Observing neck movements evokes an excitatory response in the sympathetic nervous system associated with fear of movement in patients with chronic neck pain

Abstract

The objective of this study was to evaluate the response of the sympathetic-excitatory nervous system in patients with chronic neck pain compared with a control group of asymptomatic subjects who underwent an intervention of watching activities involving movements in the neck region. Thirty participants were divided into two groups: patients with chronic neck pain (n?=?15) and the control group (n?=?15). The patients’ neck disability, fear of movement and catastrophism were assessed with a self-report. The recorded variables related to the autonomic nervous system were skin conductance and skin temperature. The ANOVA test revealed significant differences in the increase in skin conductance in the chronic neck pain group after observing the activities (both in the photographs and video) at the end of the observation and 5?minutes after the intervention (p?<?.01; d?>?0.80). There were no significant differences in skin temperature. Ultimately, the correlation analysis revealed a moderate positive correlation between kinesiophobia and skin conductance at 30?seconds (r?=?0.53) and at 60?seconds (r?=?0.52) of observing the activities in the video for the chronic neck pain group. Based on the results of the present study, we suggest that observing activities involving neck movements causes an activation of the sympathetic-excitatory nervous system in patients with chronic neck pain. These changes could be related to a fear of movement when faced with visual exposure to neck movements that could be interpreted as ‘harmful’ or ‘dangerous’.     

Seasonality of dizziness and vertigo in a tropical region

Vertigo and dizziness are among the most common medical complaints in the emergency room, and are associated with a considerable personal and health care burden. Scarce and conflicting reports indicate those symptoms may present a seasonal distribution. This study aimed at investigating the existence of a seasonal distribution of vertigo/dizziness in a tropical region, and the correlations of these findings with climatic variables. The charts of all patients consecutively admitted between 2009 and 2012 in the emergency room of a Brazilian general hospital were reviewed. A total of 4920 cases containing these terms were sorted from a sample of 276?076 emergency records. Seasonality was assessed using Cosinor Analysis. Pearson's correlations were performed between the incidence of consultations, considering separately dizziness and vertigo and each of the predictor climatic variables of that index month. Significant seasonal patterns were observed for dizziness and vertigo in the emergency room. Vertigo was more frequent in late winter–spring, negatively correlating to humidity (r?=??0.374; p?=?0.013) and rainfall (r?=??0.334; p?=?0.020). Dizziness peaked on summer months, and positively correlated to average temperatures (r?=?0.520; p?<?0.001) and rainfall (r?=?0.297; p?=?0.040), but negatively to atmospheric pressure (r?=??0.424; p?=?0.003). The different seasonal patterns evidenced for dizziness and vertigo indicate possible distinct underlying mechanisms of how seasons may influence the occurrence of those symptoms.     

Investigation of the relationship between kinesiophobia and sensory processing in fibromyalgia patients

Abstract

Purpose/aim: The aims of this study are to investigate the relationship between kinesiophobia and sensory processing in fibromyalgia (FM) patients and obtain new information about kinesiophobia in light of these results.

Materials and methods: This study has been conducted with 82 literate subjects aged 18–65?years and diagnosed with FM based on ACR 2010 diagnostic criteria. Fibromyalgia Impact Questionnaire was used for measuring functional status in FM patients, The Tampa Scale of Kinesiophobia was used for determine the levels of kinesiophobia and Adolescent/Adult Sensory Profile was used for determine the characteristics of sensory process patterns of the individuals.

Results: Among the participants, sensory sensitivity scores of 65.85% and sensation avoiding scores of 40.24% were higher than that in the general population. Sensation seeking scores of 48.78% the subjects were lower compared to the general population. A significant and weak positive correlation was found between the kinesiophobia scores and responses of sensory sensitivity and sensation avoiding (r?=?0.23, p?=?0.04; z?=?0.29, p?=?0.01)

Conclusion: This is the first study conducted to investigate the relationship between kinesiophobia and sensory processing in fibromyalgia patients. However, different studies investigating this subject are warranted in order to be able to generalize the findings and increase the value of evidence.     

