Pressure Pain Research Articles

Postprandial glycaemic response and pain sensitivity in breast cancer survivors suffering from chronic pain: a double-blind, randomised controlled cross-over pilot experiment.

The study's primary goal is to investigate differences in postprandial glycaemic response (PPGR) to beverages with varying glycaemic index (i.e. low and medium) between breast cancer survivors (BCS) with chronic pain and healthy pain-free controls (HC). The secondary goal of the study is to investigate the potential link between PPGR and pain-related outcomes in BCS with chronic pain. In this study, 15 BCS and 15 HC were included. After 12h of fasting, subjects were randomised between drinking a beverage made with 50g of sucrose (medium) or isomaltulose (low) within 250ml water. Blood glucose levels were monitored at fasting as well as at 15, 30, 45, 60, 90 and 120min following beverage consumption. Furthermore, each participant was evaluated using several experimental pain measurements, including pressure pain thresholds (PPT), electrical detection threshold, electrical pain threshold, temporal summation and electrical offset analgesia (OA). The BCS group had significantly higher PPGR to sucrose (p = .001) than the HC group. Furthermore, when PPGR to sucrose was compared to PPGR to isomaltulose within the groups, the BCS group showed a considerably larger difference (p = .012). Additionally, correlation analyses indicated both positive and negative associations between PPGR after sucrose intake and specific pain measurements (PPT-tibialis (r = .599), OA (rs = - .549), respectively) in BCS, and a positive association between the difference in PPGR between sucrose and isomaltulose and PPT-tibialis (r = .622). These findings suggest that medium glycaemic index beverage intakes result in significantly higher blood glucose responses (i.e. PPGR) than low-glycaemic index beverage intakes in BCS. Additionally, BCS show an impaired glycaemic response to medium glycaemic index beverage intake and that the impaired glycaemic response might be related to pain sensitivity and endogenous analgesia in BCS. Furthermore, the higher glycaemic response to sucrose and greater difference in the amount of change in PPGR (when isomaltulose was substituted for sucrose) compared to HC highlight the importance of understanding how dietary choices with a lower glycaemic index can alter glycaemic regulation in BCS with chronic pain.

Subgroup Characteristics of Middle-Aged and Older Women with Chronic Low Back Pain by Multiple Factors: A Hierarchical Cluster Analysis

Background/Objectives: Chronic low back pain (CLBP) after middle age is a complex multifactorial condition, and subgrouping is recommended to determine effective treatment strategies. Multidimensional data help create new groupings to increase the effectiveness of interventions in middle-aged and older adults with CLBP. This study aimed to investigate the relationship between the factors associated with CLBP after middle age and to create and characterize a new subgroup based on these factors. Methods: A cross-sectional observational study was conducted and included 46 women aged ≥40 years with CLBP who participated in health events. Trunk muscle mass, lumbar movement control ability, autonomic balance, lumbar tenderness threshold, lumbar proprioception, and severity of central sensitization were assessed. Results: Partial correlation analysis revealed a significant negative correlation between lumbar movement control ability and autonomic balance. A significant positive correlation was observed between trunk muscle mass and the lumbar tenderness threshold. Hierarchical clustering analysis identified three subgroups. The cluster 1 participants had low trunk muscle mass, low tenderness threshold, and low severity of central sensitization. The cluster 2 participants had low trunk muscle mass and tenderness threshold and high severity of central sensitization. The cluster 3 participants had high trunk muscle mass and tenderness threshold and were sympathetically predominant. Trunk muscle mass, pressure pain threshold, severity of central sensitization, and autonomic balance were significantly different between the clusters. Conclusions: Three characteristic subgroups were identified. The results contribute to treatment and prevention strategies for middle-aged and older adults with CLBP based on the characteristics of the subgroups rather than a uniform approach.

