Pressure Pain Research Articles

Electroacupuncture induces analgesia by regulating spinal synaptic plasticity via the AMPA/NMDA receptor in a model of cervical spondylotic radiculopathy: secondary analysis of an experimental study in rats.

Cervical spondylotic radiculopathy (CSR) is characterized by neuropathic pain (NP). Although the analgesic effect of electroacupuncture (EA) has been widely recognized in clinical practice, the mechanism of EA in the treatment of CSR remains unknown. We previously reported that 7 days of EA improved behavioral markers of NP, attenuated increases in α-synuclein, synapsin 1 and 2, postsynaptic density (PSD)-95 and growth-associated protein (GAP)-43, and improved ultrastructural changes within synapses in a rat model of CSR. Herein, we present supplemental data from the same cohort of animals examining the timing of behavioral improvement within the first week (through additional measurements at 3 and 5 days into the EA treatment) and new data on the effects of EA on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) and N-methyl-d-aspartic acid receptor (NMDAR) levels. As previously reported, the rats were divided into four groups at random: normal, sham, CSR and CSR + EA. EA at bilateral LI4 and LR3 was administered once a day for 7 days (20 min each) in the CSR + EA group after the CSR model was established by inserting a fishing line under the laminae. Behavioral assessments were carried out prior to initiation of EA and at 3, 5 and 7 days into the 7-day treatment course. Concentrations ofγ-aminobutyric acid (GABA) and glutamate (Glu) were determined using enzyme-linked immunosorbent assay and ultraviolet colorimetry, respectively, and AMPAR (glutamate receptor (GluR)1 and GluR2 membrane protein) expression was determined using Western blotting. Immunohistochemistry was used to detect the protein expression and average optical density (AOD) of NMDAR1 (NR1), NMDAR2A (NR2A) and NMDAR2B (NR2B). Quantitative reverse transcription-polymerase chain reaction was used to detect the mRNA expression of NR1, NR2A and NR2B. Transmission electron microscopy was used to observe changes in synaptic ultrastructure. EA significantly improved the pressure pain threshold (PPT) and mechanical withdrawal threshold (MWT) 5 days into the intervention, although effects were less pronounced than at 7 days (at completion of treatment). However, significant effects on gait scores were not seen prior to 7 days. As previously reported, EA also improved markers of synaptic ultrastructure. In the spinal cord, GluR1 membrane protein expression was decreased, GluR2 membrane protein expression was increased, and the GluR1/GluR2 ratio was decreased. Protein and mRNA expression of NR1, NR2A and NR2B was significantly decreased. GABA concentration was markedly increased, while Glu concentration was markedly decreased. Evidence of EA analgesia (higher PPT and MWT scores) was seen after 5 days of EA, while positive effects on motor function required 7 days of treatment. The underlying mechanism may be related to inhibition of AMPAR and NMDAR expression, regulation of the concentration of related neurotransmitters and improvement of spinal cord synaptic plasticity. This study establishes a preliminary theoretical foundation for the use of EA in the clinical treatment of CSR.

Effect of blown air temperature on morphology, phase structure and filtration efficiency of PVDF nanofibrous mats produced via electro‐blowing

AbstractThis study investigates the effects of temperature of pressurized blown air on fiber morphology, porosity, phase structure, and filtration performance of PVDF nanofibers produced via the electro‐blowing method for the first time. The blown air heated to 20, 40, 60, and 80°C was utilized during production. Increasing air temperature resulted in more homogeneous distribution of fibers and defect‐free fibrous mats, accompanied by a significant reduction in fiber diameter. A linear relationship between fiber diameter and pore size was observed; as fiber diameter decreased, reducing air permeability due to smaller pore sizes. FTIR measurements revealed the highest β‐phase content (82%) in the PVDF‐80C sample produced at 80°C. The rise in temperature lowered solution viscosity and surface tension, contributing to improved drawing effect and therefore higher β‐phase content in the PVDF polymer. Corona discharge treatment further enhanced the surface potential, with the finest fibers exhibiting the highest surface charge. The PVDF‐80C sample demonstrated the best performance during filtration tests against NaCl aerosols (PM0.3) at a flow rate of 95 L/min, achieving a filtration efficiency of 98.68% with a pressure drop of 153 Pa. These findings highlight the critical role of temperature in influencing nanofiber properties and filtration performance.Highlights Finer fibers and defect‐free mats achieved with increased air temperature. PVDF‐80C showed 82% β‐phase content, the highest among all samples. Smaller fiber diameter led to reduced pore size and lower air permeability. Corona discharge enhanced surface potential, boosting fiber charge. PVDF‐80C achieved 98.68% filtration efficiency with 153 Pa pressure drop.