Comparative study of observed actions,motor imagery and control therapeutic exercise on the conditioned pain modulation in the cervical spine: a randomized controlled trial

Abstract

Aim: The aim of this study was to compare the effects of cervical exercise, motor imagery (MI) and action observation (AO) of cervical exercise actions on conditioned pain modulation and pressure pain thresholds. The second objective was to assess the effects of these interventions on cervical motor activity (ranges of motion and muscle endurance), attention, and the ability to generate motor images.

Study design: Single-blinded randomized controlled trial.

Materials and methods: Fifty-four healthy subjects were randomly assigned to each group. Response conditioned pain modulation, pressure pain threshold, were the main variables. The secondary outcome measures included, cervical range of motion, Neck flexor endurance test, mental movement representation associated and psychosocial variables.

Results: All groups showed significant differences in time factor for all evaluated variables (p?<?.01) except pressure pain threshold over the tibial region. The post hoc analysis revealed significant within-group differences in the AE and AO groups in conditioned pain modulation (p?<?.05), with medium effect size in time [AE (d –0.61); AO (d –0.74)].

Conclusion: The results showed that within-group changes in conditioned pain modulation, cervical muscle endurance, and attention where founded only in the AE and AO groups. Variations in pain thresholds at pressure in the trapezium area were also obtained in the three groups. Changes in the ranges of flexion-extension and rotation movement were presented exclusively in the exercise group, and in the capacity to generate motor images only in the AO group. However, there was no difference in the pressure pain threshold over the tibial region.     

Bridging the gap between temporomandibular disorders,static balance impairment and cervicogenic dizziness: Posturographic and clinical outcomes

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.     

Reliability study of thermal quantitative sensory testing in healthy Chinese

Background: Test–retest reliability is important to establish for any diagnostic tool. The reliability of quantitative sensory testing (QST) in the trigeminal region has recently been described in Caucasians as well as differences in absolute thresholds and responses between Caucasians and Chinese. However, the test–retest reliability has not been determined in a Chinese population.

Objective: To provide novel information on the test–retest reliability of thermal QST in the trigeminal and spinal system in healthy Chinese.

Methods: Twenty healthy volunteers (10 women and 10 men) participated. Cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), and heat pain threshold (HPT) were measured at two sites: the surface of the left hand and the left masseter. The testing was performed over three consecutive stimuli trials, three sessions conducted on one day and repeated one week later. Data were analyzed with intra-tester reliability test and four-way analysis of variance (ANOVA) for repeated measures.

Results: There was a tendency for the first trial in CDT (p?=?0.005), CPT (p?=?0.02), and HPT (p?p?=?0.003) and HPT (p?=?0.045) with higher sensitivity at the masseter muscle. There were significant gender differences with higher sensitivity in women for CPT (p?=?0.001) and HPT (p?=?0.001).

Conclusion: Test site and gender affect thermal thresholds substantially. The test–retest reliability of most thermal threshold measures were acceptable for assessing somatosensory function, however, innocuous thresholds appear to be associated with larger variability than noxious thresholds in a Chinese population.     

Corticomotor correlates of somatosensory reaction time and variability in individuals with post concussion symptoms