Therapeutic Neuroscience Education In Fibromyalgia: A Randomized Controlled Trial

Abstract To investigate additive effect of Therapeutic Neuroscience Education (TNE) to pilates exercises in female patients with fibromyalgia (FM).25 female patients FM included in the study. They randomly separated into two groups. There were 11 patients in the intervention group and 14 patients in the control group. Pilates exercises and TNE were applied in the intervention group, and only pilates exercises were applied in the control group. Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA), Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), Widespread Pain Index (WPI), Fibromyalgia Impact Questionnare (FIQ), Symptom Severity Scale (SSS), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Biopsychosocial Questionnaire (BETY-BQ) and pressure algometer was used for evaluation.After the treatment, control group improved in the “visuomotor construction” and “thinking operations"cognitive areas andtotal score of DLOTCA, BPI-pain severity score, VAS, FIQ, SSS, PCS-magnification, and only left medial knee mean score of pressure pain thresholds (p<0.05). Intervention group improved in the “thinking operations” cognitive area and total score of DLOTCA, BPI-pain severity score, BPI-pain interference score, VAS, WPI, FIQ, SSS, TSK, BETY-BQ and all pressure pain thresholds (excluding left trapezius) (p<0.05). In the comparison of delta values, the intervention group improved more in WPI, FIQ, right trapezius mean score and left trapezius, right quadriceps femoris, right-left medial knee maximum and mean scores of pressure pain thresholds (p<0.05). TNE increased the effectiveness of pilates exercises on pain, functional status and pressure pain thresholds in patients with FM.

Comparative Efficacy of Platelet-Rich Plasma, Corticosteroid, Hyaluronic Acid, and Placebo (Saline) Injections in Patients with Lateral Elbow Tendinopathy: A Randomized Controlled Trial

Background: Lateral elbow tendinopathy is a common condition that significantly alters the function of the upper extremities. In case of first-line treatment failure, different local injections are usually used. Due to the lack of sufficient evidence to support it, we conducted the study to compare the outcomes of different single injections, including Platelet-Rich Plasma (PRP), Corticosteroids (CS), Hyaluronic Acid (HA), and placebo (saline). Methods: Sixty patients with confirmed lateral elbow tendinopathy were enrolled in the study and divided into four groups. Pain intensity (average for the current day, at rest, during provocative tests) measured by Visual Analogue Scale (VAS), pressure pain threshold (PPT), Patient-Rated Tennis Elbow Evaluation (PRTEE), Disability of Arm, Shoulder and Hand (DASH), Subjected Elbow Value (SEV), and strength of selected muscle groups were measured before and during follow-up visits (1, 4, 12, 24, and 52 weeks after treatment). The treatment was considered successful when minimal clinically important difference (MCID) was achieved in primary outcomes (VAS, PRTEE). Results: A significant improvement was achieved in most measurements in all groups. At the final follow-up, MCID for the mean pain reduction measured with VAS and improvement in the PRTEE score were achieved in 52 and 54 patients, respectively. The complete absence of pain was achieved after 1, 4, 12, 24, and 52 weeks in 2, 5, 10, 22, and 40 patients, respectively. The comparison between the groups found a significant difference in pain intensity between CS and other groups one week after injection, between the CS and PRP group in the fourth week, and between PRP and HA in the fourth week (p < 0.05). No other significant differences were found between each group at each follow-up time point. Conclusions: We conclude that each injection treatment provides good long-term clinical outcomes, but not better than placebo. A CS injection might be regarded as a more effective treatment only within the first month post-injection.

Effects of Neural Load on Hamstring Stretching upon Flexibility, Maximum Isometric Strength, and Tibial Nerve Pressure Pain Threshold in Healthy Subjects: A Randomized Clinical Trial

(1) Background: Stretching has been shown to improve flexibility, muscle activation, and coordination, but its effects may depend on neural tension during the stretch. This study evaluated the short- and medium-term effects of hamstring stretching with and without neural load on flexibility, tibial nerve pressure pain threshold, and maximum isometric strength. (2) Methods: Seventy-eight healthy participants (mean age: 24.96 ± 6.11 years) were randomly assigned to stretching programs with (n = 39) or without neural load (n = 39). Flexibility, pressure pain threshold, and maximum isometric strength were assessed at baseline, after the first session, at the end of the intervention, and one month later. (3) Results: The group using neural load showed significant flexibility improvements after the first session (MD = −5.2; p < 0.001), which were maintained at two months (MD = −8.6; p < 0.001) and follow-up (MD = −6.4; p < 0.001). In the control group, flexibility gains diminished at follow-up (MD = −3.9; p = 0.052). Other variables showed no significant changes across time points. (4) Conclusions: Since neither treatment showed superior efficacy, no specific stretching type could be recommended.