Do Female and Male Chests Feel the Same? A Comprehensive Quantitative Sensory Analysis

There is growing interest in understanding chest sensory function due to the significant morbidity associated with impaired sensation following nerve injury. While the baseline quantitative sensory and pain thresholds in female and male patients have been studied in various other anatomic areas, there is little knowledge on quantitative sensation at the chest as well as the presence of possible gender differences. Therefore, this study aimed to conduct a comprehensive quantitative sensory analysis to determine if female and male chests feel the same. A total of 100 chests in 50 subjects (25 females and 25 males) were evaluated. Quantitative sensory testing (QST) was performed on the nipple areola complex (NAC) and surrounding chest skin and included mechanical detection using Semmes-Weinstein monofilaments, two-point discrimination, vibration detection, pin prick, cold detection, warm detection, heat pain and pressure pain thresholds. Male chests were significantly more sensitive to mechanical detection, two-point discrimination, vibration, pin prick as well as cold and warm detection at both the NAC and chest as compared to female chests (p<0.05). Females had significantly lower sensory thresholds to heat pain and pressure pain detection at both the NAC and chest as compared to males (p<0.05). The quantitative sensory functions of female and male chests are significantly different. This knowledge helps to better understand baseline sensory functions at the chest and the awareness of gender differences in this anatomic area.

Differences on lower trapezius pressure pain threshold, muscle strength and muscle thickness in individuals with chronic neck pain and active or latent myofascial triggers points.

Myofascial trigger points (MTrPs) in the lower trapezius have been recognized as an important source of neck pain. This study aims to compare the lower trapezius muscle strength, pressure pain threshold (PPT) and muscle thickness at rest and contraction between participants and painful vs. no-painful side with active and latent MTrPs; and to examine the associations among these variables with pain intensity, duration and disability in patients with neck pain. A cross-sectional study was carried out in 64 people with neck pain with active or latent MTrPs (34 Active MTrPs group and 30 Latent MTrPs groups). Muscle strength, pressure pain threshold and muscle thickness at rest and contraction of the lower trapezius was recorded. No significant differences were found in descriptive data, dominant side, or side of neck pain. However, the Active MTrPs Group had lower pain pressure thresholds (PPT) on the neck pain side compared to the Latent MTrPs Group, indicating greater sensitivity. Muscle thickness and strength showed minor differences between groups. Pain intensity correlated moderately with pain duration and strongly with neck pain disability. The results of the present study showed differences in PPT on the lower trapezius muscle in active and latent MTrP in neck side pain compared to non-neck side pain. In addition, lower trapezius strength reported differences between the neck side pain compared to non-neck side pain in both active and latent MTrP. Lower trapezius muscle strength showed significant moderate association with muscle thickness at contraction.

Evidence for spinal disinhibition as a pain-generating mechanism in fibromyalgia syndrome.