Abstract

Persistent post concussion symptoms (PPCS) describe the condition when an individual experiences chronic symptoms, particularly fatigue, beyond the expected time of recovery. The aim of this study was to quantify the effect of fatigue and related ongoing symptoms on somatosensory and corticomotor pathways using reaction time (RT) testing, and single-pulse and paired-pulse transcranial magnetic stimulation (TMS). Eighty-three participants (nine female, mean age 37.9?±?11.5?years) were divided into two groups (persistent symptoms versus asymptomatic) following self-report based upon previously published clinical symptom scores. All participants completed somatosensory and visuomotor RT testing, as well as corticomotor excitability and inhibition measurements via TMS. Participants in the persistent symptom group (n?=?38) reported greater number of previous concussions (t?=?2.81, p?=?0.006) and significantly higher levels of fatigue and related symptoms in the asymptomatic group (n?=?45; t?=?11.32, p?<?0.006). Somatosensory RT showed significant slowing and increased variability in the persistent symptoms group (p?<?0.001), however no significant differences were observed between groups for visuomotor RTs. Transcranial magnetic stimulation revealed differences between groups for intracortical inhibition at all stimulus intensities and paired pulse measures. The results indicate that somatosensory and corticomotor systems reflect on-going fatigue. From a practical perspective, objective and simplistic measures such as somatosensory and corticomotor measures can be used in the assessment of PPCS and gauging the efficacy of post concussion rehabilitation programmes.     

Supervised exercise with or without laser-guided feedback for people with non-specific chronic low back pain. A randomized controlled clinical trial

BackgroundAmong the most effective therapeutic interventions in non-specific chronic low back pain (NSCLBP), clinical practice guidelines highlight exercise therapy and patient education; However, regarding the combined intervention of exercise and Pain Neuroscience Education (PNE), there is no consensus on the most effective form of exercise.ObjetiveTo find out what changes occurred after the application of two exercise modalities [Supervised Exercise (SE) and Laser-Guided Exercise (LGE)] and PNE on pain, pain pressure thresholds, disability, catastrophizing, kinesiophobia and lumbar proprioception in subjects with NSCLBP.MethodsSingle-blind randomized clinical controlled trial. 60 subjects with NSCLBP. Both groups performed a a total of 16 therapeutic exercise sessions and 8 Pain Neuroscience Education sessions. With the Laser-Guided Exercise Therapy group performing laser-guided exercises.ResultsA significant decrease was observed for pain intensity for both groups between baseline and post-intervention and the 3 month follow-up (p < 0.001). There was a significant between-group difference between baseline and post-intervention scores in terms of pain intensity and kinesiophobia in favour of the LGE group.ConclusionSupervised exercise with or without laser feedback, when combined with PNE, reduces pain intensity, disability, pain catastrophizing, kinesiophobia and improves proprioception and PPTs in patients with NSCLBP. At a 3-month follow-up, the combination of LGE plus PNE is most effective for reducing pain intensity.     

Visual motor imagery predominance in professional Spanish dancers

Abstract

Purpose: The main objectives of the study were to analyse the predominant motor imagery modality used by professional Spanish dancers and to compare Spanish dancers’ ability to perform mental motor imagery with that of non-dancers, and to analyse differences between male and female dancers. As a secondary aim, to compare the motor imagery ability between two styles of Spanish dance: classical Spanish dancers and Flamenco dancers.

Methods: A total of 74 participants were classified into two groups: professional Spanish dancers (n?=?37) and sedentary participants (n?=?37). The professional Spanish dancer group was composed of two dance disciplines: flamenco dancers (n?=?17), and classical dancers (n?=?20).

Results: Professional Spanish dancers used predominantly visual imagery modalities over kinesthetics to generate motor imagery, with a moderate effect size (p?<?.01, d?=?0.68). Regarding the ability to generate motor imagery, significant intergroup differences between professional Spanish dancers and sedentary participants were observed in all variables, with a large effect size (p?<?.05, d?>?0.80). Differences were obtained between men and women among non-dancers group (t?=??3.34; p?=?.03; d?=?0.5). No differences between Flamenco and classical dancers were observed.

Conclusion: Visual motor imagery modality was easier than the kinaesthetic modality in the generation of motor imagery for professional Spanish dancers regardless of the dance style. Spanish dancers had a greater ability to perform motor imagery compared with non-dancer individuals, needing less time to perform these mental tasks. Men non-dancers had a greater ability to generate motor imagery than women. Reinforcing the training of kinaesthetic motor imagery might be useful for professional Spanish dancers.     

