Modulation of the nociceptive flexor reflex by the electrostimulation of auricular acupuncture points

Nociceptive flexor reflex (NFR) in patients with vertebrogenic lumbosacral pain syndromes was recorded before and after the ipsi- and contralateral auricular electroacupuncture (AEAP). Changes in NFR were observed after ipsi- and contralateral AEAP, each producing facilitatory and inhibitory effects on NFR. Facilitatory influence of AEAP on NFR correlated with hypalgesia, that apparently reflected recovery of the afferent input peculiarities.     

Changes in the excitability of soleus muscle short latency stretch reflexes during human hopping after 4 weeks of hopping training

Changes in the excitability of the human triceps surae muscle short latency stretch reflexes were investigated in six male subjects before and after 4 weeks of progressive two-legged hopping training. During the measurements the subjects performed 2-Hz hopping with: preferred contact time (PCT) and short contact time. The following reflex parameters were examined before and after the training period: the soleus muscle (SOL) Hoffmann-reflex (H-reflex) at rest and during hopping, the short latency electromyogram (EMG) components of the movement induced stretch reflex (MSR) in SOL and medial gastrocnemius muscle (MG), and the EMG amplitude of the SOL and MG tendon reflexes (T-reflexes) elicited at rest. The main results can be summarized as follows: the SOL T-reflex had increased by about 28% (P < 0.05) after training while the MG T-reflex was unchanged; the SOL MSR (always evident) and the MG MSR (when observable) did not change in amplitude with training, and before training the SOL H-reflex in both hopping situations was significantly depressed to about 40% of the reference value at standing rest (P < 0.05). After training the H-reflex during PCT hopping was no longer depressed. As the value of the measured mechanical parameters (the total work rate, joint angular velocity and the ankle joint work rate) was unchanged after training in both hopping situations, the reflex changes observed could not be ascribed to changes in the movement pattern. To explain the observed changes, hypotheses of changes in the excitability of the stretch reflex caused by the training were taken into consideration and discussed. Accepted: 22 May 1998     

Back extension exercises decompress the spinal root and improve standing mobility in patients with sub-acute lumbosacral radiculopathy

Purpose: Repeated back extension exercises (RBEEs) have been reported to cause changes in the distribution and intensity of radicular symptoms. Therefore, the objective of this study was to investigate the effects of RBEEs on the neurophysiology of the compromised nerve root and on standing mobility and pain intensity in patients with sub-acute and chronic lumbosacral radiculopathy (LSR).

Subjects and methods: A total of 40 patients with unilateral sub-acute/chronic LSR voluntarily participated in the study; the patients performed three sets of 10 RBEEs in the prone position with 1?min of rest between the sets. The soleus H-reflex, standing mobility, and pain intensity were recorded before and after the RBEEs.

Results: The results of the study showed that the RBEEs significantly improved the H-reflex, standing mobility, and pain intensity in patients with sub-acute LSR (p?p?Conclusion: RBEEs in the prone position are recommended for improving the neurophysiological function of the compromised nerve root and standing mobility in patients with sub-acute LSR.     

Alterations of spectral parameters of rat brain electrical activity after sciatic nerve section

Changes in electrophysiological brain characteristics accompanying the development of neurogenic pain syndrome induced by transsection of sciatic nerve were analyzed. At the maximum pain syndrome 3 weeks after the deafferentation, a reorganization of the brain electrical activity was observed in the limbic structures (hippocampus, amygdale, and nucleus accumbens), frontal cortex, and the caudate putamen. An increase in the relative spectral power of the delta and alpha bands and a decrease in the relative power of the beta2 band (as compared to baseline activity) took place. Alteration of the electrical activity in the limbic structures did not depend on manifestations of the neurogenic pain syndrome (autotomy). The increase in the relative spectral power of the alpha-band activity in all the structures under study suggests the involvement of the reticular thalamic nucleus in pathogenesis of neurogenic pain syndrome.     