Does smartphone addiction affect cervical mobility, head posture, body awareness and pain pressure threshold?

Aims: With the rapid development of technology, the increasing use of smartphones has become a subject of concern due to its multifaceted effects on the cervical spine and body awareness. The present study investigates effects of smartphone addiction on general cervical/isolated upper cervical mobility, body awareness, head posture, and cervical pain pressure threshold (PPT). Methods: This prospective and cross-sectional study was conducted on 108 participants, categorized as heavy users and light users based on daily smartphone use. General cervical / isolated upper cervical mobility (right and left rotation), body awareness, head posture, and PPT (midpoint of the upper trapezius muscle, and 2 cm lateral to the C2 spinous process) were assessed using the Cervical Range of Motion Device (CROM), the Body Awareness Questionnaire, craniovertebral angle, and an algometer, respectively. The comparison of cervical mobility, head posture, body awareness, and pain pressure threshold between the groups was performed using the Independent samples T test. Results: The results showed that smartphone addiction significantly affects isolated upper cervical mobility in the directions of right and left rotation (p

Effects of a rehabilitation program in patients with temporomandibular disorders. A case series

Objective The purpose of this prospective case series study was to evaluate the effects of a rehabilitation program based on Splint Therapy (ST), Rhythmic Temporomandibular Joint Mobilization (RTJM), and Self-management (SM) on jaw functional limitations, pain intensity, pressure pain threshold and myoelectric activity in patients with Temporomandibular Disorders (TMDs). Methods A single group of 17 participants (14 females and 3 males; mean age 31.18 ± 9.60 years) with symptoms of TMDs according to Research Diagnosis Criteria for Temporomandibular Disorders was evaluated. Jaw functional limitation scale (JFLS), pain intensity (VAS), pressure pain threshold (PPT), and myoelectric activity (MA) were assessed at baseline, post-treatment, and follow-up after an 8-week rehabilitation program. All statistical analyses were performed using the SPSS package version 20.0. A p = <0.05 was considered statistically significant and an effect size = >0.8 was considered clinically significant. Results Statistically significant differences were found at post-treatment and follow-up for JFLS, VAS, and PPT (p = <0.05). Clinically significant improvements were observed in JFLS (d = 1.99), VAS (d = 1.28), and PPT at post-treatment (d = >0.8). No statistically significant effect was observed for MA at any time point, except for isometric MA in the right masseter between T1 and T2 (p = 0.04). Conclusion This prospective case series suggests that a rehabilitation program based on ST, RTJM, and SM could improve jaw function, pain intensity, and pressure pain threshold in patients with TMDs.

Ankle injury due to supination trauma: Potential factors worsening patient outcome