Serum paraoxonase level and paraoxonase polymorphism in patients with acromegaly

Background: Acromegalic patients have increased cardiometabolic risk factors due to an elevation of growth hormone (GH) levels. Human serum paraoxonase (PON), a high-density lipoprotein (HDL)-related enzyme, is one of the major bioscavengers and decreases the oxidation of low-density lipoprotein (LDL), a key regulator in the pathogenesis of atherosclerosis. In this study, we investigated a potential relationship between serum PON levels or PON polymorphisms and acromegaly.

Methods: A total of 48 acromegalic patients and 44 healthy controls were included in this study. Serum GH levels, insulin-like growth factor-1 levels and lipid profiles were measured. Serum PON levels, as well as PON 1 L55M and Q192R gene polymorphisms, were examined.

Results: No significant differences were found in terms of age, gender, presence of diabetes, serum LDL cholesterol (LDL-C), HDL-C, or triglyceride levels between the case and control groups (P?>?0.05). A statistically significant difference was found in serum PON levels between the cases and controls (P?=?0.007). The median serum PON level was 101?±?63.36?U/l in the case group and 63?±?60.50?U/l in the control group. There was a significant correlation between serum PON levels and IGF-1 levels (P?=?0.004, r?=?0.319); however, no significant differences were found in PON1 L55M and PON Q192R polymorphisms between the patients and controls (P?=?0.607 and P?=?0.308, respectively). In addition, no significant differences were found in serum PON levels in acromegalic patients who were and were not in remission (P?=?0.385), nor between those with PON1 L55M and Q192R polymorphisms (P?=?0.161 and P?=?0.336, respectively).

Conclusions: Elevated serum PON levels were detected in acromegalic patients, independently of their remission status. This suggests protective effects for cardiometabolic risk parameters.     

Effect of laterality discrimination on joint position sense and cervical range of motion in patients with chronic neck pain: a randomized single-blind clinical trial

Purpose: The main objective of the present study was to evaluate the effects of laterality discrimination training on neck joint position sense and cervical range of motion (ROM) in patients with chronic non-specific neck pain (NSCNP).

Materials and methods: Forty-eight patients with NSCNP were randomly assigned to the neck group (NG) that observed neck images or the foot group (FG) that observed foot images. Response time, response accuracy, cervical ROM, and joint position error (JPE) were the main variables. The secondary outcome measures included psychosocial variables.

Results: Differences between groups in the cervical ROM for flexion (p?=?.043) were obtained, being NG group the one which obtained greater values. NG showed an improvement in right rotation (p?=?.018) and a decrease in flexion was found in the FG (p?=?.039). In JPE, differences between groups were obtained in the left rotation (p?=?.021) and significant changes were found in the NG for flexion, extension, and left rotation movements (p?<?.05). Moderate associations were found between left and right accuracy regarding to post-intervention flexion and right rotation (r?=?0.46, r?=?0.41; p?<?.05) in NG.

Conclusion: Improvements in cervical range of motion and joint position sense are obtained after the performance of the laterality discrimination task of images of the neck but not the feet. Visualization of images of the painful region presents moderate correlations with the accuracy and response time in the movements of flexion and right rotation.     

Role of kinesiophobia in the selective motor control during gait in patients with low back-related leg pain