Pain phenomenology in patients with fibromyalgia syndrome (FMS) shows considerable overlap with neuropathic pain. Altered neural processing leading to symptoms of neuropathic pain can occur at the level of the spinal cord, and 1 potential mechanism is spinal disinhibition. A biomarker of spinal disinhibition is impaired H-reflex rate-dependent depression (HRDD). This study investigated whether patients with FMS exhibit evidence of spinal disinhibition. Thirty-one individuals with FMS and 20 healthy volunteers underwent testing of Hoffman reflex including HRDD, along with assessment of clinical signs and symptoms, pressure pain thresholds, temporal summation of pain (wind-up), and conditioned pain modulation (CPM). Small nerve fibre structure was quantified using intraepidermal nerve fibre density and corneal confocal microscopy. Patients with FMS had significantly impaired HRDD at 1 Hz (P = 0.026) and 3 Hz (P = 0.011) and greater wind-up ratio (P = 0.008) compared with healthy controls. Patients with the most impaired HRDD also had the most inefficient CPM but HRDD was not associated with wind-up. Both HRDD and CPM were most impaired in patients with a shorter duration of disease. We demonstrate for the first time that people with FMS show evidence of spinal disinhibition, which is most dominant in shorter duration of disease and may represent a putative mechanism of pain generation in FMS. Identifying people with impairment of central pain processing at an early stage may provide opportunities for targeted mechanistically directed interventions. Longitudinal studies are warranted to tease out the precise contribution of these mechanisms.

Evaluation of Inadequate Response to Ultrasound-Guided Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome: Treatment Failure or Central Sensitization?: Central Sensitization in Injection Response.

To evaluate whether central sensitization (CS), pain catastrophizing, and psychological factors are associated with inadequate response to ultrasound-guided subacromial corticosteroid injection (SCI) in patients with chronic shoulder impingement syndrome (SIS). This study was designed as a prolective observational study, combining analytical cross-sectional and prospective elements to evaluate associations and treatment responses. Secondary care outpatient clinic. A total of 72 patients aged 18-75 years with SIS and at least 6 months of shoulder pain, planned to undergo ultrasound-guided SCI, were included in the study. Not applicable. Treatment response was defined as a ≥50% reduction in pain (VAS) at 4 weeks post-injection. The presence of central sensitization was assessed using the Central Sensitization Inventory (CSI) and Pressure Pain Threshold (PPT) via algometry (ipsilateral deltoid, contralateral deltoid, and contralateral vastus lateralis). Negative thoughts related to pain were evaluated with the Pain Catastrophizing Scale (PCS), and mood status was assessed using the Hospital Anxiety and Depression Scale (HADS). 48 patients (responders) experienced ≥50% VAS reduction, while 24 (non-responders) did not. Non-responders had significantly higher CSI (p=0.000), HADS-depression (p=0.001), and HADS-anxiety (p=0.000) scores. PPT values were significantly lower in non-responders at ipsilateral deltoid (p=0.030), contralateral deltoid (p=0.045), and contralateral vastus lateralis (p=0.036). CSI was significantly correlated with PPT at ipsilateral deltoid (r=-0.400, p=0.001), contralateral deltoid (r=-0.354, p=0.002), and contralateral vastus lateralis (r=-0.442, p=0.000); PCS total score (r=0.449, p=0.000); HADS-depression score (r=0.572, p=0.000); and HADS-anxiety score (r=0.618, p=0.000). CSI was the most predictive factor for non-response (AUC=0.755, 95% CI: 0.635-0.875). Multivariate analysis identified CSI as an independent predictor (p=0.022), with a predictive accuracy of 72.2%. Inadequate response to SCI in chronic SIS is strongly associated with CS, psychological distress, and altered pain perception. Integrating CS-targeted interventions into treatment strategies may improve outcomes.

