Injection Of Hypertonic Saline Research Articles

Experimental pain in the groin may refer into the lower abdomen: Implications to clinical assessments.

To investigate the effects of experimental adductor pain on the pain referral pattern, mechanical sensitivity and muscle activity during common clinical tests. Repeated-measures design. In two separate sessions, 15 healthy males received a hypertonic (painful) and isotonic (control) saline injection to either the adductor longus (AL) tendon to produce experimental groin pain or into the rectus femoris (RF) tendon as a painful control. Pain intensity was recorded on a visual analogue scale (VAS) with pain distribution indicated on body maps. Pressure pain thresholds (PPT) were assessed bilaterally in the groin area. Electromyography (EMG) of relevant muscles was recorded during six provocation tests. PPT and EMG assessment were measured before, during and after experimental pain. Hypertonic saline induced higher VAS scores than isotonic saline (p<0.001), and a local pain distribution in 80% of participants. A proximal pain referral to the lower abdominal region in 33% (AL) and 7% (RF) of participants. Experimental pain (AL and RF) did not significantly alter PPT values or the EMG amplitude in groin or trunk muscles during provocation tests when forces were matched with baseline. This study demonstrates that AL tendon pain was distributed locally in the majority of participants but may refer to the lower abdomen. Experimental adductor pain did not significantly alter the mechanical sensitivity or muscle activity patterns.

Pain catastrophizing moderates changes in spinal control in response to noxiously induced low back pain

It is generally accepted that spine control and stability are relevant for the prevention and rehabilitation of low back pain (LBP). However, there are conflicting results in the literature in regards to how these variables are modified in the presence of LBP. The aims of the present work were twofold: (1) to use noxious stimulation to induce LBP in healthy individuals to assess the direct effects of pain on control (quantified by the time-dependent behavior of kinematic variance), and (2) to assess whether the relationship between pain and control is moderated by psychological features (i.e. pain catastrophizing (PC) and kinesiophobia). Participants completed three conditions (baseline, pain, recovery) during a task involving completion of 35 cycles of a repetitive unloaded spine flexion/extension movement. The neuromuscular control of spine movements was assessed during each condition using maximum finite-time Lyapunov exponents (λmax). Nociceptive stimulus involved injection of hypertonic saline into the interspinous ligament, eliciting pain that was greater than baseline and recovery (p<0.001). Although there was no overall main effect of the nociceptive stimulation (i.e. pain) on λmax when the whole group was included in the statistical model (p=0.564), when data were considered separately for those with high and low PC, two distinct and well established responses to the pain were observed. Specifically, those with high PC tightened their control (i.e. stabilized), whereas those with low PC loosened their control (i.e. destabilized). This study provides evidence that individuals’ beliefs and attitudes towards pain are related to individual-specific motor behaviors, and suggests that future research studying spine control/stability and LBP should account for these variables.

Loss of Displaced Starburst Amacrine Cells in a Rat Glaucoma Model

Acetylcholine (ACh) release by starburst amacrine cells (SACs) has been implicated in the production of retinal waves during early retinal development. Inhibitory gamma-aminobutyric acid (GABA) release by SACs is known to be involved in directional selectivity in the mature retina. However, the role of SAC release of acetylcholine in the adult developed mammalian retina is not entirely understood. Some evidence suggests a neuroprotective effect on retinal ganglion cells (RGCs) acting through alpha7 nicotinic acetylcholine receptors (nAChRs) present in RGCs. If ACh released by SACs is neuroprotective to RGCs, it would follow that this cholinergic transmission might be compromised in glaucoma conditions, at a time point prior to RGC loss. In this study, hypertonic saline injections into the episcleral veins surrounding the eyes of adult Long Evans rats were made to induce glaucoma-like conditions.

Minocycline Prevents Muscular Pain Hypersensitivity and Cutaneous Allodynia Produced by Repeated Intramuscular Injections of Hypertonic Saline in Healthy Human Participants.

Four repeated injections of HS at 48-hour intervals induce a state of persistent hypersensitivity in healthy human participants. This hypersensitivity was characterized by bilateral muscular hyperalgesia and cutaneous cold allodynia, symptoms commonly reported in many chronic pain conditions. Minocycline pretreatment abolished the development of this state.