Changes in H reflex and V wave following short-term endurance and strength training

This study examined the effects of 3 wk of either endurance or strength training on plasticity of the neural mechanisms involved in the soleus H reflex and V wave. Twenty-five sedentary healthy subjects were randomized into an endurance group (n = 13) or strength group (n = 12). Evoked V-wave, H-reflex, and M-wave recruitment curves, maximal voluntary contraction (MVC), and time-to-task-failure (isometric contraction at 40% MVC) of the plantar flexors were recorded before and after training. Following strength training, MVC of the plantar flexors increased by 14.4 ± 5.2% in the strength group (P < 0.001), whereas time-to-task-failure was prolonged in the endurance group (22.7 ± 17.1%; P < 0.05). The V wave-to-maximal M wave (V/M(max)) ratio increased significantly (55.1 ± 28.3%; P < 0.001) following strength training, but the maximal H wave-to-maximal M wave (H(max)/M(max)) ratio remained unchanged. Conversely, in the endurance group the V/M(max) ratio was not altered, whereas the H(max)/M(max) ratio increased by 30.8 ± 21.7% (P < 0.05). The endurance training group also displayed a reduction in the H-reflex excitability threshold while the H-reflex amplitude on the ascending limb of the recruitment curve increased. Strength training only elicited a significant decrease in H-reflex excitability threshold, while H-reflex amplitudes over the ascending limb remained unchanged. These observations indicate that the H-reflex pathway is strongly involved in the enhanced endurance resistance that occurs following endurance training. On the contrary, the improvements in MVC following strength training are likely attributed to increased descending drive and/or modulation in afferents other than Ia afferents.     

Static otolithic drive alters presynaptic inhibition in soleus motor pool

The vestibular system has both direct and indirect connections to the soleus motor pool via the vestibulospinal and reticulospinal tracts. The exact nature of how this vestibular information is integrated within the spinal cord is largely unknown. The purpose of this study was to identify whether changes in static otolithic drive altered the amount of presynaptic inhibition in the soleus H-reflex pathway. Changes in static otolithic drive were investigated in sixteen healthy participants using a tilt table. Two presynaptic pathways (common peroneal and femoral) to the soleus H-reflex were tested in three weight conditions (supine, non-weight bearing, and weight bearing). The dependent variable was the peak-to-peak amplitude of the soleus H-reflex. Inhibition to the soleus motor pool through the common peroneal nerve pathway differed significantly during weight conditions and tilt. During tilt and non-weight bearing there was greater inhibition of the soleus H-reflex compared to supine, however, this effect was reversed during tilt and weight bearing. Facilitation from the femoral nerve pathway was reduced by tilt compared to supine, but this reduction was unaffected by weight condition. This supports a role of the vestibular system as providing complex, task-dependent presynaptic input to motoneurons in the lower limbs.     

Interrelation of respiratory variability and ventilatory sensitivity to a hypercapnic stimulus

Breathing variability and ventilatory response to carbon dioxide (SCO2) were studied after premedication with moradol, in healthy subjects and those with acute pain syndrome. Inverse relationship between SCO2 and breathing variability was established. SCO2 was the highest in the group of patients with acute pain syndrome and the lowest in patients after premedication with moradol.     

Effects of wrist position and contraction on wrist flexors H-reflex, and its functional implications.

In order to determine whether joint position exerts a powerful influence on length-tension regulation in multiarticulate wrist flexors, three wrist positions (neutral, flexion and extension) and four levels of flexor contraction [0%, 10%, 20% and 30% maximum voluntary contraction (MVC)] were manipulated. There were significant differences in H-reflex amplitudes according to wrist positions and levels of flexor contraction. H-reflex increased linearly as a function of contraction in all three wrist positions. H-reflex was consistently larger in the wrist flexion than in the wrist extension position. The strength of the relationship (omega2) indicated that wrist position had a greater effect on H-reflex than force of muscle contraction. The interaction between wrist flexors contraction and joint position was significant only in the wrist flexion position. Trend analysis showed that, in the wrist flexion position, a low level of contraction was sufficient to maximally facilitate the H-reflex; however, a quadratic component was seen at higher contraction levels. The above findings may reflect the length-tension relationship of the multiarticulate wrist flexors. Therefore, this paper will discuss the functional implications related to the larger H-reflex in flexion position and the depressed H-reflex in the wrist extension position.     