Elevated Posterior Insula Glutamate in Patients with Sickle Cell Disease

Sickle cell disease (SCD) is an inherited hemolytic disorder accompanied by chronic pain and recurrent acute painful episodes known as vaso-occlusive crises (VOCs). Increased Glx (glutamate+glutamine) and lowered insula GABA concentration has been reported in the insula of patients with fibromyalgia, a nociplastic chronic pain condition, and may affect the pathophysiology of pain-related syndromes. Therefore, proton magnetic resonance spectroscopy (1H-MRS) was conducted to measure levels of Glx and other brain metabolites using a single voxel (size: 2×3×3 cm3) in the right posterior insula cortex (PIC) in 17 individuals with SCD and 17 ethnicity-, age- and sex-matched healthy controls (HCs). The frequency of VOCs in the preceding 12 months was recorded. The concentration of Glx (p=0.019) and the ratio of Glx to tCr (total creatine, p=0.035) in the PIC were significantly higher in patients with SCD as compared to matched HCs (n=17). Secondary analyses with the unpaired full sample of 24 SCD also showed a significantly higher level of Glx/tCr than HCs (n=19), with a positive correlation between the level of Glx/tCr and the number of VOCs (p=0.034, r=0.476), as well as a negative correlation between Glx and sensory sensitivity assessed by tonic pressure pain in gastrocnemius area of the non-dominant leg (p=0.040, r=-0.462). The unpaired full sample additionally revealed a significant difference in sensory sensitivity (p=0.050). Altered metabolites such as GABA and myoinositol were also observed between SCD and HCs. These results suggest that elevated excitatory neurotransmission in the insula might contribute to nociplastic pain in SCD. PerspectiveOur work highlighted the innovative finding of elevated levels of the excitatory neurotransmitter glutamate with glutamine in patients with SCD compared to healthy controls. The trend of positive relationship between Glx/tCr and the frequency of VOCs suggests that an excitatory brain neurotransmitter imbalance may be involved in VOCs.

Cut-Off Values Able to Identify Migraine Patients With Increased Pressure-Pain Sensitivity Independent of the Migraine Cycle Through a Single Assessment: A Secondary Analysis of a Multicentre, Cross-Sectional, Observational Study.

Identify values that could predict the presence of increased pressure-pain sensitivity independent of the migraine cycle through a single assessment. This was a secondary analysis of a previous study in which 198 episodic and chronic migraine patients were assessed during all phases of the migraine cycle. Pressure pain threshold (PPT) was assessed over the temporalis, cervical spine, hand, and leg. Migraine patients were divided into two sub-groups: patients with increased pressure-pain sensitivity (IPS) and with No IPS (No-IPS). A Chi-squared Automatic Interaction Detection decision tree analysis was used to identify predictors to be included in the IPS or NoIPS group. To assess the internal validity of the model, a tenfold cross-validation was applied. 161 (81%) patients were included in the IPS group, while 37 (19%) in the NoIPS group. Migraine patients with: (1) Temporalis PPT ≤ 130 kPa; (2) Temporalis PPT > 130 kPa and ≤ 197.5 kPa and hand PPT ≤ 347.33 kPa; (3) Temporalis PPT > 197.5 kPa and hand PPT ≤ 315 kPa; were correctly included in the IPS group with a sensitivity of 96%, a specificity of 81%, a positive predictive value of 96%, and a negative predictive value of 81%. The accuracy of the model and the cross-validation analysis were respectively 93% and 92%. The high internal validity suggests that our model could precisely predict the presence of IPS independently by the phase in which the assessment occurred. Trigeminal and hand PPT cut-off values could be used to identify patients with IPS.

Catheter-directed thrombolysis of massive pulmonary embolism in high risk bleeding patients (local experience in kenya, single centre study)