Abnormal Spontaneous Brain Activity in Acute Low-Back Pain Revealed by Resting-State Functional MRI.

Neuroimaging studies have revealed that low-back pain (LBP) alters spatiotemporal dynamics of the blood oxygen level-dependent signal in response to persistent noxious stimulus. This study aimed to investigate changes in spontaneous neural activity of various brain regions in acute LBP using resting-state functional magnetic resonance imaging and amplitude of low-frequency fluctuation (ALFF). Twelve healthy subjects underwent two separate resting-state functional magnetic resonance imaging scans at health status as baseline and after intramuscular injection of hypertonic saline (0.5 mL, 5%) into the back muscles to induce acute LBP. Compared with baseline, acute LBP showed decreased ALFF in the right posterior cingulate cortex/precuneus and left primary somatosensory cortex (S1) but increased ALFF in the right medial prefrontal cortex, right middle temporal gyrus, bilateral inferior temporal gyrus, bilateral insula, right anterior cingulate cortex, and left cerebellum. In addition, significant negative correlations were observed between visual analog scale scores and ALFF of the bilateral medial prefrontal cortex, left inferior frontal gyrus, left S1, right anterior cingulate cortex, and left middle temporal gyrus. These findings suggest that abnormally spontaneous neural activity involving some brain regions are responsible for sensory, affective, and cognitive functions, which may be implicated in the underlying pathophysiology of acute LBP.

Upregulation of the endothelin A (ETA) receptor and its association with neurodegeneration in a rodent model of glaucoma

BackgroundPrimary open angle glaucoma is a heterogeneous group of optic neuropathies that results in optic nerve degeneration and a loss of retinal ganglion cells (RGCs) ultimately causing blindness if allowed to progress. Elevation of intraocular pressure (IOP) is the most attributable risk factor for developing glaucoma and lowering of IOP is currently the only available therapy. However, despite lowering IOP, neurodegenerative effects persist in some patients. Hence, it would be beneficial to develop approaches to promote neuroprotection of RGCs in addition to IOP lowering therapies. The endothelin system is a key target for intervention against glaucomatous neurodegeneration. The endothelin family of peptides and receptors, particularly endothelin-1 (ET-1) and endothelin B (ETB) receptor, has been shown to have neurodegenerative roles in glaucoma. The purpose of this study was to examine changes in endothelin A (ETA) receptor protein expression in the retinas of adult male Brown Norway rats following IOP elevation by the Morrison’s model of ocular hypertension and the impact of ETA receptor overexpression on RGC viability in vitro.ResultsIOP elevation was carried out in one eye of Brown Norway rats by injection of hypertonic saline through episcleral veins. After 2 weeks of IOP elevation, immunohistochemical analysis of retinal sections from rat eyes showed an increasing trend in immunostaining for ETA receptors in multiple retinal layers including the inner plexiform layer, ganglion cell layer and outer plexiform layer. Following 4 weeks of IOP elevation, a significant increase in immunostaining for ETA receptor expression was found in the retina, primarily in the inner plexiform layer and ganglion cells. A modest increase in staining for ETA receptors was also found in the outer plexiform layer in the retina of rats with IOP elevation. Cell culture studies showed that overexpression of ETA receptors in 661W cells as well as primary RGCs decreases cell viability, compared to empty vector transfected cells. Adeno-associated virus mediated overexpression of the ETA receptor produced an increase in the ETB receptor in primary RGCs.ConclusionsElevated IOP results in an appreciable change in ETA receptor expression in the retina. Overexpression of the ETA receptor results in an overall decrease in cell viability, accompanied by an increase in ETB receptor levels, suggesting the involvement of both ETA and ETB receptors in mediating cell death. These findings raise possibilities for the development of ETA/ETB dual receptor antagonists as neuroprotective treatments for glaucomatous neuropathy.

Combination of hypertonic saline and fibrin glue: Another selection to treat chronic enterocutaneous fistula

Gastrointestinal tract fistula is a frequent complication of surgery or disease. In general, cases involving failure to manage fistulae after 5–6 weeks of nonoperative treatment possibly require surgery. Here, we report a case involving a chronic enterocutaneous fistula (ECF) for 24 months that was treated using hypertonic saline injection within the duodenal mucosa and use of fibrin glue as an adhesive to ensure rapid closure. This technique is a simple and effective method for treating an ECF. The procedure is easy to perform, carries minimal surgical risk, and features the advantages of reduced hospitalization or home nursing care and expenses compared with traditional therapy.

