouth syndrome compared to controls

OBJECTIVES

Burning mouth syndrome (BMS) is a long-lasting pain condition which is commonly associated with anxiety symptoms and experience of adverse, stressful life events have been reported by those diagnosed with the syndrome. Stress-related biomarkers have been related to personality traits in BMS and a personality with high stress susceptibility and perceived stress may be of importance. Although biopsychosocial approaches are suggested to manage long-lasting orofacial pain, to date little is known about physical activity in women with BMS. The aim of this study was to investigate if personality, perceived stress and physical activity distinguish women with BMS from controls.

METHODS

Fifty-six women with BMS and 56 controls matched on age and gender completed Swedish universities Scales of Personality (SSP), Perceived Stress Questionnaire (PSQ) and a general questionnaire with an item on weekly physical activity frequency. In addition, health-related quality of life was explored by additional questionnaires and reported in a companion article (Jedel et al. Scand J Pain. 2020. PubMed PMID: 32853174).

RESULTS

SSP subscales Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Verbal Trait Aggression differed between women with BMS and controls and the personality factor scores for Neuroticism and Aggressiveness were higher. Perceived stress measured by PSQ index was higher for women with BMS compared to controls. Women with BMS reported lower physical activity frequency compared to controls and those reporting physical activity <4 days/week scored higher on PSQ compared to those with weekly physical activity ≥4 days/week.

CONCLUSIONS

Personality distinguished women with BMS from controls in this study. Perceived stress was higher and weekly physical activity was lower in women with BMS compared to controls. Our findings suggest physical activity should be more comprehensively measured in future BMS studies and, by extension, physical activity may be a treatment option for women with BMS. Pain management aiming to restore function and mobility with stress reduction should be considered in clinical decision making for women with BMS who have a personality with stress susceptibility, especially if reporting high perceived stress and insufficient physical activity.