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Tanaka F, Mazzardo G, Salm DC, de Oliveira BH, Joaquim L, Machado RS, Cidreira T, Petronilho FC, Bittencourt EB, Bianco G, Bobinski F, Piovezan AP, Srbely JZ, Shah JP, Moré AOO, Mazzardo-Martins L, Martins DF. Peripheral Activation of Formyl Peptide Receptor 2/ALX by Electroacupuncture Alleviates Inflammatory Pain by Increasing Interleukin-10 Levels and Catalase Activity in Mice. Neuroscience 2023; 529:1-15. [PMID: 37572879 DOI: 10.1016/j.neuroscience.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
In the context of the electroacupuncture (EA) neurobiological mechanisms, we have previously demonstrated the involvement of formyl peptide receptor 2 (FPR2/ALX) in the antihyperalgesic effect of EA. The present study investigated the involvement of peripheral FPR2/ALX in the antihyperalgesic effect of EA on inflammatory cytokines levels, oxidative stress markers and antioxidant enzymes in an animal model of persistent inflammatory pain. Male Swiss mice underwent intraplantar (i.pl.) injection with complete Freund's adjuvant (CFA). Mechanical hyperalgesia was assessed with von Frey monofilaments. Animals were treated with EA (2/10 Hz, ST36-SP6, 20 minutes) for 4 consecutive days. From the first to the fourth day after CFA injection, animals received i.pl. WRW4 (FPR2/ALX antagonist) or saline before EA. Levels of inflammatory cytokines (TNF, IL-6, IL-4 and IL-10), antioxidant enzymes (catalase and superoxide dismutase), oxidative stress markers (TBARS, protein carbonyl, nitrite/nitrate ratio), and myeloperoxidase activity were measured in paw tissue samples. As previously demonstrated, i.pl. injection of the FPR2/ALX antagonist prevented the antihyperalgesic effect induced by EA. Furthermore, animals treated with EA showed higher levels of IL-10 and catalase activity in the inflamed paw, and these effects were prevented by the antagonist WRW4. EA did not change levels of TNF and IL-6, SOD and MPO activity, and oxidative stress markers. Our work demonstrates that the antihyperalgesic effect of EA on CFA-induced inflammatory pain could be partially associated with higher IL-10 levels and catalase activity, and that these effects may be dependent, at least in part, on the activation of peripheral FPR2/ALX.
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Affiliation(s)
- Fernanda Tanaka
- Postgraduate Program in Neuroscience, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Gustavo Mazzardo
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil; Faculty of Medicine, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Daiana C Salm
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Bruna H de Oliveira
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Larissa Joaquim
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes (NEUROIMet), Postgraduate Program in Health Science, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Richard S Machado
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes (NEUROIMet), Postgraduate Program in Health Science, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Thaina Cidreira
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes (NEUROIMet), Postgraduate Program in Health Science, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Fabrícia C Petronilho
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes (NEUROIMet), Postgraduate Program in Health Science, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
| | | | - Gianluca Bianco
- Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, Italy; Istituto di Formazione in Agopuntura e Neuromodulazione IFAN, Roma, Italy
| | - Franciane Bobinski
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Anna Paula Piovezan
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - John Z Srbely
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Jay P Shah
- Rehabilitation Medicine Department, National Institutes of Health, Rockville Pike, Bethesda, MD, USA
| | - Ari O O Moré
- Integrative Medicine and Acupuncture Service, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Leidiane Mazzardo-Martins
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Daniel F Martins
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil; Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.