Influence of Polymorphisms in the HTR3A and HTR3B Genes on Experimental Pain and the Effect of the 5-HT3 Antagonist Granisetron.

The aim of this study was to investigate experimentally if 5-HT3 single nucleotide polymorphisms (SNP) contribute to pain perception and efficacy of the 5-HT3-antagonist granisetron and sex differences. Sixty healthy participants were genotyped regarding HTR3A (rs1062613) and HTR3B (rs1176744). First, pain was induced by bilateral hypertonic saline injections (HS, 5.5%, 0.2 mL) into the masseter muscles. Thirty min later the masseter muscle on one side was pretreated with 0.5 mL granisetron (1 mg/mL) and on the other side with 0.5 mL placebo (isotonic saline) followed by another HS injection (0.2 mL). Pain intensity, pain duration, pain area and pressure pain thresholds (PPTs) were assessed after each injection. HS evoked moderate pain, with higher intensity in the women (P = 0.023), but had no effect on PPTs. None of the SNPs influenced any pain variable in general, but compared to men, the pain area was larger in women carrying the C/C (HTR3A) (P = 0.015) and pain intensity higher in women with the A/C alleles (HTR3B) (P = 0.019). Pre-treatment with granisetron reduced pain intensity, duration and area to a lesser degree in women (P < 0.05), but the SNPs did not in general influence the efficacy of granisetron. Women carrying the C/T & T/T (HTR3A) genotype had less reduction of pain intensity (P = 0.041) and area (P = 0.005), and women with the C/C genotype (HTR3B) had less reduction of pain intensity (P = 0.030), duration (P = 0.030) and area compared to men (P = 0.017). In conclusion, SNPs did not influence experimental muscle pain or the effect of granisetron on pain variables in general, but there were some sex differences in pain variables that seem to be influenced by genotypes. However, due to the small sample size further research is needed before any firm conclusions can be drawn.

Motor adaptations to local muscle pain during a bilateral cyclic task.

The aim of this study was to determine how unilateral pain, induced in two knee extensor muscles, affects muscle coordination during a bilateral pedaling task. Fifteen participants performed a 4-min pedaling task at 130W in two conditions (Baseline and Pain). Pain was induced by injection of hypertonic saline into the vastus medialis (VM) and vastus lateralis (VL) muscles of one leg. Force applied throughout the pedaling cycle was measured using an instrumented pedal and used to calculate pedal power. Surface electromyography (EMG) was recorded bilaterally from eight muscles to assess changes in muscle activation strategies. Compared to Baseline, during the Pain condition, EMG amplitude of muscles of the painful leg (VL and VM-the painful muscles, and RF-another quadriceps muscle with no pain) was lower during the extension phase [(mean±SD): VL: -22.5±18.9%; P<0.001; VM: -28.8±19.9%; P<0.001, RF: -20.2±13.9%; P<0.001]. Consistent with this, pedal power applied by the painful leg was also lower during the extension phase (-16.8±14.2W, P=0.001) during Pain compared to Baseline. This decrease was compensated for by an 11.3±8.1W increase in pedal power applied by the non-painful leg during its extension phase (P=0.04). These results support pain adaptation theories, which suggest that when there is a clear opportunity to compensate, motor adaptations to pain occur to decrease load within the painful tissue. Although the pedaling task offered numerous possibilities for compensation, only between-leg compensations were systematically observed. This finding is discussed in relation to the mechanical and neural constraints of the pedaling task.

Bilateral experimental neck pain reorganize axioscapular muscle coordination and pain sensitivity.