Fear of movement has been related to changes in motor function in patients with low back pain, but little is known about how kinesiophobia affects selective motor control during gait (ability of muscles performing distinct mechanical functions) in patients with low back-related leg pain (LBLP). The aim of the study was to determine the association between kinesiophobia and selective motor control in patients with LBLP. An observational cross-sectional study was performed on 18 patients. Outcome included: kinesiophobia using the Tampa Scale of Kinesiophobia; pain mechanism using Leeds Assessment of Neuropathic Signs and Symptoms; disability using Roland-Morris Disability Questionnaire; mechanosensitivity using Straight Leg Raise. Surface electromyography was used to assess selective motor control during gait by examining the correlation and coactivation in muscle pairs involved in the stance phase. Pairs included vastus medialis (VM) and medial gastrocnemius (MG), causing opposite moments around the knee joint, and gluteus medius (GM) and MG, as muscles with distinct mechanical functions (weight acceptance vs. propulsion). A strong association was observed between kinesiophobia and correlation (r = 0.63; p = 0.005) and coactivation (r = 0.69; p = 0.001) between VM versus MG. A moderate association was observed between kinesiophobia and correlation (r = 0.58; p = 0.011) and coactivation (r = 0.55; p = 0.019) between GM versus MG. No significant associations were obtained for other outcomes. A high kinesiophobia is associated with low selective motor control of the muscles involved in the weight acceptance and propulsion phases during gait in patients with LBLP. Fear of movement was better associated with decreased neuromuscular control than other clinical variables such as pain mechanism, disability, and mechanosensitivity.     

Cervical and axioscapular muscle stiffness measured with shear wave elastography: A comparison between different levels of work-related neck disability

Assessing muscle mechanical properties in terms of stiffness may provide important insights into mechanisms underlying work-related neck pain. This study compared stiffness of cervical and axioscapular muscles between 92 participants (sonographers) with no (n = 31), mild (n = 43) or moderate/severe (n = 18) neck disability. It was hypothesized that participants with more severe neck pain and disability would present with altered distribution of stiffness in cervical and axioscapular muscles than those with no disability. Using shear wave elastography, the shear modulus (kPa) of five cervical and six axioscapular muscles or muscle segments were measured in a relaxed seated upright or side-lying position. Muscle activity was measured simultaneously using surface electromyography during the elastography measurements and scapular depression was measured using a measurement tape and inclinometer before the elastography measurements to evaluate their potential confounding influences on shear modulus. Increased shear modulus was found in deeper than superficial cervical muscles and more cranial than caudal axioscapular muscles. However, no differences in shear modulus of the cervical or axioscapular muscles were found between sonographers with varying levels of disability. This study suggests no alterations in stiffness of cervical and axioscapular muscles were associated with work-related neck pain and disability.     

A study on variability of quantitative sensory testing in healthy participants and painful temporomandibular disorder patients

Objectives: Quantitative sensory testing has mainly used thresholds to evaluate somatosensory sensitivity so far. The variability of different measures from session to session has also been investigated, but the variability of the single individual measures of a threshold or subject-based reports has not been considered. This study aimed to investigate the potential value of threshold variability in one session as a measure of internal consistency in somatosensory function.

Methods: The standardized quantitative sensory testing battery developed by the German Research Network on Neuropathic Pain was performed bilaterally over the infraorbital, mental, and hand regions in 70 healthy and 22 temporomandibular disorder pain participants. Somatosensory variability was investigated by calculating the Coefficient of Variation of three to five repeated measures in one threshold determination. The influences of side, gender, site, age, and presence of pain on the somatosensory variability were evaluated.

Results: In the healthy participants, somatosensory variability was region dependent: hand?>?mental and/or infraorbital for CDT, WDT, HPT, MDT-N, MPT-Y, MPT-N, WUR, and MPS (p?≤?0.043), infraorbital?>?hand for VDT (p?=?0.001), mental?>?infraorbital for HPT and WUR (p?≤?0.001); and age dependent for WDT, TSL, CPT, HPT, MDT-Y, MDT-N, MPT-N, and WUR (p?≤?0.017). Gender and side had no main effect on variability (p?≥?0.136). The pain patients presented higher variability compared with healthy participants for TSL, MDT-N, MPT-Y, WUR, and PPT (p?≤?0.033).

Discussion: The somatosensory variability along with the threshold would be a more complete method to investigate the somatosensory disorders and underlying pain mechanisms. The correlation between pain duration and somatosensory variability should be studied further with different pain conditions.     