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Linde LD, Bent LR, Dickey JP, Kumbhare DA, Srbely JZ. Exploring the effect of capsaicin-induced central sensitization on the upper limb nociceptive withdrawal reflex threshold. Exp Brain Res 2021; 239:3405-3415. [PMID: 34505162 DOI: 10.1007/s00221-021-06216-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
The nociceptive withdrawal reflex (NWR) threshold is commonly employed in the lower limb to assess clinical and experimentally induced pain. However, no studies to date have investigated changes in spinal nociception in the upper limb, via the NWR threshold, following experimentally induced central sensitization (CS). We tested the hypothesis that experimentally induced CS of the C5-C6 spinal segment significantly reduces NWR thresholds in muscles of the upper limb. Upper limb NWR thresholds from 20 young, healthy adults were assessed by applying noxious electrical stimuli to the right index finger and recording muscle activity from the biceps brachii (BI), triceps brachii (TRI), flexor carpi ulnaris (WF), and extensor carpi radialis longus (WE) muscles via surface electromyography. Topical cream (either 0.075% capsaicin, or control) was applied to the C5-C6 dermatome of the lateral forearm (50 cm2). NWR thresholds were compared at baseline, and four 10-min intervals after topical application. WF muscle NWR thresholds were significantly reduced in the capsaicin session compared to control, while TRI muscle NWR thresholds were significantly reduced 40 min after capsaicin application only (p < 0.05). There were no significant differences for BI or WE muscle NWR thresholds. We observed poor to moderate test-retest reliability for all upper limb NWR thresholds, a key contributor to the selective reduction in NWR thresholds among muscles. Accordingly, while our findings demonstrate some comparability to previously reported lower limb NWR studies, we concurrently report limitations of the upper limb NWR technique. Further exploration of optimal parameters for upper limb NWR acquisition is needed.
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Affiliation(s)
- Lukas D Linde
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
| | - Leah R Bent
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - James P Dickey
- School of Kinesiology, Western University, London, ON, Canada
| | - Dinesh A Kumbhare
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - John Z Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
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Duarte FCK, Zwambag DP, Brown SHM, Clark A, Hurtig M, Srbely JZ. Increased Substance P Immunoreactivity in Ipsilateral Knee Cartilage of Rats Exposed to Lumbar Spine Injury. Cartilage 2020; 11:251-261. [PMID: 30461296 PMCID: PMC7097978 DOI: 10.1177/1947603518812568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The present study aimed to investigate whether experimentally induced lumbar facet-joint OA lead to degenerative changes and enhanced SP expression within the ipsilateral neurosegmentally linked tibiofemoral cartilage. METHODS Adult male Sprague-Dawley rats were assigned to left side L5-L6 facet mechanical compression injury (surgery) (n = 6), L5-L6 facet exposure with no compression (sham) (n = 5), or naïve (no surgery) (n = 4) groups. The morphology of the tibiofemoral articular cartilage was assessed using a modified Mankin scoring system. Immunohistochemistry was used to examine the density of chondrocytes stained positive for SP (cells/cm2) in the ipsilateral tibiofemoral cartilage at 28 days postintervention. RESULTS Tibiofemoral cartilage in the surgery group showed consistent loss of superficial zone chondrocytes, mild roughening of the articular surface and occasional chondrocyte clusters as well as a greater density of SP mainly in the superficial cartilage zone compared with sham and naïve groups, although they also had a basic SP-expression. CONCLUSION Our results support the hypothesis that neurogenic mechanisms may mediate the spread of SP to neurosegmentally linked heterologous joints affecting the distal cartilage homeostasis. These findings contribute additional insight into the potential role of neurogenic inflammation with implications in the pathophysiology of chronic inflammatory joint disease and OA.
