How does physical activity modulate pain?

Do people with unilateral mid-portion Achilles tendinopathy who participate in running-related physical activity exhibit a meaningful conditioned pain modulation (CPM) effect: a pilot study

OBJECTIVES

Our primary objective was to report the presence of a conditioned pain modulation (CPM) effect in people with localised mid-portion Achilles tendinopathy and whether changes occur over a 12-week period. Our secondary objectives were to quantify the proportion of participants who present for tendinopathy research with previous interventions or co-morbidities, which may impact the CPM-effect and investigate modulating factors.

DESIGN

Prospective, observational cohort pilot study.

METHOD

215 participants presented for this Achilles tendinopathy research and were screened for inclusion with nine being included. Included participants had the CPM-effect (cold-pressor test) assessed using pressure pain thresholds at the Achilles tendon and quantified as absolute, relative and meaningful change at baseline and 12-week follow-up.

RESULTS

The most common reasons for exclusion were failure to meet a load-related diagnosis for Achilles tendinopathy (15.5%), presence of confounding other injury (14.1%) and previous injection therapy (13.6%). All participants had a meaningful CPM-effect at baseline and 12-week follow-up. The mean (SD, n) baseline relative CPM effect (reduction in PPTs) was -40.5 (32.7, 9) percent. Moderators of the CPM-effect as well as follow-up changes were not statistically analysed due to a small sample size.

CONCLUSION

Based on these data, we would suggest that a homogenous population of patients with chronic, unilateral mid-portion Achilles tendinopathy and no other co-morbidities are likely to exhibit a meaningful CPM-effect. Impairments to endogenous analgesic mechanisms seen in people presenting with mid-portion Achilles tendinopathy may be due to other confounding variables.

Musculoskeletal pain and its relation to individual and work-related factors: a cross-sectional study among Turkish office workers who work using computers

Objective. Office workers are commonly exposed to work-related musculoskeletal pain. This study investigated the individual and work-related risk factors linked to musculoskeletal pain and pain-related disability among Turkish office workers who work using computers. Methods. One-hundred and fifty office workers were included. Data were collected using an online survey with a combination of the Nordic musculoskeletal questionnaire, Oswestry disability index (ODI), neck disability index (NDI) and disabilities of the arm, shoulder, and hand questionnaire short-form (Q-DASH). The participants were divided into four subgroups: no pain (n = 26), lower back pain (n = 37), neck pain (n = 49) and upper-extremity pain (n = 38). Results. There were differences between subgroups in terms of the condition that feet touch the floor and the condition that the keyboard, mouse and wrist are in a straight line (p = 0.013 and p = 0.025, respectively). Working years was correlated with the ODI score (ρ = 0.802, p = 0.041). There was also a significant correlation between the NDI score and working hours (ρ = 0.415, p = 0.003), while Q-DASH was correlated with body mass index and working years (ρ = 0.406, p = 0.014, and ρ = 0.327, p = 0.043, respectively). Conclusions. Pain-related disability was associated with various risk factors such as physical inactivity, body mass index, working hours, working years and workplace ergonomics in the office workers.

A training program for fibromyalgia management: A 5-year pilot study

We studied the effects of a specific cardio training program lasting 5 years on pain and quality of life in fibromyalgia patients.

Physical exercise and chronic pain in university students

Background

Physical inactivity and chronic pain are both major public health concerns worldwide. Although the health benefits of regular physical exercise are well-documented, few large epidemiological studies have investigated the association between specific domains of physical exercise and chronic pain in young adults. We sought to investigate the association between frequency, intensity and duration of physical exercise, and chronic pain.

Methods

Data stem from the SHoT2018-study, a national health survey for higher education in Norway, in which 36,625 fulltime students aged 18–35 years completed all relevant questionnaires. Chronic pain, defined according to the International Classification of Diseases 11th Revision (ICD-11), was assessed with a newly developed hierarchical digital instrument for reporting both distribution and characteristics of pain in predefined body regions. Physical exercise was assessed using three sets of questions, measuring the number of times exercising each week, and the average intensity and the number of hours each time.