PurposeSupination trauma is a common sports injury, and often leads to chronic ankle instability. This study analyses whether indications of healing can be detected 2 weeks after supination trauma. MethodsThis prospective, monocentric study at a German Medical Center examined patients with acute supination trauma. Only patients with severity levels 2-3 were included in the study, and were advised to wear an orthosis for 5 weeks starting in the emergency room. The follow-up period was two weeks after trauma (follow-up examination 1/FE1: swelling of the ankle joint, tenderness over the lateral ligament complex and the syndesmosis, questionnaire). Nine months after injury (follow-up examination 2/FE2), these patients were interviewed by telephone using a questionnaire surveying current complaints in everyday life, sports, and work, as well as the general healing process. ResultsForty-one patients aged 35.1 years (±10.5) were included in the study. The presence of hematoma two weeks post-injury (n=6) correlated significantly with inability to work (p=0.02). Calcaneofibular ligament (CFL) tenderness was seen in 36 patients, posterior talofibular ligament (PTFL) tenderness in 29 patients, and syndesmosis tenderness in 9 patients. All patients who reported pressure pain at the anterior talofibular ligament (ATFL) at FE1 were significantly more likely to experience feelings of instability at FE2 (p=0.011). All patients who reported instability at FE1 had significantly greater problems climbing stairs at FE2 (p=0.003). All patients with hematoma and instability two weeks post-injury had a persistent feeling of instability at FE2. Patients with hematoma and pressure pain at the ATFL at FE1 had persistent pain through FE2. ConclusionsPersistent hematoma, pressure pain at the ATFL or feelings of instability two weeks after ankle sprain increase the likelihood of symptoms persisting for up to nine months post-injury. Physicians and patients should be well informed about the treatment guidelines and not underestimate this injury. In general, further studies are necessary to clarify why acute ankle sprains often lead to persistent complaints.

From breast cancer diagnosis to survivorship: analyzing perioperative biopsychosocial phenotypes and their relationship to pain on long term.

Persistent breast cancer treatment-related pain affects up to 40% of patients, decreasing their quality of life (QoL). While current research typically utilizes correlation and regression analysis to identify biopsychosocial phenotypes contributing to this pain, this study employs cluster analysis to identify qualitatively different phenotypes based on somatosensory and psychosocial characteristics both before and one week post-breast cancer surgery. Further, it investigates how these phenotypes are related to pain intensity one year post-surgery and examines the evolution of phenotype membership from pre- to post-surgery. Somatosensory and psychosocial functioning was evaluated pre- and post-surgery in 184 women undergoing unilateral breast cancer surgery. Eight different quantitative sensory testing (QST) methods including mechanical detection and pain thresholds, pressure pain thresholds, thermal detection and pain thresholds, and conditioned pain modulation were performed at the surgical area (trunk, arm, major pectoral muscle) and a distant location (quadriceps muscle). Psychosocial functioning was assessed using the Central Sensitization Inventory, Pain Catastrophizing Scale, Depression Anxiety Stress Scale-21, and the McGill Quality of Life Questionnaire. Pain intensity was evaluated one year post-breast cancer surgery using the Visual Analogue Scale. Latent class analysis identified five distinct phenotypes before and post-surgery, characterized by differences in mechanical and pain thresholds alongside psychosocial factors. Moreover, higher psychosocial distress and lower QoL correlated with elevated pain intensity one year post-surgery. These findings underscore the importance of addressing breast cancer patients' mental health perioperatively. Therefore, future research should explore whether psychological interventions perioperatively can reduce long-term pain intensity. PerspectiveThis secondary analysis, utilizing cluster analysis, reveals five distinct phenotype based on somatosensory and psychosocial characteristics both before and post breast cancer surgery. Higher psychosocial distress and lower quality of life correlated with elevated pain intensity one year post-surgery, emphasizing the need to address patients' mental health perioperatively. Trial registrationclinicaltrials.gov (NCT03351075)

Pressure pain threshold and perceived impact of pain differentially predict short-term and long-term pain reduction following acupuncture in fibromyalgia

Pressure pain threshold and perceived impact of pain differentially predict short-term and long-term pain reduction following acupuncture in fibromyalgia

Trans-Catheter Device Closure of Atrial Septal Defect in Symptomatic Children Up to 10 Kg of Body Weight: A Multicentric Retrospective Observational Cohort Study to Assess Feasibility, Safety and Midterm Results After Closure