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Affiliation(s)
- Felipe C. K. Duarte
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Derek P. Zwambag
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Stephen H. M. Brown
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Andrea Clark
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Mark Hurtig
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - John Z. Srbely
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
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Linde LD, Srbely JZ. The Acute Effect of Skin Preheating on Capsaicin-Induced Central Sensitization in Humans. Pain Pract 2019; 19:811-820. [PMID: 31231923 DOI: 10.1111/papr.12811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/17/2019] [Accepted: 06/11/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Topical capsaicin is commonly employed to experimentally induce central sensitization (CS) in humans. While previous studies have investigated the effect of skin preheating on the sensitizing effect of capsaicin, no studies have compared the synergistic effect of skin preheating on the magnitude of sensitization via topical capsaicin within the first 30 minutes of application. We tested the hypothesis that skin preheating potentiates the sensitizing effect of topical capsaicin by evoking a larger region of secondary hyperalgesia vs. topical capsaicin alone. METHODS Twenty young, healthy subjects each received topical capsaicin (Zostrix HP 0.075%) only (CAP), topical capsaicin with preheating (CAP + HEAT), and topical nonsensitizing placebo cream (CON) in a crossover design. Capsaicin and placebo creams were applied to a 50 cm2 area of the dorsal forearm. The CAP + HEAT session also included a 10-minute preheating session. Regions of secondary hyperalgesia were assessed using mechanical brush allodynia testing, and skin temperature was assessed via infrared thermography. Outcomes were normalized to baseline and compared at 10, 20, and 30 minutes after cream application. RESULTS The CAP + HEAT session led to a significantly larger area of secondary hyperalgesia compared to the CAP session as measured by brush allodynia (CON: 0 ± 0 cm; CAP: 2.08 ± 0.45 cm; CAP + HEAT: 3.70 ± 0.46 cm; P < 0.05) and skin temperature (CON: -2.92% ± 0.03%; CAP: -0.63% ± 0.09%; CAP + HEAT: 2.50% ± 0.11%; ( of baseline) P < 0.05). CONCLUSION Preheating amplifies the sensitizing effect of topical capsaicin within 30 minutes of application. The heat-capsaicin technique may be employed to assess differing magnitudes of CS induction and enables future studies investigating the development and progression of CS in humans.
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Affiliation(s)
- Lukas D Linde
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - John Z Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Duarte FCK, Hurtig M, Clark A, Simpson J, Srbely JZ. Association between naturally occurring spine osteoarthritis in geriatric rats and neurogenic inflammation within neurosegmentally linked skeletal muscle. Exp Gerontol 2019; 118:31-38. [PMID: 30615897 DOI: 10.1016/j.exger.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between naturally occurring spinal osteoarthritis (OA) (L3-L5), the expression of substance P (SP) centrally (L4-L5) and the presence of neurogenic inflammation within the neurosegmentally linked quadriceps (L2-L5) in elderly rats versus young controls. DESIGN Eight aged (27 ± 3.2 months) and six young (4 ± 0.0 months) male Wistar Kyoto rats were euthanized and submitted to micro-computerized tomography for determination of spine OA. SP expression (% area) at the dorsal horn of the spinal cord as well as the relative expression of SP and protease-activated receptor 2 (PAR2) to alpha-tubulin within quadriceps muscle were determined by immunohistochemistry and Western Blot. RESULTS Spine osteoarthritis was confirmed in all aged rats but no young controls. Aged rats expressed significant increase of SP protein expression within the dorsal horn (MD = 0.086; 95% CI [0.026 to 0.145]; p = 0.0094) and quadriceps (MD = 1.209; 95% CI [0.239 to 2.179]; p = 0.0191) and PAR2 (MD = 0.797; 95% CI [0.160 to 1.435]; p = 0.0187) compared to young controls. CONCLUSION These observations provide novel insight into the potential role of neurogenic inflammation in the pathophysiology of myofascial pain syndrome in the naturally occurring spinal OA in elderly population.
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Affiliation(s)
- Felipe C K Duarte
- Department of Human Health and Nutritional Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
| | - Mark Hurtig
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 McGilvray Lane, Guelph, ON N1G 2W1, Canada.