Abstract Background Pulmonary Embolism (PE) is the third most common cause of death after myocardial infarction (MI), and cerebrovascular accidents (CVA) (1). For patients who are at risk of major bleeding such as advanced age, recent operation or delivery or major trauma, strategies to minimise bleeding risk should be considered, including catheter directed thrombolysis therapy (2) in reduced dose. Death from massive PE often occurs within the first two hours, and the risk remains elevated for up to 72 hours after presentation (3,4). Thirty-day survival following the diagnosis of a PE is only estimated to be 59.1%, and despite advances in medical care, in-hospital mortality from acute PE has remained stable over the past decade (5). Catheter directed thrombolysis (CDT) is a novel treatment option for massive/sub massive pulmonary embolism as systemic thrombolysis for acute PE carries up to 20% risk of major bleeding, including 2-5% risk of hemorrhagic stroke (6). Purpose To determine the clinical outcomes of catheter directed thrombolysis in patients with massive/ sub massive pulmonary embolism. Methods We conducted a retrospective quantitative study of 15 patients who presented with massive pulmonary embolism. A systematic random sampling was done to select the patients at advanced age, recent operation or first 2 weeks post labour with high bleeding risk, clinical data was recorded. All patients were taken to Cath lab with right heart catheterization, RA, RV and PA pressure were measured. Swan-Ganz catheter were placed in the main pulmonary trunk in case of bilateral PE, or sub-selective in the culprit branch. Alteplase infusion was given for 24-72 hours until proof for significant lysis of the clot. Clinical success defined as: 1. Stabilization of hemodynamics 2. Improvement in pulmonary systolic pressures, D-Dimer, TAPSE, RV/LV ratio and repeat CT findings 3. Survival to hospital discharge 4. Improvement in 30-day morbidity and mortality. Results There were no death on the trial group at discharge or at 30 days follow up. There were significant improvement of RV size and function elucidated by improvement of RV/LV ratio which were reduced from 1.06±0.18 to 0.89±0.2, TAPSE increased from 14.07±1.6 to 17.6±2.2, p &amp;lt; 0.01. There was significant drop in systolic pulmonary pressure(sPA) 67±14.5 mmHg to 38±14.5mmHg, p&amp;lt;0.001. The improvement of RV function and reduced sPA pressure were associated with increase in D-Dimer by at least 35% post thrombolysis, p&amp;lt;0.001. Conclusion Catheter directed thrombolysis (CDT) improves clinical outcomes in patients with acute pulmonary embolism with minimal risk of minor bleeding, and rapid recovery of right ventricular dysfunction. There were no major bleeding or death noticed in the treatment group and at one month follow up. In experienced centres, CDT is a safe and an effective treatment for both massive and/ or submassive PE. Echocardiography findings before CDT Echocardiography findings after CDT

The Role of Maladaptive Plasticity in Modulating Pain Pressure Threshold Post-Spinal Cord Injury

Background: Spinal cord injury (SCI) frequently leads to pain, leading to significant disability. Pain sensitization, a key feature of SCI, is commonly assessed via quantitative sensory testing like the Pressure Pain Threshold (PPT), though the factors influencing PPT changes remain unclear. This study hypothesizes that specific clinical and neurophysiological factors modulate PPT in SCI patients. The primary objective is to identify predictors of PPT in SCI patients. Methods: We conducted a cross-sectional analysis of neurophysiological, clinical, and demographic data from 102 SCI patients in an ongoing prospective cohort study called “Deficit of Inhibition as a Marker of Neuroplasticity” (DEFINE study). Multivariable regression analyses were used to evaluate demographic, clinical, and functional variables associated with PPT, the primary outcome measure. Results: The sample comprised 87.9% males with an average age of 41. Trauma was the leading cause of SCI (77.45%), predominantly affecting the cervical and thoracic levels. Pain was reported by 44% of participants, and the mean PPT was 8.3 kPa, measured bilaterally. Multivariate analysis of PPT in the left, right, and bilateral thenar regions revealed consistent trends. Significant negative associations were found between bilateral PPT and low beta EEG frequency in the central area (β = −14.94, p = 0.017), traumatic lesion etiology (β = −1.99, p = 0.038), and incomplete lesions by the American Spinal Injury Association classification (β = −1.68, p = 0.012). In contrast, positive associations were observed with age (β = 0.08, p &lt; 0.001). Conclusions: Our findings show that increased beta oscillations and traumatic brain injury having a lower PPT indicate that factors associated with maladaptive plasticity are associated with decreased and likely less functional PPT. On the other hand, increased motor function may help to regulate PPT in a more functional status.

The effect of peri-operative pain neuroscience education on pain and recovery in adult patients receiving laparoscopic inguinal hernia repair