The acute effect of whole-body vibration on the hoffmann reflex

The extent to which motoneuron pool excitability, as measured by the Hoffmann reflex (H-reflex), is affected by an acute bout of whole-body vibration (WBV) was recorded in 19 college-aged subjects (8 male and 11 female; mean age 19 +/- 1 years) after tibial nerve stimulation. H/M recruitment curves were mapped for the soleus muscle by increasing stimulus intensity in 0.2- to 1.0-volt increments with 10-second rest intervals between stimuli, until the maximal M-wave and H-reflex were obtained. After determination of Hmax and Mmax, the intensity necessary to generate an H-reflex approximately 30% of Mmax (mean 31.5% +/- 4.1%) was determined and used for all subsequent measurements. Fatigue was then induced by 1 minute of WBV at 40 Hz and low amplitude (2-4 mm). Successive measurements of the H-reflex were recorded at the test intensity every 30 seconds for 30 minutes post fatigue. All subjects displayed a significant suppression of the H-reflex during the first minute post-WBV; however, four distinct recovery patterns were observed among the participants (alpha = 0.50). There were no significant differences between genders across time (P = 0.401). The differences observed in this study cannot be explained by level or type training. One plausible interpretation of these data is that the multiple patterns of recovery may display variation of muscle fiber content among subjects. Future investigation should consider factors such as training specificity and muscle fiber type that might contribute to the differing H-reflex response, and the effect of WBV on specific performance measures should be interpreted with the understanding that there may be considerable variability among individuals. Recovery times and sample size should be adjusted accordingly.     

Neural adaptation to resistance training: changes in evoked V-wave and H-reflex responses.

Combined V-wave and Hoffmann (H) reflex measurements were performed during maximal muscle contraction to examine the neural adaptation mechanisms induced by resistance training. The H-reflex can be used to assess the excitability of spinal alpha-motoneurons, while also reflecting transmission efficiency (i.e., presynaptic inhibition) in Ia afferent synapses. Furthermore, the V-wave reflects the overall magnitude of efferent motor output from the alpha-motoneuron pool because of activation from descending central pathways. Fourteen male subjects participated in 14 wk of resistance training that involved heavy weight-lifting exercises for the muscles of the leg. Evoked V-wave, H-reflex, and maximal M-wave (M(max)) responses were recorded before and after training in the soleus muscle during maximal isometric ramp contractions. Maximal isometric, concentric, and eccentric muscle strength was measured by use of isokinetic dynamometry. V-wave amplitude increased approximately 50% with training (P < 0.01) from 3.19 +/- 0.43 to 4.86 +/- 0.43 mV, or from 0.308 +/- 0.048 to 0.478 +/- 0.034 when expressed relative to M(max) (+/- SE). H-reflex amplitude increased approximately 20% (P < 0.05) from 5.37 +/- 0.41 to 6.24 +/- 0.49 mV, or from 0.514 +/- 0.032 to 0.609 +/- 0.025 when normalized to M(max). In contrast, resting H-reflex amplitude remained unchanged with training (0.503 +/- 0.059 vs. 0.499 +/- 0.063). Likewise, no change occurred in M(max) (10.78 +/- 0.86 vs. 10.21 +/- 0.66 mV). Maximal muscle strength increased 23-30% (P < 0.05). In conclusion, increases in evoked V-wave and H-reflex responses were observed during maximal muscle contraction after resistance training. Collectively, the present data suggest that the increase in motoneuronal output induced by resistance training may comprise both supraspinal and spinal adaptation mechanisms (i.e., increased central motor drive, elevated motoneuron excitability, reduced presynaptic inhibition).     

Stereotactic mesencephalotomy versus multiple thalamotomies in the treatment of chronic cancer pain syndromes

Two neurosurgical centers, Bologna (Italy) and Freiburg (FRG), have compared results obtained with stereotactic mesencephalotomy (SM; Bologna) and multiple thalamotomies (MT; Freiburg) in the surgical treatment of chronic cancer pain syndromes. In total, 161 patients were operated, 109 in Bologna and 52 in Freiburg. In SM the lesions were single and centered on the spinothalamic tract at the mesencephalic level, while in MT the lesions were multiple in the thalamic nuclei (ventrocaudal parvocellular nucleus, nucleus limitans, lamella medialis, centromedian nuclei). The following results emerged after 2-7 months' follow-up: (1) in an antalgic sense, SM was much more beneficial, with 91 patients (83.5%) pain-free after the operation versus 27 patients (51.9%) who had only an attenuation of the pain syndrome after MT; (2) SM, compared to MT, is burdened by mortality and a higher morbidity [2 deaths (1.8%) vs. 0; 3 anesthesia dolorosa and 8 severe gaze palsies (10.1%) vs. only 1 case of permanent aphasia (1.9%)].     