| | - Andrea Clark
- Department of Human Health and Nutritional Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
| | - Jeremy Simpson
- Department of Human Health and Nutritional Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
| | - John Z Srbely
- Department of Human Health and Nutritional Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
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Linde LD, Kumbhare DA, Joshi M, Srbely JZ. The Relationship between Rate of Algometer Application and Pain Pressure Threshold in the Assessment of Myofascial Trigger Point Sensitivity. Pain Pract 2017; 18:224-229. [DOI: 10.1111/papr.12597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Lukas D. Linde
- Department of Human Health and Nutritional Sciences; University of Guelph; Guelph Ontario Canada
| | - Dinesh A. Kumbhare
- Department of Medicine; Division of Physical Medicine and Rehabilitation; Toronto Rehabilitation Institute; University of Toronto; Toronto Ontario Canada
| | - Maneil Joshi
- School of Human Kinetics; University of Ottawa; Ottawa Ontario Canada
| | - John Z. Srbely
- Department of Human Health and Nutritional Sciences; University of Guelph; Guelph Ontario Canada
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Srbely JZ, Kumbhare D, Grosman-Rimon L. A narrative review of new trends in the diagnosis of myofascial trigger points: diagnostic ultrasound imaging and biomarkers. J Can Chiropr Assoc 2016; 60:220-225. [PMID: 27713577 PMCID: PMC5039775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Myofascial pain syndrome (MPS) is one of the most common conditions of chronic musculoskeletal pain encountered by primary healthcare practitioners on a daily basis. It is generally accepted amongst the broad profile of healthcare practitioners treating MPS that the presence of discrete, palpable and tender nodules within the muscle, known as myofascial trigger points (MTrP), is necessary to confirm the diagnosis of MPS. Manual palpation is currently the most common technique used to detect MTrP, however, previous research has shown that the reliability of manual palpation for detecting MTrP is poor, and in our opinion unacceptably poor, leading to inconsistent diagnosis of MPS and poor patient outcomes. There are currently no objective accepted diagnostic criteria for the clinical detection of MTrP, nor are there standardized diagnostic criteria for MPS. Two promising areas of research with potential for enhancing the diagnosis of MPS include the use of diagnostic ultrasound and biomarkers. Further research is needed to advance the development of composite diagnostic criteria employing ultrasound imaging, biomarker assessments and physical assessment to enhance the accuracy and objectivity of MTrP detection and diagnosis of chronic MPS disorder.
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Affiliation(s)
- John Z Srbely
- Department of Human Health and Nutritional Science, University of Guelph
| | - Dinesh Kumbhare
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto
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Srbely JZ, Dickey JP. Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy? Clin Rehabil 2016; 21:411-7. [PMID: 17613561 DOI: 10.1177/0269215507073342] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective : To investigate whether therapeutic ultrasound modulates the pain sensitivity of myofascial trigger points. Design : Repeated measures, single-blinded randomized controlled trial of ultrasound treatment of trigger points. Setting : Outpatient injury rehabilitation clinic. Subjects : Forty-four patients (22 males, 22 females) with trigger points identified within the trapezius muscle. Interventions : Five-minute therapeutic intensity of ultrasound versus 5-min low-intensity application of ultrasound to a trapezius myofascial trigger point locus. Main measures : Pain pressure threshold readings were measured at the trapezius trigger point site before and after exposure to the ultrasound intervention. Results : Pain pressure threshold scores increased an average of 44.4 (14.2)% after therapeutic exposure to ultrasound (pre-ultrasound test 35.4 (8.5) N, post-ultrasound test 51.1 (12.8) N). No significant difference in pain pressure threshold scores was observed with low-intensity ultrasound exposures (pre-ultrasound 36.1 (6.1) N, post-ultrasound 36.6 (4.8) N). Conclusions : Therapeutic exposures to ultrasound reduce short-term trigger point sensitivity. Ultrasound may be a useful clinical tool for the treatment and management of trigger points and myofascial pain syndromes.
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Affiliation(s)
- John Z Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.