Neck pain is a large clinical problem where reorganized trunk and axioscapular muscle activities have been hypothesised contributing to pain persistence and pain hypersensitivity. This study investigated the effects of bilateral experimental neck pain on trunk and axioscapular muscle function and pain sensitivity. In 25 healthy volunteers, bilateral experimental neck pain was induced in the splenius capitis muscles by hypertonic saline injections. Isotonic saline was used as control. In sitting, subjects performed slow, fast and slow-resisted unilateral arm movements before, during and after injections. Electromyography (EMG) was recorded from eight shoulder and trunk muscles bilaterally. Pressure pain thresholds (PPTs) were assessed bilaterally at the neck, head and arm. Data were normalized to the before-measures. Compared with control and post measurements, experimental neck pain caused (1) decreased EMG activity of the ipsilateral upper trapezius muscles during all but slow-resisted down movements (p<0.001), and (2) increased EMG activity in the ipsilateral erector spinae muscle during slow and fast movements (p<0.02), and in the contralateral erector spinae muscle during all but fast up and slow-resisted down movements (p<0.007). The PPTs in the painful condition increased at the head and arm compared with post measurements and the control condition (p<0.001). In the post-pain condition, the neck PPT was decreased compared with the control condition (p<0.001). Acute bilateral neck pain reorganized axioscapular and trunk muscle activity together with local hyperalgesia and widespread hypoalgesia indicating that acute neck pain immediately affects trunk and axioscapular function which may affect both assessment and treatment. Bilateral clinical neck pain alters axioscapular muscle coordination but only effects of unilateral experimental neck pain has been investigated. Bilateral experimental neck pain causes task-dependent reorganized axioscapular and trunk muscle activity in addition to widespread decrease in pressure pain sensitivity.

Does induced masseter muscle pain affect integrated jaw-neck movements similarly in men and women?

Normal jaw opening-closing involves simultaneous jaw and head-neck movements. We previously showed that, in men, integrated jaw-neck movements during jaw function are altered by induced masseter muscle pain. The aim of this study was to investigate possible sex-related differences in integrated jaw-neck movements following experimental masseter muscle pain. We evaluated head-neck and jaw movements in 22 healthy women and 16 healthy men in a jaw opening-closing task. The participants performed one control trial and one trial with masseter muscle pain induced by injection of hypertonic saline. Jaw and head movements were registered using a three-dimensional optoelectronic recording system. There were no significant sex-related differences in jaw and head movement amplitudes. Head movement amplitudes were significantly greater in the pain trials for both men and women. The proportional involvement of the neck motor system during jaw movements increased in pain trials for 13 of 16 men and for 18 of 22 women. Thus, acute pain may alter integrated jaw-neck movements, although, given the similarities between men and women, this interaction between acute pain and motor behaviour does not explain sex differences in musculoskeletal pain in the jaw and neck regions.

The influence of induced shoulder muscle pain on rotator cuff and scapulothoracic muscle activity during elevation of the arm

Altered recruitment of rotator cuff and scapulothoracic muscles has been identified in patients with subacromial impingement syndrome. To date, however, the cause-consequence relationship between pain and altered muscle recruitment has not been fully unraveled. The effect of experimental shoulder pain induced by injection of hypertonic saline in the supraspinatus on the activity of the supraspinatus, infraspinatus, subscapularis, trapezius, and serratus anterior activity was investigated during the performance of an elevation task by use of muscle functional magnetic resonance imaging in 25 healthy individuals. Measurements were taken at 4 levels (C6-C7, T2-T3, T3-T4, and T6-T7) at rest and after the elevation task performed without and with experimental shoulder pain. During arm elevation, experimentally induced pain caused a significant activity reduction, expressed as reduction in T2 shift of the IS (P = .029). No significant changes in T2 shift values were found for the other rotator cuff muscles or the scapulothoracic muscles. This study demonstrates that acute experimental shoulder pain has an inhibitory effect on the activity of the IS during arm elevation. Acute experimental shoulder pain did not seem to influence the scapulothoracic muscle activity significantly. The findings suggest that rotator cuff muscle function (infraspinatus) should be a consideration in the early management of patients with shoulder pain.