Background: Atrial septal defect (ASD) is the second most prevalent congenital heart diseases (CHD) encompassing 8-10% of all CHDs beyond neonatal period. Although relatively benign, if left untreated can amount to several adverse outcomes. Trans-catheter Device closure of ASD is a preferred therapy for a hemodynamically significant shunt. Despite multitude of septal occluders being available these days, paucity of literature concerning appropriateness of device sizing, and various adaptations of techniques for device deployment in large ASDs with deficient rims and their outcomes in children up to 10 kg weight nevertheless still exists. Aims and Methods: A retrospective multi-centric observational study, was conducted in a cohort of children who underwent ASD device closure weighing up to 10 kg conducted over a period of 4 years, to assess its safety and feasibility. Results: Of the included 85 patients, 63% were females and 37% were males with mean age at intervention being 32 months. The mean weight and height were 9.17 Kg and 88 cm respectively. Mean of maximum ASD dimension was 14.92mm. Hemodynamic assessment with invasive PA pressures recordings suggested normal PA pressure in 82%, while 18% had pulmonary arterial hypertension. Mean Qp/Qs and PVR was 2.58 and 1.8 Wood units respectively. Average device: weight ratio was 1.9. Arrhythmias occurred in 6 children, five had Adenosine sensitive SVTs and one had persisting CHB necessitating surgical device retrieval and Permanent pacemaker implantation. No mortality occurred in this study. Conclusion: Trans-catheter closure of ASD is indeed safe and effective procedure if performed in children weighing up to 10 Kg, in a hemodynamically significant shunt, adopting modified techniques, even in presence of flimsy or deficient rims with device weight ratio up to 3:1

An Economic Analysis Of Environmental And Health Conditions Of Urban Dweller Slums In Raipur

Abstract One of the most emerging problems in India is environmental and health conditions of urban slums as social exclusion in India cities is the explosion of slums and informal settlements. Urban slums as social exclusion people living in these settlements experience the most terrible living and environmental conditions. Due that situation the majority of the slums population is suffering from all types of diseases and also, they were excluded from participating in the economic social, political, and cultural spheres of the city. This paper is attempted to make an economic analysis of environmental and health aspects of the living conditions of the slum dwellers in general in particular Greater Municipality of Raipur of Chhattisgarh, India. The empirical analysis identifies the incidence of chronic diseases like diabetes, blood pressure, respiration syndromes, kidney problems, skin problems and joint pains is studied. In the General sickness category cholera, typhoid, malaria, woofing cough, diarrhea, fever, digestive problems are reported Keywords: Environmental, Health Conditions, Urban Slums, Diseases Emerging Problems

Enhanced Surgical Recovery Nursing Program: A Multidisciplinary Approach to Optimize Postoperative Patient Recovery.

Enhanced recovery is currently considered to be the treatment of various elective major surgeries. Enhanced recovery after surgery (ERAS) includes applying various perioperative measures, strategies, and active participation of patients in the recovery process. A quasi-experimental study was conducted in the surgical units of a hospital in Karnataka, India. Data were collected from patients undergoing elective abdominal surgery (n = 142). Psychological (anxiety) and physiological outcomes (vital capacity, pulse, respiration, and blood pressure) were assessed in experimental and treatment-as-usual groups on preoperative day 1 (2 days before surgery) and preoperative day 2 (1 day before surgery). The results showed a significant decrease in the state-anxiety scores in the experimental group than in the treatment-as-usual group (p < 0.05). Physiological outcomes such as pain, pulse, respiration, and blood pressure showed a significant decrease in the experimental group than the treatment-as-usual group (p < 0.05). Vital capacity was significantly increased in the experimental group and decreased in the treatment-as-usual group in the postoperative days (p < 0.05). A significant decrease in the length of postoperative stay was seen in the experimental group than in the treatment-as-usual group (p = 0.001). In the experimental group, there were less postoperative complications than in the treatment-as-usual group. Enhanced recovery is considered to be the treatment for various elective major surgeries. It is an essential responsibility of healthcare professionals to improve postoperative outcomes by reducing complications and length of postoperative hospital stay. Barboza HR, Dsilva F, Lobo AS, Moosabba MS, Gurmitkal B. Enhanced Surgical Recovery Nursing Program: A Multidisciplinary Approach to Optimize Postoperative Patient Recovery. Indian J Crit Care Med 2025;29(1):21-26.