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Maracle EC, Hung LY, Fell SI, Osmond MR, Brown SHM, Srbely JZ. A Comparison of the Sensitivity of Brush Allodynia and Semmes-Weinstein Monofilament Testing in the Detection of Allodynia Within Regions of Secondary Hyperalgesia in Humans. Pain Pract 2016; 17:16-24. [PMID: 26936430 DOI: 10.1111/papr.12418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/22/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Two of the most common Quantitative Sensory Techniques (QST) employed to detect allodynia include mechanical brush allodynia and Semmes-Weinstein monofilaments. However, their relative sensitivity at detecting allodynia is poorly understood. The purpose of this study was to compare the sensitivity of brush allodynia against Semmes-Weinstein monofilament technique for detecting allodynia within regions of secondary hyperalgesia in humans. METHODS Twenty subjects (10 males, 10 females; 21.1 ± 0.9 years) were recruited and randomly allocated to allodynia or monofilament groups. Topical capsaicin (Zostrix 0.075%) was applied to a target region defined by C4-C7 dermatomes. Allodynia testing was performed at 0- (baseline) and 10 minutes postcapsaicin. The Semmes-Weinstein group assessed changes in skin sensitivity 8 cm inferior to target region and 2 cm lateral to the spinous process, while brush allodynia was employed to detect the point inferior to the target region where subjects reported changes in skin sensitivity. The distance (cm) from this point to the inferior border of the target region was termed the Allodynia Score. RESULTS Statistically significant increases in the Allodynia Score were observed at 10 minutes postcapsaicin compared to baseline (P < 0.001). No differences in monofilament scores were observed between 10 minutes postcapsaicin and baseline (P = 0.125). Brush allodynia also demonstrated superior sensitivity, detecting allodynia in 100% of cases compared to 60% in the Semmes-Weinstein group. CONCLUSION Brush allodynia is more sensitive than Semmes-Weinstein monofilaments for detecting mechanical allodynia in regions of secondary hyperalgesia. Brush allodynia may be preferred over Semmes-Weinstein monofilaments for clinical applications requiring reliable detection of allodynia.
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Affiliation(s)
- Emmalee C Maracle
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Laurie Y Hung
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Sabrina I Fell
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Michael R Osmond
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Stephen H M Brown
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - John Z Srbely
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Huntley AH, Srbely JZ, Zettel JL. Experimentally induced central sensitization in the cervical spine evokes postural stiffening strategies in healthy young adults. Gait Posture 2015; 41:652-7. [PMID: 25670652 DOI: 10.1016/j.gaitpost.2015.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/26/2014] [Accepted: 01/16/2015] [Indexed: 02/07/2023]
Abstract
Dysequilibrium of cervicogenic origin can result from pain and injury to cervical paraspinal tissues post-whiplash; however, the specific physiological mechanisms still remain unclear. Central sensitization is a neuradaptive process which has been clinically associated with conditions of chronic pain and hypersensitivity. Strong links have been demonstrated between pain hypersensitivity and postural deficits post-whiplash; however, the precise mechanisms are still poorly understood. The purpose of this study was to explore the mechanisms of cervicogenic disequilibrium by investigating the effect of experimentally induced central sensitization in the cervical spine on postural stability in young healthy adults. Sixteen healthy young adults (7 males (22.6±1.13 years) and 9 females (22±2.69 years)) performed 30-s full-tandem stance trials on an AMTI force plate under normal and centrally sensitized conditions. The primary outcome variables included the standard deviation of the center of pressure (COP) position in medio-lateral (M-L) and antero-posterior (A-P) directions; sway range of the COP in M-L and A-P directions and the mean power frequency (MPF) of the COP and horizontal ground shear forces. Variability and sway range of the COP decreased with experimental induction of central sensitization, accompanied by an increase in MPF of COP displacement in both M-L and A-P directions, suggesting an increase in postural stiffening post-sensitization versus non-sensitized controls. Future studies need to further explore this relationship in clinical (whiplash, chronic pain) populations.
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Affiliation(s)
- Andrew H Huntley
- Human Health and Nutritional Sciences, University of Guelph, Canada.