Results

The majority (54%) of the students reported chronic pain in at least one location, and the prevalence was especially high among women. The overall pattern was an inverse dose-response association between exercise and chronic pain: the more frequent, harder or longer the physical exercise, the lower the risk of chronic pain. Similar findings were generally also observed for the number of pain locations: frequent exercise was associated with fewer pain locations. Adjusting for demographical, lifestyle factors and depression had little effect on the magnitude of the associations.

Conclusion

Given the many health benefits of regular exercise, there is much to be gained in facilitating college and university students to be more physically active, ideally, thru a joint responsibility between political and educational institutions. Due to the cross-sectional nature of the study, one should be careful to draw a firm conclusion about the direction of causality.

Differences in pain, fatigue, and quality of life in patients with chronic venous insufficiency based on physical activity level

Background

This study aims to compare the effect of different physical activity levels on pain, fatigue, and quality of life in patients with chronic venous insufficiency.

Methods

Between October 2018 and February 2019, a total of 69 patients (4 males, 65 females; mean age 50 years; range, 19 to 73 years) who were diagnosed with chronic venous insufficiency and consulted for physiotherapy were included in the study. The physical activity level of the patients was determined using the International Physical Activity Questionnaire in three groups as light, moderate, or vigorous. Fatigue, pain, and QoL were assessed using the Fatigue Severity Scale, visual analog scale (during the night, activity, and rest), and Venous Insufficiency Epidemiological and Economic Study Quality/Symptom Scale, respectively.

Results

Of a total of 69 patients, 17 were in the light-intensity physical activity group, 32 in the moderate-intensity physical activity group, and 20 in the vigorous-intensity physical activity group. Perceived pain during activity and fatigue were significantly different between the light- and moderate-intensity physical activity groups (p<0.05). There was no significant difference in pain, fatigue, and quality of life scores between the vigorous-intensity physical activity group and the other two groups (p>0.05).

Conclusion

Our study results suggest that a moderate level of physical activity may be helpful to overcome symptoms such as pain and fatigue in patients with chronic venous insufficiency and to improve quality of life.

State of the art: What have the pain sciences brought to physiotherapy?

Background

Pain is the most common reason for patients to seek help from a health care professional. In the past few decades, research has yielded gains in the Pain Sciences - multiple fields of scientific research that, when integrated, help to clarify what causes and influences human pain.

Objectives

In this article, we discuss the key areas in which the Pain Sciences have shifted the physiotherapy profession.

Method

A narrative review of the Pain Sciences literature was conducted. The review analyses how the Pain Sciences have influenced physiotherapy in several categories: assessment; clinical reasoning; treatment; research rigor and building the profile of the profession.

Results

Scientific research on pain has largely converged in support of three ‘game-changing’ concepts that have shifted the physiotherapy profession’s understanding and treatment of pain: (1) pain is not a signal originating from bodily tissues, (2) pain is not an accurate measure of tissue damage and (3) the plasticity of the nervous system means the nervous system itself is a viable target of treatment. These three concepts have influenced physiotherapy assessment and treatment approaches, and research design to consider pain mechanisms using patient-centred models.

Conclusion

The Pain Sciences have shifted physiotherapists’ assessment and treatment approaches and shifted the status of the physiotherapy profession. Ultimately the Pain Sciences have embedded interdisciplinary teams and expanded physiotherapy practice.

Clinical implications

We believe that the pain sciences should be embedded in undergraduate and postgraduate education and training of physiotherapists (including the three key concepts regarding pain) to benefit physiotherapists and their patients.