To optimize the efficacy of analgesia for patients receiving laparoscopic inguinal hernia repair, peri-operative pain neuroscience education (PNE) as a pain-specific cognitive therapy was incorporated into multi-modal analgesia. A randomized controlled trial was conducted to compare conventional analgesia (group CA) and the addition of pain neuroscience education into it (group PNE) in patients receiving laparoscopic inguinal hernia repair. Characteristics of peri-operative pain was evaluated with Douleur Neuropathique 4 questionnaire (DN-4), central sensitization inventory (CSI), pain catastrophizing scale (PCS) post-operatively and pressure pain threshold. Post-operative quality of recovery was measured with EuroQol five dimensions questionnaire (EQ-5D-5L). The incidence of chronic post-operative pain was also recorded. A total of 184 patients consented to participate in this study and finished follow-up. Compared with those receiving conventional analgesia (group CA, N = 91), patients in group PNE (N = 93) reported reduced incidence of moderate-to-severe pain and less dosages of opioid during hospitalization (p < 0.05). Catastrophing, sensitization related to pain were reduced in group PNE (p < 0.05). Quality of recovery was improved till 1 month after surgery (p < 0.05). The addition of pain neuroscience education improved analgesic effect and quality of recovery for patients undergoing laparoscopic inguinal hernia repair. It also helped reduce sensitization and catastrophic of acute surgical pain. This psychologically-oriented analgesic approach merits future research and application for these patients.

Estimation of Pressure Pain in the Lower Limbs Using Electrodermal Activity, Tissue Oxygen Saturation, and Heart Rate Variability

Quantification of pain or discomfort induced by pressure is essential for understanding human responses to physical stimuli and improving user interfaces. Pain research has been conducted to investigate physiological signals associated with discomfort and pain perception. This study analyzed changes in electrodermal activity (EDA), tissue oxygen saturation (StO2), heart rate variability (HRV), and Visual Analog Scale (VAS) under pressures of 10, 20, and 30 kPa applied for 3 min to the thigh, knee, and calf in a seated position. Twenty participants were tested, and relationships between biosignals, pressure intensity, and pain levels were evaluated using Friedman tests and post-hoc analyses. Multiple linear regression models were used to predict VAS and pressure, and five machine learning models (SVM, Logistic Regression, Random Forest, MLP, KNN) were applied to classify pain levels (no pain: VAS 0, low: VAS 1–3, moderate: VAS 4–6, high: VAS 7–10) and pressure intensity. The results showed that higher pressure intensity and pain levels affected sympathetic nervous system responses and tissue oxygen saturation. Most EDA features and StO2 significantly changed according to pressure intensity and pain levels, while NN interval and HF among HRV features showed significant differences based on pressure intensity or pain level. Regression analysis combining biosignal features achieved a maximum R2 of 0.668 in predicting VAS and pressure intensity. The four-level classification model reached an accuracy of 88.2% for pain levels and 81.3% for pressure intensity. These results demonstrated the potential of EDA, StO2, HRV signals, and combinations of biosignal features for pain quantification and prediction.

Association between symptom characteristics and disease severity in patients suspected of coronary artery disease.

Discrepancies often exist between patient-reported symptoms and diagnostic test findings in patients with suspected obstructive coronary artery disease (CAD). To quantify the association between patient-reported symptoms and the diagnosis of severe stenosis in patients with suspected obstructive CAD. Two large-scale cohorts of patients with new-onset symptoms suggestive of obstructive CAD were evaluated. Chest discomfort was assessed by typicality, location, type, exertional/stress factors, and relief with rest/nitroglycerine. Patients underwent non-invasive diagnostic testing (coronary computed tomographic angiography (CCTA) or functional testing), followed by test-result-driven invasive coronary angiography (ICA). Severe stenosis was defined as ≥70​% diameter stenosis on ICA. Sensitivity analyses included CCTA stenosis, functional abnormalities, and revascularization. Of 14,410 patients, 2093 (14.5​%) were referred for ICA, and 765 (5.3​%) were diagnosed with severe stenosis. Patients with typical angina (n​=​224) had higher odds of being diagnosed with severe stenosis on ICA (OR and 95​% CIs: 2.84 [2.40-3.34]) than those with atypical or non-anginal symptoms. In patients diagnosed with severe stenosis on ICA, those with exertional/stress factors (n​=​418; OR [95​% CI]: 2.50 [2.16-2.90]) and relief with rest/nitroglycerine (n​=​318, 2.28; [1.96-2.65]) had higher odds compared to those without. Patients reporting pressure or burning pain had higher odds of severe stenosis. Associations were consistent across sex and age groups, and sensitivity references. Exertional/stress-related chest discomfort and relief with rest/nitroglycerine increased the odds of severe stenosis in patients with suspected CAD undergoing test-result-driven ICA, while location and type of chest pain were less associated, with no differences across sex or age groups.