Dizziness and Panic in China: Associated Sensations of Zang Fu Organ Disequilibrium

In China, distress is commonlyexperienced as dizziness that can develop intoacute episodes resembling Western panicattacks. These distressing sensations occur ina unique cultural context with a distinctiveset of associated symptoms, beliefs andpurported etiologies. The experience ofillness is informed by traditional Chinesemedicine (TCM), an indigenous theory thatelaborates a system of organ functioning calledzang fu. Depending on the implicatedzang fu organ disequilibrium, dizzinessand panic present with a specific constellationof associated physical and mental symptoms. This paper presents a clinical survey ofpsychiatric disorders that demonstratesdizziness to be characteristic of Chineseanxiety states, most particularly panic. Threespecific cases of dizziness-focused panicascribed to different states of zang fudisequilibrium are described. In a typicalpattern, initial dizziness and associatedsymptoms intensify until they generalize intopanic attacks. The degree of dizziness andpanic corresponds to the state ofdisequilibrium of the zang fu organsystem as well as instability of the social,interpersonal and environmental context of thepatient. This paper elucidates the dynamicinterpretants of dizziness in the Chinesecontext to contribute to a medical anthropologyof this sensation.     

The impact of administration of tranexamic acid in reducing the use of red blood cells and other blood products in cardiac surgery

Background

Cervicogenic headache (CEH) is a unilateral headache localised in the neck or occipital region, projecting to the frontal and temporal regions. Since the pathogenesis of this syndrome appears to have an anatomical basis in the cervical region, several surgical procedures aimed at reducing the nociceptive input on the cervical level, have been tested. We developed a sequence of various cervical radiofrequency neurotomies (facet joint denervations eventually followed by upper dorsal root ganglion neurotomies) that proved successful in a prospective pilot trial with 15 CEH patients. To further evaluate this sequential treatment program we conducted a randomised controlled trial

Methods

30 patients with cervicogenic headache according to the Sjaastad diagnostic criteria, were randomised. 15 patients received a sequence of radiofrequency treatments (cervical facet joint denervation, followed by cervical dorsal root ganglion lesions when necessary), and the other 15 patients underwent local injections with steroid and anaesthetic at the greater occipital nerve, followed by transcutaneous electrical nerve stimulation (TENS) when necessary. Visual analogue scores for pain, global perceived effects scores, quality of life scores were assessed at 8, 16, 24 and 48 weeks. Patients also kept a headache diary.

Results

There were no statistically significant differences between the two treatment groups at any time point in the trial.

Conclusion

We did not find evidence that radiofrequency treatment of cervical facet joints and upper dorsal root ganglions is a better treatment than the infiltration of the greater occipital nerve, followed by TENS for patients fulfilling the clinical criteria of cervicogenic headache.     

小醒脑针刺法联合度洛西汀对持续性姿势-知觉性头晕患者心理状态、平衡功能及睡眠质量的影响

摘要 目的：探讨小醒脑针刺法联合度洛西汀对持续性姿势-知觉性头晕（PPPD）患者心理状态、睡眠质量及平衡功能的影响。方法：收集2017年1月~2019年6月期间我院收治的70例PPPD患者为研究对象。按门诊号单双数将研究对象分为对照组（n=35,度洛西汀治疗）和研究组（n=35,小醒脑针刺法联合度洛西汀治疗）,对比两组头晕发作频次、头晕发作持续时间以及眩晕残障程度评定量表（DHI）评分、汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分、Berg平衡量表（BBS）评分、活动平衡信心量表（ABC）评分、微觉醒指数、入睡后清醒时间、睡眠分期转换次数、醒转次数、匹兹堡睡眠质量指数（PSQI）评分。结果：两组治疗后头晕发作频次、头晕发作持续时间、微觉醒指数、入睡后清醒时间、睡眠分期转换次数、醒转次数以及DHI、PSQI、HAMA、HAMD评分均较治疗前降低,且研究组较对照组低（P<0.05）。治疗后两组BBS、ABC评分均较治疗前升高,且研究组较对照组高（P<0.05）。结论：小醒脑针刺法联合度洛西汀治疗PPPD患者,可有效改善患者眩晕症状、心理状态、睡眠质量及平衡功能。     