Neuropathic pain after spinal cord injury and physical exercise in animal models: A systematic review and meta-analysis

The aim of this systematic review was to summarize the effects of physical exercise on neuropathic pain (NP) in animal models of SCI. The search was conducted in Medline and Science Direct to identify experimental preclinical studies involving animal models of SCI, physical exercise as an intervention and the assessment of NP. Fifteen articles met the eligibility criteria. The review shows that in studies of NP involving animal models of SCI, rodents are the most common species. Thoracic contusion is the most common injury and mechanical and thermal nociception are the most frequently assessed NP components. The benefits of physical exercise vary according to its starting period and total duration. In addition, there is considerable heterogeneity regarding the type and intensity of exercise capable of alleviating NP after SCI. Furthermore, physical exercise has beneficial effects on mechanical, thermal and cold nociception, and spontaneous pain. These results are weakened by the paucity of studies involving these pain outcomes. The review protocol is published for free access on the SyRF platform (http://syrf.org.uk/protocols/).

Sedentary behaviour facilitates conditioned pain modulation in middle-aged and older adults with persistent musculoskeletal pain: a cross-sectional investigation

INTRODUCTION

Higher physical activity (PA) and lower sedentary behaviour (SB) levels have demonstrated beneficial effects on temporal summation (TS) and conditioned pain modulation (CPM) in healthy adults. This cross-sectional study investigated the relationships between PA and SB and TS/CPM responses in individuals with chronic musculoskeletal pain.

METHODS

Sixty-seven middle-aged and older adults with chronic musculoskeletal pain were recruited from the community. Questionnaires measuring demographics, pain, and psychological measures were completed. Physical activity/SB levels were measured using the International Physical Activity Questionnaire-short form and Sedentary Behaviour Questionnaire, respectively. Semmes monofilament was used to assess mechanical TS (MTS) at the most symptomatic (MTS-S) and a reference region (MTS-R); change in the pain scores (baseline-10th application) was used for analysis. Conditioned pain modulation procedure involved suprathreshold pressure pain threshold (PPT-pain4) administered before and after (CPM30sec, CPM60sec, and CPM90sec) conditioning stimulus (2 minutes; ∼12°C cold bath immersion). For analysis, PPT-pain4 (%) change scores were used.

RESULTS

PPT-pain4 (%) change scores at CPM30sec and CPM60sec demonstrated significant weak positive correlations with SB levels and weak negative correlations with PA measures. After adjusting for confounding variables, a significant positive association was found between SB (h/d) and PPT-pain4 (%) change scores at CPM30sec and CPM60sec. No significant associations between MTS and PA/SB measures.

CONCLUSION

Sedentariness is associated with higher pain inhibitory capacity in people with chronic musculoskeletal pain. The observed relationship may be characteristic of a protective (sedentary) behaviour to enhance pain modulatory mechanism. Prospective longitudinal studies using objective PA/SB measures are required to validate the observed relationship in a larger sample size.

Stable prevalence of chronic back disorders across gender, age, residence, and physical activity in Canadian adults from 2007 to 2014

BACKGROUND

Chronic back disorders (CBD) are a global health problem and the leading cause of years lived with disability. The present study aims to examine overall and specific trends in CBD in the Canadian population aged 18 to 65 years.

METHODS

Data from the Canadian Community Health Survey (CCHS), a cross-sectional study, from 2007 to 2014 (8 cycles) were used to calculate CBD prevalence across gender, age, geographical area (urban/rural and ten provinces and northern territories), and physical activity levels. CBD was defined in the CCHS as having back problems, excluding fibromyalgia and arthritis, which have lasted or are expected to last six months or more and that have been diagnosed by a health professional. Prevalence of CBD using survey weights and associated 95% confidence intervals (95% CI) were calculated yearly using balanced repeated replications technique. Trend tests were calculated using joinpoint regressions; ArcGIS software was used for mapping.

RESULTS

Age-standardized CBD prevalence in 2007 and 2014 were 18.9% (95% CI = 18.4;19.5) and 17.8% (95% CI = 17.2,18.4), respectively. CBD prevalence was consistently higher in women, older age groups, rural dwellers, and people classified as inactive. Crude and age-standardized CBD prevalence decreased faster in people classified as physically active compared to those who were inactive (p < 0.006). Although CBD slightly decreased over time, no statistically significant trends were found overall or by gender, area of residence, province or level of physical activity. The prevalence of CBD remained consistently high in the province of Nova Scotia, and consistently low in the province of Quebec over the eight CCHS cycles.