Intervensi Fisioterapi pada Kasus Sprain Ankle : A Case Report

Background: An ankle sprain is an acute musculoskeletal injury that causes damage to one or more ligaments in the ankle. There are 3 grades of damage to an ankle sprain, namely grade 1: mild ligament tear, grade 2: partial ligament tear, grade 3 : complete ligament tear. Therefore, this study aims to find out how to treat physiotherapy in cases of ankle sprains and the progress that patients find after being given intervention. Methods: This case study was carried out at Panembahan Senopati Hospital Bantul on ankle sprain patients. The problems experienced by patients are pain, weakness of muscle strength, limited range of motion of joints, and decreased functional activity. Findings: Numeric Rating Scale (NRS) pain assessment revealed that quiet pain remained at zero while pressure pain decreased from two to one and movement pain decreased from four to two. Ankle eversion, dorsiflexion, plantar flexion, and inversion are used in Manual Muscle Testing (MMT) to test muscle strength, and the results range from 3 to 4. Goniometers are used to measure range of motion (ROM) when moving plantar-dorso flexi S : 15 °-0-30° becomes S: 18°-0-32°, while in the inversion-eversion movement R: 25°-0-15° becomes R: 27°-0-17°. Functional activity as measured by the Foot and Ankle Disability Index (FADI) showed an increase, initially with a value of 71 which increased to 78. Conclusion: Providing intervention for ankle sprains with 3 meetings where the modalities used were infrared, active resisted exercise and calf raises were able to reduce pain relief, increasing muscle strength, increasing joint range of motion and functional activities

Rapid weight loss and combat athletes: a study on psychological resilience and mechanical hyperalgesia

IntroductionThe study investigates the effects of Rapid Weight Loss (RWL) on the levels of psychological resilience and mechanical pain sensitivity in elite kickboxers. The primary aim was to examine changes in psychological resilience subdimensions and pressure pain threshold (PPT) values in the thoracolumbar region before and after a one-month RWL period leading up to competition. Hypotheses included expectations of significant reductions in PPT values due to biomechanical and physiological changes during RWL, along with improvements in psychological resilience subdimensions due to structured routines and social support.MethodsThirty-seven elite male athletes (age: 22.94 ± 1.98) participated in the study. Psychological resilience was assessed using the Psychological Resilience Scale for Adults, and mechanical pain sensitivity was evaluated through Pressure Pain Threshold (PPT) measurements. Measurements were conducted before and after the RWL period, spanning one month prior to competition.ResultsThe results revealed significant PPT values across all thoracolumbar segments after RWL (p &amp;lt; 0.001). Cohen’s d values indicated large effect sizes for these changes (d = 2.10–2.36). The L5 segment exhibited the largest PPT decrease (t = −10.45, d = 2.36), while the Th1 segment showed the smallest decrease (t = −8.23, d = 2.10). Measurements taken at 4 cm from the spine midline also demonstrated significant PPT reductions (p &amp;lt; 0.001), with the highest change recorded in the L5 segment (t = −9.78, d = 2.30). Psychological resilience subdimensions, including “structured style,” “social competence,” “future orientation,” and “social resources,” improved significantly after RWL (p &amp;lt; 0.05), while “family cohesion” and “personal strength” did not show significant changes. Athletes who previously ranked in tournaments exhibited higher psychological resilience, potentially due to enhanced self-confidence.DiscussionThese findings align with literature suggesting that competitive success and optimism play crucial roles in resilience development. Personality traits and perceived social support further contributed to the observed resilience levels. This study highlights the multidimensional impact of RWL, emphasizing its detrimental effects on pain sensitivity and its mixed outcomes on psychological resilience. RWL-associated increases in mechanical hyperalgesia, especially in the lumbar region, were attributed to biomechanical and neurophysiological factors. Enhanced psychological resilience observed in certain subdimensions underscores the importance of structured and social support systems in mitigating RWL-induced stress. Future research should explore interventions to optimize resilience and manage pain during RWL periods, focusing on individualized support strategies for athletes. These findings contribute to understanding the interplay between psychological and physiological factors during RWL, practical insights for athletic training.