Comparison of the Effects of Extracorporeal Shockwave Therapy Application Sites on Pain, Pressure Pain Threshold, Strength, and Functional Improvement in Patients with Lateral Epicondylitis

Comparison of the Effects of Extracorporeal Shockwave Therapy Application Sites on Pain, Pressure Pain Threshold, Strength, and Functional Improvement in Patients with Lateral Epicondylitis

The Impact of Autonomic Nervous System Modulation on Heart Rate Variability and Musculoskeletal Manifestations in Chronic Neck Pain: A Double-Blind Randomized Clinical Trial.

Background: The role of autonomic nervous system (ANS) modulation in chronic neck pain remains elusive. Transcutaneous vagus nerve stimulation (t-VNS) provides a novel, non-invasive means of potentially mitigating chronic neck pain. This study aimed to assess the effects of ANS modulation on heart rate variability (HRV), pain perception, and neck disability. Methods: In this double-blind randomized clinical trial, 102 participants with chronic neck pain were randomly allocated to one of three groups: t-VNS plus standard-care physiotherapy (SC-PT), heart rate variability biofeedback (HRV-BF) with SC-PT, or SC-PT alone. Interventions were administered three times weekly for 6 weeks. The following outcome measures were assessed at baseline and after 6 weeks: HRV, the visual analog scale (VAS), the pressure pain threshold (PPT), and the neck disability index (NDI). Results: The t-VNS group exhibited significant improvements compared to the HRV-BF and SC-PT groups. Specifically, t-VNS increased the RR interval (mean difference [MD] = 35.0 ms; p = 0.037) and decreased the average heart rate (MD = -5.4 bpm; p = 0.039). Additionally, t-VNS reduced the VAS scores (versus HRV-BF: MD = -0.8 cm, p = 0.044; SC-PT: MD = -0.9 cm, p = 0.018), increased the PPT (versus HRV-BF: MD = 94.4 kPa, p < 0.001; SC-PT (MD = 56.2 kPa, p = 0.001)), and lowered the NDI scores (versus HRV-BF: MD = -4.0, p = 0.015; SC-PT: MD = -5.9, p < 0.001). Conclusions: t-VNS demonstrated superior effectiveness compared to HRV-BF and SC-PT in regulating HRV, alleviating pain, and enhancing functional capabilities in individuals with chronic neck pain.

Explaining persistent physical symptoms to patients in general practice: can tests to measure central sensitisation add value? A mixed-methods study

IntroductionGeneral practitioners (GPs) often face challenges in explaining to patients with persistent physical symptoms (PPS) why their symptoms persist. Providing an explanation of the central sensitisation (CS) mechanism to patients could be helpful, yet GPs do not routinely test for signs of CS in these patients. The aim of this study was to explore the value of applying a test to assess CS in enhancing explanations provided to patients.MethodsIn this prospective study, 25 GPs applied three tests, selected through a Delphi study, to assess CS-related symptoms: (1) the Central Sensitisation Inventory (CSI); (2) an algometer for measuring pressure pain thresholds (PPT); and (3) a monofilament for assessing temporal summation. Following the tests, both the GP and the patient completed a short questionnaire. Subsequently, GPs shared their experiences in focus groups and interviews, while a sample of patients was interviewed individually. The questionnaires were analysed quantitatively, and the focus groups and interviews were analysed qualitatively.ResultsGPs reported that all tests were feasible to perform during consultations; testing took less than 5 min in 25% of cases and between 5 and 10 min in 60% of cases. In approximately 50% of cases, an additional consultation was required to perform the test. The results of the CSI confirmed CS-related symptoms more frequently (74%) than the algometer (46%) and the monofilament (43%). Consequently, many GPs preferred the CSI. Patients did not show a preference for any specific test; two-third found the tests valuable and approximately 50% reported that the explanation of CS was clearer when a test was used.ConclusionsTesting during the consultation was feasible, although an additional consultation was required in 50% of the cases. GPs preferred the CSI because its results confirmed CS-related symptoms more frequently than those from the algometer and monofilament.