CONCLUSION

Despite prevention efforts, such as the Canadian back pain mass media campaign, CBD prevalence has remained stable between 2007 and 2014. Tailored prevention and management of CBD should consider gender, age, and geographical differences. Further longitudinal studies could elucidate the temporal relationship between potentially modifiable risk factors such as physical activity and CBD.

Impact of a specific training programme on the neuromodulation of pain in female patient with fibromyalgia (DouFiSport): a 24-month, controlled, randomised, double-blind protocol

INTRODUCTION

The main symptom of fibromyalgia (FM) is diffuse pain. There is currently no aetiological treatment for FM. However, all pain associations and best practice guidelines strongly advocate the practice of aerobic physical activity to improve the symptoms of FM subjects. The mechanisms of dysfunctional pain are mostly central and related to stress axis dysfunction (autonomic nervous system and corticotropic axis). Our main objective is to assess the efficacy of a specific training programme on endogenous pain control mechanisms in female patients with FM. Further aims include rebalancing the autonomic neurovegetative system, improving quality of life and sleep quality, and reintegrating patients into society and work.

METHODS AND ANALYSIS

110 female patients with FM diagnosed on American College of Rheumatology 2010 criteria, aged 18-65 years and meeting inclusion conditions will be recruited and randomised into two groups (active and semiactive). The training programme will consist of three 45 min sessions per week of supervised, individualised physical activity over 2 years. Only the intensity of the exercises will differ between the two groups (moderate intensity vs low intensity).All outcome measures will be conducted at baseline (T0), after 6-9 months of training (T6-9) and after 24 months of training (T24). The primary endpoint will be an improvement of pain modulation (activation of diffuse noxious inhibitory control) evaluated by the stimulation test. The secondary endpoint will be relief of pain, anxiety, depression, stress, sleep disorders, pain impact on life quality, and improved heart rate, blood pressure and salivary cortisol.

ETHICS AND DISSEMINATION

This study is approved by the Committee for the Protection of Persons West VI. The results will be published in specialised scientific journals and will be presented at scientific meetings on pain and/or physical activity.

TRIAL REGISTRATION NUMBER

NCT02486965; Pre-results.

Psychosoziale Risikofaktoren in der Entstehung von chronisch unspezifischen Rückenschmerzen

Zusammenfassung. Chronisch unspezifische Rückenschmerzen (CURS) gehören international zu den häufigsten Schmerzphänomenen und können für Athletinnen und Athleten karrierelimitierend sein. Knapp ein Drittel der jährlichen Trainingsausfallzeiten werden auf CURS zurückgeführt. In der Entstehung von chronischen Schmerzen ist ein multifaktorielles Ätiologiemodell mit einem signifikanten Einfluss psychosozialer Risikofaktoren evident. Obwohl dies in der Allgemeinbevölkerung bereits gut erforscht ist, gibt es in der Sportwissenschaft vergleichsweise wenige Arbeiten darüber. Dieses Thema wird daher in drei Multicenterstudien und zahlreichen Teilstudien des MiSpEx-Netzwerks ( Medicine in Spine-Exercise-Network, Förderzeitraum 2011 – 2018) aufgegriffen. Entsprechend der Empfehlung einer frühzeitigen Diagnostik von Chronifizierungsfaktoren in der „Nationalen Versorgungsleitlinie Kreuzschmerz“, beschäftigt sich das Netzwerk u. a. mit der Überprüfung, Entwicklung und Evaluation diagnostischer Möglichkeiten. Der vorliegende Beitrag beschreibt die Entwicklung einer Diagnostik von psychosozialen Risikofaktoren, die einerseits eine Einschätzung des Risikos der Entwicklung von CURS und andererseits eine individuelle Zuweisung zu (Trainings)Interventionen erlaubt. Es wird die Entwicklungsrationale beschrieben und dabei verschiedene methodische Herangehensweisen und Entscheidungssequenzen reflektiert.