Wearable Pressure Sensor Based on Triboelectric Nanogenerator for Information Encoding, Gesture Recognition, and Wireless Real‐Time Robot Control

AbstractWearable sensor has attracted a broad interesting in application prospect of human‐machine interaction (HMI). However, most of sensors are assembled in the shape of gloves to accurately capture complex hand motion information, thereby seriously blocking the hand to complete complex tasks. Herein, a wearable pressure sensor based on drum‐structured triboelectric nanogenerator (DS‐TENG) is developed to capture subtle pressure signals for physiological signal detection, information encoding, gesture recognition, and wireless real‐time robot control. The DS‐TENG enables a limit of detection down to 3.9 Pa pressure, which can sensitively capture human micromotion signals of pulse, throat sounds, and wrist muscles contraction. Especially, combined with a microprocessor and Morse code, the DS‐TENG worn on wrist can detect single‐finger motion signals to translate into regular voltage signals, which is employed to encode information of 26 letters and subsequently decode into the corresponding letters. Furthermore, with an aid of machine learning, the DS‐TENG array (2 × 2) can successfully achieve gesture recognition with high accuracy of 92% to wirelessly perform real‐time robot control. Consequently, the wearable pressure sensor based on DS‐TENG can capture subtle pressure signals for information encoding and wireless real‐time robot control, which demonstrates extreme potential in the field of HMI and artificial intelligence.

Transcutaneous vagus nerve stimulation as a pain modulator in knee osteoarthritis: a randomized controlled clinical trial

BackgroundOur understanding of osteoarthritis (OA) has evolved from a degenerative disease to one in which low-grade, chronic inflammation plays a central role. In addition, evidence suggests that OA is accompanied by both peripheral and central nervous system sensitization that can cause pain. It has been demonstrated that transcutaneous vagus nerve stimulation (tVNS) can relieve pain, inflammation, and central sensitization in other conditions including fibromyalgia, pelvic pain, and headaches. We aimed to assess the efficacy and safety of tVNS on nociceptive pain, central sensitization, and physical function in knee OA.MethodsIn this 12-week study, we stimulated the auricular branch of the vagus nerve with an auricular electrode connected to a transcutaneous electrical nerve stimulation device once a day for 3 days each week for 12 weeks. A total of 68 patients with chronic knee OA were randomly assigned to the active and sham groups (34 patients in each group). We used a variety of outcome measures, including the visual analog scale (VAS), pressure pain threshold (PPT), knee injury and osteoarthritis outcome score (KOOS), PainDETECT (PD-Q) and Douleur Neuropathique 4 (DN4) questionnaires. Outcome measures were recorded at baseline, At the end of the stimulation period, and then after 4 weeks.ResultsIn the active group, compared to baseline, there was a significant improvement in VAS scores between the first and second follow-up visits (P < 0.001). A significant improvement in PPT was seen in the right knee, left knee, and right elbow in active tVNS, and this improvement persisted for four weeks post-intervention. Meanwhile, in the sham group, right knee PPT was improved but not maintained. There were statistically significant improvements in the PD-Q and DN4 scores in the active tVNS group (P < 0.001), whereas in the sham group, DN4 questionnaire did not show any improvement. In terms of functional outcomes, the improvement in KOOS was significant only in the active group (31.44 ± 18.49, P < 0.001). No serious adverse events were observed.ConclusionThere is preliminary evidence to support the benefits of tVNS in OA, suggesting that neuromodulation can be used as an adjunct to existing pharmacological and non-pharmacological treatments.Trial registrationThe study was registered on ClinicalTrials.gov (NCT05387135) on 24/05/2022.

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.

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. 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. 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. 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&lt;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&lt;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&lt;0.05). TNE increased the effectiveness of pilates exercises on pain, functional status and pressure pain thresholds in patients with FM.