The effects of acute experimental hip muscle pain on dynamic single-limb balance performance in healthy middle-aged adults

Middle-aged adults with painful hip conditions show balance impairments that are consistent with an increased risk of falls. Pathological changes at the hip, accompanied by pain, may accelerate pre-existing age-related balance deficits present in midlife. To consider the influence of pain alone, we investigated the effects of acute experimental hip muscle pain on dynamic single-limb balance in middle-aged adults. Thirty-four healthy adults aged 40–60 years formed two groups (Group-1: n=16; Group-2: n=18). Participants performed four tasks: Reactive Sideways Stepping (ReactSide); Star Excursion Balance Test (SEBT); Step Test; Single-Limb Squat; before and after an injection of hypertonic saline into the right gluteus medius muscle (Group-1) or ∼5min rest (Group-2). Balance measures included the range and standard deviation of centre of pressure (CoP) movement in mediolateral and anterior-posterior directions, and CoP total path velocity (ReactSide, Squat); reach distance (SEBT); and number of completed steps (Step Test). Data were assessed using three-way analysis of variance. Motor outcomes were altered during the second repetition of tasks irrespective of exposure to experimental hip muscle pain or rest, with reduced SEBT anterior reach (−1.2±4.1cm, P=0.027); greater step number during Step Test (1.5±1.7 steps, P<0.001); and slower CoP velocity during Single-Limb Squat (−4.9±9.4mms−1, P=0.024). Factors other than the presence of pain may play a greater role in balance impairments in middle-aged adults with hip pathologies.

Reduced Maximal Force during Acute Anterior Knee Pain Is Associated with Deficits in Voluntary Muscle Activation.

Although maximal voluntary contraction (MVC) force is reduced during pain, studies using interpolated twitch show no consistent reduction of voluntary muscle drive. The present study aimed to test if the reduction in MVC force during acute experimental pain could be explained by increased activation of antagonist muscles, weak voluntary activation at baseline, or changes in force direction. Twenty-two healthy volunteers performed maximal voluntary isometric knee extensions before, during, and after the effects of hypertonic (pain) and isotonic (control) saline injections into the infrapatellar fat pad. The MVC force, voluntary activation, electromyographic (EMG) activity of agonist, antagonist, and auxiliary (hip) muscles, and pain cognition and anxiety scores were recorded. MVC force was 9.3% lower during pain than baseline (p < 0.001), but there was no systematic change in voluntary activation. Reduced MVC force during pain was variable between participants (SD: 14%), and was correlated with reduced voluntary activation (r = 0.90), baseline voluntary activation (r = − 0.62), and reduced EMG amplitude of agonist and antagonist muscles (all r > 0.52), but not with changes in force direction, pain or anxiety scores. Hence, reduced MVC force during acute pain was mainly explained by deficits in maximal voluntary drive.

Effects of Experimental Anterior Knee Pain on Muscle Activation During Landing and Jumping Performed at Various Intensities.

Although knee pain is common, some facets of this pain are unclear. The independent effects (ie, independent from other knee injury or pathology) of knee pain on neural activation of lower-extremity muscles during landing and jumping have not been observed. To investigate the independent effects of knee pain on lower-extremity muscle (gastrocnemius, vastus medialis, medial hamstrings, gluteus medius, and gluteus maximus) activation amplitude during landing and jumping, performed at 2 different intensities. Laboratory-based, pretest, posttest, repeated-measures design, where all subjects performed both data-collection sessions. Thirteen able-bodied subjects performed 2 different land and jump tasks (forward and lateral) under 2 different conditions (control and pain), at 2 different intensities (high and low). For the pain condition, experimental knee pain was induced via a hypertonic saline injection into the right infrapatellar fat pad. Functional linear models were used to evaluate the influence of experimental knee pain on muscle-activation amplitude throughout the 2 land and jump tasks. Experimental knee pain independently altered activation for all of the observed muscles during various parts of the 2 different land and jump tasks. These activation alterations were not consistently influenced by task intensity. Experimental knee pain alters activation amplitude of various lower-extremity muscles during landing and jumping. The nature of the alteration varies between muscles, intensities, and phases of the movement (ie, landing and jumping). Generally, experimental knee pain inhibits the gastrocnemius, medial hamstring, and gluteus medius during landing while independently increasing activation of the same muscles during jumping.