西甲硅油联合枯草杆菌肠球菌对肠易激综合征的疗效观察

目的:探讨西甲硅油乳剂联合枯草杆菌肠球菌二联活菌肠溶胶囊(美常安)在肠易激综合征(IBS)治疗中的临床效果。方法:将2014年1月至2015年10月收治的180例IBS患者随机分为西甲硅油乳剂联合枯草杆菌肠球菌二联活菌治疗组92例和单药枯草杆菌肠球菌二联活菌治疗对照组88例,治疗4周后随访观察两组患者的治疗总有效率、不同胃肠症状的治疗有效率,以及不同型IBS患者的胃肠症状评分。结果:IBS治疗组的治疗总有效率为88.0%,明显高于对照组70.5%(P0.05)。治疗4周后腹胀和排便次数改善的有效率分别为94.6%和78.3%明显高于对照组的77.3%和60.2%(P0.05),但两组在腹痛和排便性状改善方面比较无明显差异(P0.05)。对两组不同胃肠症状评分结果:显示同组同型IBS治疗4周后胃肠症状评分均明显低于治疗前(P0.05)治疗有效。但两组同型IBS患者的治疗后胃肠症状评分比较时,仅在便秘型IBS患者差异明显(P0.05)。结论:西甲硅油乳剂联合枯草杆菌二联活菌肠溶胶囊对肠易激综合征(IBS)患者治疗有效,对缓解腹胀和改善排便次数上治疗效果尤为明显,对IBS便秘型患者的胃肠症状恢复疗效最佳。     

Study of the audiospinal effect on the H-reflex

Studies of the audiospinal effect on the H-reflex demonstrated that in normal test subjects and in patients with injuries to the spinal cord coupled with parapareses and in part of patients with paraplegia of the lower limbs, there was a sound-induced 30-70% increase in the amplitude of the H-reflex. As the interval between the conditioning sound and testing electric stimulations was raised, two maxima of the increment of the H-reflex amplitude within 30-40 ms and 80-100 ms were revealed. The increased H-response within these intervals seems likely to be connected with the conduction of excitation from the brain cortex via the pyramidal tract and the reticulospinal tract. Part of the patients with spinal cord injuries and paraplegia of the lower limbs did not manifest any sound-induced increase in the H-reflex. Apparently, such lack of increase is either a consequence of the functional blockade of the afferent conduction tract or that of their anatomical disturbance. The method of the audiospinal effect on the H-reflexes may be used for diagnostic purposes, namely for the determination of the conduction via the afferent cerebrospinal tract.     

Influence of stimulus intensity on the soleus H-reflex amplitude and modulation during locomotion

Diverging results have been reported regarding the modulation and amplitude of the soleus H-reflex measured during human walking and running. A possible explanation to this could be the use of too high stimulus strength in some studies while not in others. During activities like walking and running it is necessary to use a small M-wave to control the effective stimulus strength during all phases of the movement. This implies that the descending part of the H-reflex recruitment curve is being used, which may lead to an unwanted suppression of the H-reflex due to limitations imbedded within the H-reflex methodology itself.Accordingly, the purpose of the present study was to study the effect on the soleus H-reflex during walking and running using stimulus intensities normally considered too high (up to 45% Mmax).Using M-waves of 25–45% Mmax as opposed to 5–25% Mmax showed a significant suppression of the peak H-reflex during the stance phase of walking, while no changes were observed during running. No differences were observed regarding modulation pattern. So a possible use of too high stimulus intensity cannot explain the differences mentioned. The surprising result in running may be explained by the much higher voluntary muscle activity, which implies the existence of a V-wave influencing the H-reflex amplitude in positive direction.     

Use of sensory-sympathetic coupling indices for diagnosing sympathetically maintained pain with laser Doppler flowmetry

The first objective diagnosis of sympathetically maintained forms of pain employing laser Doppler flowmetry (LDF) and specifically targeted at detecting sensory-sympathetic coupling in the skin has been developed and tested in 49 patients with the posttraumatic complex regional pain syndrome. Sensory-sympathetic coupling was diagnosed as a combination of sympathetic vasomotor activity and the presence of sensory peptidergic blood flow oscillations in a frequency band of 0.047–0.069 Hz in the LDF wavelet spectrum. The results of the LDF diagnosis were compared with the clinical evaluation of sympathetically maintained pain carried out after desympathization surgery (thoracoscopic clipping above and below the Th3 ganglion of the sympathetic chain in 33 patients and perivascular sympathectomy at the level of the brachial vascular bundle in 16 patients). The sensitivity of preoperative LDF diagnosis was 90.2%; the specificity was 87.5%; the positive predictive value was 97.3%; the negative predictive value was 63.6%; and the diagnostic efficiency was 89.8%.     

Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care

Objectives To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain.Design Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing perspective.Setting The emergency department at the Northern General Hospital, Sheffield, United Kingdom.Participants 972 patients with acute, undifferentiated chest pain (479 attending on days when care was delivered in the chest pain observation unit, 493 on days of routine care) followed up until six months after initial attendance.Main outcome measures The proportion of participants admitted to hospital, the proportion with acute coronary syndrome sent home inappropriately, major adverse cardiac events over six months, health utility, hospital reattendance and readmission, and costs per patient to the health service.Results Use of a chest pain observation unit reduced the proportion of patients admitted from 54% to 37% (difference 17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65, P < 0.001) and the proportion discharged with acute coronary syndrome from 14% to 6% (8%, -7% to 23%, P = 0.264). Rates of cardiac event were unchanged. Care in the chest pain observation unit was associated with improved health utility during follow up (0.0137 quality adjusted life years gained, 95% confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of £78 per patient (-£56 to £210, P = 0.252).Conclusions Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service. It seems to be more effective and more cost effective than routine care.     

Prevalence of myofascial pain in general internal medicine practice.

Myofascial pain is a regional pain syndrome characterized in part by a trigger point in a taut band of skeletal muscle and its associated referred pain. We examined a series of 172 patients presenting to a university primary care general internal medicine practice. Of 54 patients whose reason for a visit included pain, 16 (30%) satisfied criteria for a clinical diagnosis of myofascial pain. These patients were similar in age and sex to other patients with pain, and the frequency of pain as a primary complaint was similar for myofascial pain as compared with other reasons for pain. The usual intensity of myofascial pain as assessed by a visual analog scale was high, comparable to or possibly greater than pain due to other causes. Patients with upper body pain were more likely to have myofascial pain than patients with pain located elsewhere. Physicians rarely recognized the myofascial pain syndrome. Commonly applied therapies for myofascial pain provided substantial abrupt reduction in pain intensity. The prevalence and severity of myofascial pain in this university internal medicine setting suggest that regional myofascial pain may be an important cause of pain complaints in the practice of general internal medicine.     

Mannitol for the prevention of decompensation symptoms in hydrated patients undergoing long-term hemodialysis

Symptoms of decompensation syndrome were frequently noted during sequential ultrafiltration/hemodialysis. In 9 adult patients chronically dialysed 101 cases of overhydration were seen. Mannitol was administered in a 20% solution (250 ml) in a continuous intravenous infusion during 49 dialyses. Changes in body weight were measured, arterial blood pressure, pulse rate, hematocrit, total plasma protein levels, urea, creatinine, sodium and potassium were determined as well as plasma osmolality. Mannitol significantly decreased muscular contractions during dialysis, weakness after dialysis, and incidence of various symptoms of decompensation. The values of analysed clinical parameters and laboratory tests did not differ from those determined without mannitol. Plasma creatinine, total plasma protein levels and hematocrit were significantly lower after several hours after the end of ultrafiltration/hemodialysis. We suggest that mannitol decreases the incidence of the symptoms of decompensation syndrome and is safe. Beneficial effect of mannitol is most probably produced by the changes in body fluids distribution.     

Effects of homosynaptic depression on spectral properties of H-reflex recordings

The purpose of this study was to determine the effects of homosynaptic depression (HD) on spectral properties of the soleus (SOL) H-reflex. Paired stimulations, separated by 100?ms, were used to elicit an unconditioned and conditioned H-reflex in the SOL muscle of 20 participants during quiet standing. Wavelet and principal component analyses were used to analyze features of the time-varying spectral properties of the unconditioned and conditioned H-reflex. The effects of HD on spectral properties of the H-reflex signal were quantified by comparing extracted principal component scores. The analysis extracted two principal components: one associated with the intensity of the spectra and one associated with its frequency. The scores for both principal components were smaller for the conditioned H-reflex. HD decreases the spectral intensity and changes the spectral frequency of H-reflexes. These results suggest that HD changes the recruitment pattern of the motor units evoked during H-reflex stimulations, in that it not only decreases the intensity, but also changes the types of motor units that contribute to the H-reflex signal.