Characteristics of attention-related body sensations. Temporal stability and associations with measures of body focus,affect, sustained attention,and heart rate variability

Aim: This study investigated the temporal stability and correlates of attention-related body sensations that emerge without external stimulation during rest and due to focused attention on a body part.

Materials: To assess attention-related body sensations, participants were asked to focus on a freely chosen body area with closed eyes, and had to report whether the sensation of that area had changed. Self-report questionnaires were used to assess various aspects of body focus (body awareness, body responsiveness, somatosensory amplification, subjective somatic symptoms), and positive and negative affectivity. Previous experiences in body–mind therapies were also measured. PEBL Continuous Performance Test was used to assess sustained attention. Heart rate variability scores were based on a 3-minute long resting heart rate measurement.

Methods: Fifty-eight university students (22.3?±?3.95 years; 34 females) participated in the study. The stability of attention-related body sensations was measured 8?weeks later on a randomly chosen sub-group (n?=?28).

Results: Attention-related body sensations showed a mediocre temporal stability (r_ρ?=?0.47, p?=?0.012). People reporting attention-related body sensations showed significantly higher body awareness, somatosensory amplification, and resting heart rate; and marginally higher somatic symptoms. No relation was found with body–mind practice, body responsiveness, positive and negative affect, the vagal component of heart rate variability, and performance in the sustained attention task.

Conclusion: Attention-related sensations are relatively stable over time. They are connected to some, but not to all of the aspects of body focus. Further studies are needed to elaborate the influencing stable and situational factors.     

Are Pain-Related Fears Mediators for Reducing Disability and Pain in Patients with Complex Regional Pain Syndrome Type 1? An Explorative Analysis on Pain Exposure Physical Therapy

Objective

To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy.

Design

An explorative secondary analysis of a randomised controlled trial.

Participants

Fifty-six patients with Complex Regional Pain Syndrome type 1.

Interventions

The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline.

Outcome measures

Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up.

Results

The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation.

Conclusion

The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment.

Trial registration

International Clinical Trials Registry NCT00817128     

Evaluating a sensitive issue: reliability of a clinical evaluation for allodynia severity

Abstract

Purpose/Aim: Allodynia is a common feature of neuropathic pain with few validated clinical evaluation options. We identified a need to estimate the measurement properties of the standardised evaluation procedure for static mechanical allodynia severity popularised by the somatosensory rehabilitation of pain method, known as the rainbow pain scale. This study (www.clinicaltrials.gov. NCT02070367) undertook preliminary investigation of the inter-rater and test-retest reliability of the rainbow pain scale.

Methods: Persons with pain in one upper extremity after Complex Regional Pain Syndrome, a peripheral nerve injury or a recent hand fracture were recruited for assessment of static mechanical allodynia threshold using calibrated monofilaments by two raters at baseline, and repeated assessment one week later.

Results: Single measures estimates suggested inter-rater reliability was substantial for the rainbow pain scale [intra-class correlation coefficient?=?0.78 (n?=?31), p?<?0.001]. Test-retest reliability was also excellent at with an intraclass correlation coefficient of 0.87 [n?=?28, p?<?0.001]. However, confidence intervals suggest the true values could be more moderate, with lower bounds of the 95% confidence interval at 0.60 and 0.74, respectively.

Conclusions: This pilot study has generated preliminary support for the inter-rater and test-retest reliability of the rainbow pain scale. Future studies should seek to increase confidence in estimates of reliability, and estimate validity and responsiveness to change in persons with somatosensory disorders.