Effects of neuromuscular exercise plus Pain Science Education on Resting-state EEG, clinical, and psychosocial outcomes in knee osteoarthritis: a randomised controlled trial protocol

Objective To compare the effect of Neuromuscular Exercise (NME) plus Pain Science Education (PSE), Isolated NME, and usual care on brain function measured by electroencephalography (EEG), clinical, and psychosocial outcomes in patients with chronic pain due to knee osteoarthritis (KOA). Methods A three-arm randomised controlled trial will be conducted. Fifty-seven participants with KOA will be recruited in a 1:1:1 ratio. Outcome assessor, and statistician will be blinded to group allocation. One experimental group (n = 19) will receive NME plus PSE (24 sessions, 60-90 min each), the other experimental group (n = 19) will receive isolated NME (24 sessions, 60-90 min each) and the control group (n = 19) will continue with usual care. The PSE will be adapted to the context of the participants. Primary outcome measures will be brain activity, and secondary outcomes will be pressure pain threshold, pain intensity, disability, fear-avoidance beliefs, self-efficacy, and pain catastrophizing. Outcome measures will be evaluated pre-intervention, immediately post-intervention, and four-month post-intervention. Conclusion The NME plus PSE intervention approach proposed in this trial could expand multimodal intervention strategies for patients with KOA. Impact NME plus PSE applied by a physical therapist could be essential in improving brain function, clinical, and psychosocial outcomes of patients with KOA. This could have a positive impact on the use of these therapeutic modalities from a multidimensional approach, and this combined protocol could potentially be a guide for health professionals.

Impact of electrical muscle stimulation-induced muscle contractions on endogenous pain modulatory system: a quantitative sensory testing evaluation

BackgroundExercise-induced hypoalgesia (EIH) is characterized by a reduction in pain perception and sensitivity across both exercising and non-exercising body parts during and after a single bout of exercise. EIH is mediated through central and peripheral mechanisms; however, the specific effect of muscle contraction alone on EIH remains unclear. Moreover, previous studies on electrical muscle stimulation (EMS) have primarily focused on local analgesic effects, often relying on subjective pain reports. This study investigated the contribution of EMS-induced muscle contractions to systemic analgesia, independent of motor cortex activity. We aimed to explore the underlying mechanisms of EIH by analyzing the influence of skeletal muscle mass (SMM), skeletal muscle mass index (SMI), and conditioned pain modulation (CPM).MethodsIn this crossover study, 27 healthy young adults participated in EMS and sham interventions, separated by a washout period of 2 to 3 days. SMM, SMI, and CPM were measured before the first intervention. Pressure pain thresholds (PPT) were evaluated before and after each intervention. EMS was applied to the non-dominant quadriceps at a frequency of 30 Hz, a pulse duration of 300 μs, and a duty cycle of 5 s on and 10 s off, without inducing joint movement, for 20 min. The sham intervention used the same settings, but the stimulation amplitude was insufficient to induce muscle contraction in the quadriceps. The average current intensity was 16.0 ± 3.2 mA and 11.3 ± 2.3 mA in the EMS and sham condition, respectively.ResultsIn the EMS condition, PPT significantly increased in the stimulated quadriceps but not in non-contracted sites. There were strong positive correlations between changes in PPT and both SMM and SMI, but not CPM. The sham condition showed no significant effects at any assessment sites.ConclusionsThese findings suggest that the analgesic effects of EMS-induced muscle contractions are primarily localized to the stimulated muscle tissues, rather than mediated by the central pain modulatory mechanisms.Trial registrationThis study was enrolled in the UMIN-CTR Clinical Trial Registry (registration number: UMIN000051951; date of approval: August 19, 2023).

High Shear Stress Reduces ERG Causing Endothelial-Mesenchymal Transition and Pulmonary Arterial Hypertension.