| | - John Z Srbely
- Human Health and Nutritional Sciences, University of Guelph, Canada
| | - John L Zettel
- Human Health and Nutritional Sciences, University of Guelph, Canada
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Srbely JZ, Vernon H, Lee D, Polgar M. Immediate Effects of Spinal Manipulative Therapy on Regional Antinociceptive Effects in Myofascial Tissues in Healthy Young Adults. J Manipulative Physiol Ther 2013; 36:333-41. [DOI: 10.1016/j.jmpt.2013.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 01/15/2013] [Accepted: 01/15/2013] [Indexed: 10/26/2022]
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Srbely JZ, Dickey JP, Lee D, Lowerison M. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med 2010; 42:463-8. [PMID: 20544158 DOI: 10.2340/16501977-0535] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To test the hypothesis that dry needle stimulation of a myofascial trigger point (sensitive locus) evokes segmental anti-nociceptive effects. DESIGN Double-blind randomized controlled trial. SUBJECTS Forty subjects (21 males, 19 females). METHODS Test subjects received intramuscular dry needle puncture to a right supraspinatus trigger point (C4,5); controls received sham intramuscular dry needle puncture. Pain pressure threshold (PPT) readings were recorded from right infraspinatus (C5,6) and right gluteus medius (L4,5S1) trigger points at 0 (pre-needling baseline), 1, 3, 5, 10 and 15 min post-needling and normalized to baseline values. The supraspinatus and infraspinatus trigger points are neurologically linked at C5; the supraspinatus and gluteus medius are segmentally unrelated. The difference between the infraspinatus and gluteus medius PPT values (PPTseg) represents a direct measure of the segmental anti-nociceptive effects acting at the infraspinatus trigger point. RESULTS Significant increases in PPTseg were observed in test subjects at 3 (p = 0.002) and 5 (p = 0.015) min post-needling, compared with controls. CONCLUSION One intervention of dry needle stimulation to a single trigger point (sensitive locus) evokes short-term segmental anti-nociceptive effects. These results suggest that trigger point (sensitive locus) stimulation may evoke anti-nociceptive effects by modulating segmental mechanisms, which may be an important consideration in the management of myofascial pain.
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Affiliation(s)
- John Z Srbely
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, N1G 2W1 , Canada.
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Srbely JZ, Dickey JP, Bent LR, Lee D, Lowerison M. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. J Pain 2009; 11:636-43. [PMID: 20015704 DOI: 10.1016/j.jpain.2009.10.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 09/22/2009] [Accepted: 10/02/2009] [Indexed: 12/19/2022]
Abstract
UNLABELLED This study investigated whether inducing central sensitization evokes segmental increases in trigger point pressure sensitivity. We evoked central sensitization at the C(5) segment and validated its presence via mechanical cutaneous sensitivity (brush allodynia) testing. Trigger point pressure sensitivity was quantified using the pain pressure threshold (PPT) value. A 50 cm(2) area of the C(5) dermatome at the right lateral elbow was pretreated with 45 degrees heat for 10 minutes. Test subjects (n = 20) then received topical capsaicin cream (0.075%; Medicis, Toronto, Canada) to the C(5) dermatome, whereas control subjects (n = 20) received a topical placebo cream (Biotherm Massage, Montreal, Canada). PPT readings were recorded from the infraspinatus (C(5,6)) and gluteus medius (L(4,5)S(1)) trigger points at zero (pre-intervention), 10, 20, and 30 minutes after intervention; all PPT readings were normalized to pre-intervention (baseline) values. The difference between the PPT readings at the 2 trigger point sites represents the direct influence of segmental mechanisms on the trigger point sensitivity at the infraspinatus site (PPT(seg)). Test subjects demonstrated statistically significant increases in Total Allodynia scores and significant decreases in PPT(seg) at 10, 20, and 30 minutes after application, when compared with control subjects. These results demonstrate that increases in central sensitization evoke increases in trigger point pressure sensitivity in segmentally related muscles. PERSPECTIVE Myofascial pain is the most common form of musculoskeletal pain. Myofascial trigger points play an important role in the clinical manifestation of myofascial pain syndrome. Elucidating the role of central sensitization in the pathophysiology of trigger points is fundamental to developing optimal strategies in the management of myofascial pain syndrome.
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Affiliation(s)
- John Z Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.