Differential responses of the vasotocin 1a receptor (V1aR) and osmoreceptors to immobilization and osmotic stress in sensory circumventricular organs of the chicken (Gallus gallus) brain

Past studies have shown that the avian vasotocin 1a receptor (V1aR) is involved in immobilization stress. It is not known whether the receptor functions in osmotic stress, and if sensory circumventricular organs may be involved. An experiment was designed with four treatment groups including a 1h immobilization acute stress (AS) group, an unstressed acute control (AC), a third given an intraperitoneal (ip) hypertonic saline injection (HS) and isotonic saline controls (IC) administered ip. One set of chick brains was perfused for immunohistochemistry while a second was sampled for quantitative RT-PCR. Plasma corticosterone (CORT) and arginine vasotocin (AVT) concentrations were significantly increased in the immobilized and hypertonic saline groups (p<0.01) compared to controls. Intense staining of the V1aR occurred throughout the organum vasculosum of the lamina terminalis (OVLT) and subseptal organ (SSO)/subfornical organ (SFO). The immunostaining allowed the boundaries of the two circumventricular organs (CVOs) to be described for the first time in avian species. Both treatment groups showed marked morphological changes in glia within the OVLT and SSO/SFO. The avian V1aR, angiotensin II type 1 receptor (AT1R), and transient receptor potential vanilloid receptor 1 (TRPV1) mRNA levels were increased in the SSO/SFO in hypertonic saline treated birds compared to isotonic controls. In contrast, the latter two genes (AT1R and TRPV1) were significantly decreased in the OVLT of birds subjected to hyperosmotic stress, while all three genes were significantly up-regulated after immobilization. Taken together, results show a possible differential function for the same receptors in two anatomically adjacent CVOs.

Effects of Prolonged and Acute Muscle Pain on the Force Control Strategy During Isometric Contractions.

Musculoskeletal pain is associated with multiple adaptions in movement control. This study aimed to determine whether changes in movement control acquired during acute pain are maintained over days of pain exposure. On day 0, the extensor carpi radialis brevis muscle of healthy participants was injected with nerve growth factor (NGF) to induce persistent movement-evoked pain (n=13) or isotonic saline as a control (n=13). On day 2, short-lasting pain was induced by injection of hypertonic saline into extensor carpi radialis brevis muscles of all participants. Three-dimensional force components were recorded during submaximal isometric wrist extensions on day 0, day 4, and before, during, and after saline-induced pain on day 2. Standard deviation (variation of task-related force) and total excursion of center of pressure (variation of force direction) were assessed. Maximal movement-evoked pain was 3.3±.4 (0-10 numeric scale) in the NGF-group on day 2 whereas maximum saline-induced pain was 6.8±.3cm (10-cm visual analog scale). The difference in centroid position of force direction relative to day 0 was greater in the NGF group than in the control group (P<.05) on day 2 (before saline-induced pain) and day 4, reflecting changes in tangential force direction used to achieve the task. During saline-induced pain in both groups, tangential and task-related force variation was greater than before and after saline-induced pain (P<.05). Persistent movement-evoked pain changes force direction from the pain-free direction. Acute pain leads to increased variation in force direction irrespective of persistent movement-evoked pain preceding the acutely painful event. These differences provide novel insight into the search for and consolidation of new motor strategies in the presence of pain.

Acute bilateral experimental neck pain: Reorganise axioscapular and trunk muscle activity during slow resisted arm movements

Abstract Aims Neck pain is frequent and many develop on-going neck pain after the initial onset. Studies on clinical neck pain suggested that altered axioscapular muscle activity may be an important factor in on-going neck pain. This study investigates the effect of bilateral experimental neck pain on axioscapular muscle activity during standardised resisted arm movements. Methods 25 healthy participants were recruited for this single blinded cross-over study. Experimental pain was induced by bilateral injection of hypertonic saline into the splenius capitis muscle. Isotonic saline was used as a control. Pain intensity was recorded using an electronic visual analogue scale (VAS; 0-10 cm). Participants performed standardised arm movements, from a seated position, while wearing 1 kg wrist weights. Six arm abduction movements (30° to frontal plane, 3 per side) were performed to an angle of 140°. Each movement consisted of two 3 s phases (up/down) and was separated by a 6 s break, before moving the opposite arm. Surface electromyography (EMG) was recoded from 8 bilateral muscles. Recordings were done before, immediately after, and 5 min after the experimental pain. Root-mean-square (RMS) of the EMG signals were extracted for each muscle and averaged for the 3 trials. Data was compared between sides and no differences were identified after which data was pooled for further analysis. Results During the painful condition for the slow upward movement, a reduced RMS-EMG activity was found for the ipsilateral upper trapezius (P&lt; 0.01). In addition, increased RMS-EMG was found bilaterally for the erector spinae muscle (P&lt; 0.01). Conclusion Bilateral experimental neck reorganise axioscapular and trunk muscle activity during resisted, slow upward movement. The results of this supports previous studies on neck pain patients suggesting neck pain is linked to axioscapular function and underpins the necessity to include the shoulder girdle in assessment and rehabilitation of neck pain patients.