Computational modeling indicated that pathological high shear stress (HSS; 100 dyn/cm2) is generated in pulmonary arteries (PAs; 100-500 µm) in congenital heart defects causing PA hypertension (PAH) and in idiopathic PAH with occlusive vascular remodeling. Endothelial-to-mesenchymal transition (EndMT) is a feature of PAH. We hypothesize that HSS induces EndMT, contributing to the initiation and progression of PAH. We used Ibidi perfusion system to determine whether HSS applied to human PA endothelial cells (ECs) induces EndMT when compared with physiological laminar shear stress (15 dyn/cm2). The mechanism was investigated and targeted to prevent PAH in a mouse with HSS induced by an aortocaval shunt. EndMT, a feature of PAH not previously attributed to HSS, was observed. HSS did not alter the induction of transcription KLF (Krüppel-like factor) 2/4, but an ERG (ETS-family transcription factor) was reduced, as were histone H3 lysine 27 acetylation enhancer-promoter peaks containing ERG motifs. Consequently, there was reduced interaction between ERG and KLF2/4, a feature important in tethering KLF and the chromatin remodeling complex to DNA. In PA ECs under laminar shear stress, reducing ERG by siRNA caused EndMT associated with decreased BMPR2 (bone morphogenetic protein receptor 2), CDH5 (cadherin 5), and PECAM1 (platelet and EC adhesion molecule 1) and increased SNAI1/2 (Snail/Slug) and ACTA2 (smooth muscle α2 actin). In PA ECs under HSS, transfection of ERG prevented EndMT. HSS was then induced in mice by an aortocaval shunt, causing progressive PAH over 8 weeks. An adeno-associated viral vector (AAV2-ESGHGYF) was used to replenish ERG selectively in PA ECs. Elevated PA pressure, EndMT, and vascular remodeling (muscularization of peripheral arteries) in the aortocaval shunt mice were markedly reduced by ERG delivery. Pathological HSS reduced lung EC ERG, resulting in EndMT and PAH. Agents that upregulate ERG could reverse HSS-mediated PAH and occlusive vascular remodeling resulting from high flow or narrowed PAs.

Efficacy and safety of low-intensity ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis.

Myofascial Pain Syndrome (MPS) is a common pain disorder characterized by the presence of trigger points within the muscles or fascia. Low-intensity ultrasound therapy, as a noninvasive modality, has indeed found application in the management of MPS, but its efficacy for myofascial pain syndrome has still been controversial. The objective of this systematic review was to assess the safety and efficacy of low-intensity ultrasound therapy for MPS. We searched PubMed, Embase, PEDro, Web of Science, and CENTRAL for RCTs on ultrasound therapy in MPS patients. We included RCTs comparing ultrasound with other therapies or placebo-sham ultrasound. Clinical outcomes included pain scores and physical functional performance. Risk of bias and heterogeneity were assessed. Two authors of the review independently evaluated the risk of bias of each trial and extracted the data. This systematic review included sixteen RCTs involving a total of 1063 participants with MPS. None of the included studies reported adverse events. Comparing with sham or no treatment, the application of low-intensity ultrasound yielded additional benefits for pain (SMD [CI] = - 1.04 [- 1.72, - 0.36], P < 0.0003), with high heterogeneity (χ2 = 116.63, P < 0.00001, I2 = 91%). Patients receiving low-intensity ultrasound had improved on pressure pain threshold. Compared with other treatments, there were no differences in outcomes functional scores. The current study indicates that low-intensity ultrasound effectively reduces pain intensity in MPS patients. The heterogeneity regarding the parameters of ultrasound, including frequency, intensity, time was found to be high among the included studies. Each therapeutic modality works differently in various situations and may lead to multitudinous effects. The positive impact of low-intensity ultrasound on functional improvement needs to be further analyzed through more high-quality clinical trials with large sample sizes in the future. This study was registered on the following website: https://www.crd.york.ac.uk/PROSPERO/ . The PROSPERO registered ID is CRD42023472032.