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Srbely JZ, Dickey JP, Lowerison M, Edwards MA, Nolet PS, Wong LL. Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain 2008; 139:260-266. [PMID: 18508198 DOI: 10.1016/j.pain.2008.04.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 03/28/2008] [Accepted: 04/15/2008] [Indexed: 10/22/2022]
Abstract
Musculoskeletal pain affects a significant proportion of the general population. The myofascial trigger point is recognized as a key factor in the pathophysiology of musculoskeletal pain. Ultrasound is commonly employed in the treatment and management of soft tissue pain and, in this study, we set out to investigate the segmental antinociceptive effect of ultrasound. Subjects (n=50) with identifiable myofascial trigger points in the supraspinatus, infraspinatus and gluteus medius muscles were selected from an outpatient rehabilitation clinic and randomly assigned to test or control groups. Test subjects received a therapeutic dose of ultrasound to the right supraspinatus trigger point while control groups received a sham (null) exposure. Baseline pain pressure threshold (PPT) readings were recorded at the ipsilateral infraspinatus and gluteus medius trigger-point sites prior to ultrasound exposure. The infraspinatus point was chosen due to its segmental neurologic link with the supraspinatus point; the gluteus medius acted as a segmental control point. Following the ultrasound intervention, PPT readings were recorded at 1, 3, 5, 10 and 15 min intervals at both infraspinatus and gluteus medius trigger points; the difference between infraspinatus and gluteus medius PPT values, PPT seg, represents the segmental influence on the PPT. The ultrasound test group demonstrated statistically significant increases in PPT seg (decreased infraspinatus sensitivity) at 1, 3 and 5 min, when compared with PPT seg in the sham ultrasound group. These results establish that low-dose ultrasound evokes short-term segmental antinociceptive effects on trigger points which may have applications in the management of musculoskeletal pain.
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Affiliation(s)
- John Z Srbely
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ont., Canada N1G 2W1 Centre for the Genetic Improvement of Livestock, University of Guelph, Guelph, Ont., Canada N1G 2W1 Academic Services, University of Guelph, Guelph, Ont., Canada N1G 2W1 Church Lane Rehabilitation Clinic, Guelph, Ont., Canada N1H 2W6 Biomedical Sciences, University of Guelph, Guelph, Ont., Canada N1G 2W1
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Srbely JZ. Ultrasound in the management of osteoarthritis: part I: a review of the current literature. J Can Chiropr Assoc 2008; 52:30-37. [PMID: 18327300 PMCID: PMC2258240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Ultrasound has been widely used in clinical settings for the management of various ailments but many authors still question its efficacy. An accumulating body of literature demonstrates that ultrasound evokes a broad spectrum of bioeffects which may be therapeutically beneficial in the management of a variety of clinical conditions. OBJECTIVE A critical review the current research investigating the use of therapeutic ultrasound in the treatment and/or management of osteoarthritis. Specific emphasis is placed on interpreting the literature in the context of its strengths and weaknesses, with particular attention placed on study protocols and technical parameters used in the trials. Relevant basic science is also introduced and meaningful inter-study comparisons are highlighted with suggestions for future research. DESIGN Literature Review. METHODS A Pubmed search of the literature was performed from 1985 to present using the key words "ultrasound" and "osteoarthritis" retrieved a total of 313 publications. Experimental, clinical and animal studies that directly assessed applications of therapeutic ultrasound in the clinical management of osteoarthritis and/or its underlying physiologic mechanisms were accepted. Studies that evaluated ultrasound in combination with other modalities were accepted but their conclusions were interpreted in the context of their methodological strengths and limitations. RESULTS A total of 17 articles met our search criteria; one study was excluded due to poor methodology. Of a total of five review papers, two concluded that ultrasound had positive therapeutic effects, two did not demonstrate any benefit and one was inconclusive. The remaining nine studies consistently reported that ultrasound has therapeutically beneficial effects on pain and functional outcomes. Five studies reported that ultrasound has positive cartilage healing properties and one experimental study demonstrated increased intra-articular absorption of high molecular weight molecules (hyaluronan) using ultrasound phonophoresis. Only one randomized controlled trial reported no effect on pain or active range of motion when ultrasound is used in combination with exercise. CONCLUSIONS Ultrasound demonstrates the ability to evoke a broad range of therapeutically beneficial effects which may provide safe and effective applications in the management of osteoarthritis.
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Affiliation(s)
- John Z Srbely
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada.
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