Motor Adaptations to Pain during a Bilateral Plantarflexion Task: Does the Cost of Using the Non-Painful Limb Matter?

During a force-matched bilateral task, when pain is induced in one limb, a shift of load to the non-painful leg is classically observed. This study aimed to test the hypothesis that this adaptation to pain depends on the mechanical efficiency of the non-painful leg. We studied a bilateral plantarflexion task that allowed flexibility in the relative force produced with each leg, but constrained the sum of forces from both legs to match a target. We manipulated the mechanical efficiency of the non-painful leg by imposing scaling factors: 1, 0.75, or 0.25 to decrease mechanical efficiency (Decreased efficiency experiment: 18 participants); and 1, 1.33 or 4 to increase mechanical efficiency (Increased efficiency experiment: 17 participants). Participants performed multiple sets of three submaximal bilateral isometric plantarflexions with each scaling factor during two conditions (Baseline and Pain). Pain was induced by injection of hypertonic saline into the soleus. Force was equally distributed between legs during the Baseline contractions (laterality index was close to 1; Decreased efficiency experiment: 1.16±0.33; Increased efficiency experiment: 1.11±0.32), with no significant effect of Scaling factor. The laterality index was affected by Pain such that the painful leg contributed less than the non-painful leg to the total force (Decreased efficiency experiment: 0.90±0.41, P<0.001; Increased efficiency experiment: 0.75±0.32, P<0.001), regardless of the efficiency (scaling factor) of the non-painful leg. When compared to the force produced during Baseline of the corresponding scaling condition, a decrease in force produced by the painful leg was observed for all conditions, except for scaling 0.25. This decrease in force was correlated with a decrease in drive to the soleus muscle. These data highlight that regardless of the overall mechanical cost, the nervous system appears to prefer to alter force sharing between limbs such that force produced by the painful leg is reduced relative to the non-painful leg.

Airway Deflation Activated Receptors Are Stimulated by Hypertonic Saline

Recently, deflation activated receptors (DARs) in the lung have been identified as a group of airway sensory receptors. DARs often share their afferents with rapidly adapting receptors (RARs) as well as slowly adapting pulmonary stretch receptors (SARs) to form a sensory unit. However, the afferent properties of DARs have not been well characterized. It has been reported that airway RAR units are stimulated, whereas typical SAR units (units do not respond to lung deflation) are not stimulated by hypertonic saline. Since RAR units are often share afferents with DARs, possibly, it is the DARs that are stimulated by hypertonic saline. The present study determines whether DARs can be stimulated by increased osmolarity. In anesthetized, open‐chest and artificially ventilated rabbits, we recorded single unit activities from typical SAR units and SAR units that respond to lung deflation (units contain DARs). We examined responses of these two groups to injection of hypertonic saline (8.1% sodium chloride, 0.1 ml) into receptive fields in the lung. Hypertonic saline decreased the activity of typical SARs, although not substantially. At baseline, activity of typical SAR units was 40.3 ± 5.4 imp/s (n=12). It decreased to 34.8 ± 4.7 imp/s (p&lt;0.05) at 17.5 seconds after injection of hypertonic saline. On the other hand, hypertonic saline stimulated deflation activated SAR units significantly. Baseline activity increased from 15.9 ± 2.2 imp/s to its speak of 43.4 ± 10.0 imp/s (n=10, p&lt;0.01) at 10.5 seconds after injection. The activity returned to the control level within a minute. Our results show that behavior of deflation activated and typical SAR units was different. The former, but not the latter, was stimulated by hypertonic saline. We conclude that DARs are stimulated by hypertonic saline.Support or Funding Information(Supported by a VA Merit Review Award PULM‐029‐10S)