Perceived Pain Intensity Research Articles

A randomized controlled trial on the impact of a specialized training program on anxiety and perceived pain in infertile women undergoing hysterosalpingography

Hysterosalpingography (HSG) is a minimally invasive procedure that can be painful. This study aimed to examine the impact of a tailored training program on anxiety and perceived pain intensity in infertile women undergoing HSG. This research was a clinical trial involving 86 infertile women who were candidates for HSG and conducted at the radiology department of the Royan Infertility Center in Tehran, Iran, between November 22, 2021, to March 11, 2023.The participants were divided into two groups:43 women in the intervention group and 43 women in the control group. The randomization of the samples was carried out using a random number table. The women in the intervention group received two face-to-face group training sessions. Data were collected using valid questionnaires. Additionally, the heart rate and blood pressure of the participants were recorded. Data analysis showed the training intervention was significantly associated with reducing anxiety levels, perceived pain, systolic blood pressure, diastolic blood pressure, and heart rate in women undergoing HSG (p < 0.05). These findings support the use of structured training interventions to improve the overall experience and outcomes for patients undergoing HSG.Trial Registration Number: IRCT20150905023897N4.

Design of a Health Education Program to Manage Chronic Neck Pain: Protocol for a Development Study.

Chronic neck pain (CNP) needs attention to its physical, cognitive, and social dimensions. We aimed to design a health education program (HEP) with a biopsychosocial approach for patients with CNP. A literature search on CNP, health education, and biopsychosocial models was carried out. Seven physiotherapists with expertise in HEPs and chronic pain participated in three teams that evaluated the literature and prepared a synthesis document in relation to the three target topics. Experts compiled the information obtained and prepared a proposal for an HEP with a biopsychosocial approach aimed at patients with CNP. This proposal was tested in the physiotherapy units of primary care health centers belonging to the East Assistance Directorate of Madrid, and suggestions were included in the final program. The HEP for CNP with a biopsychosocial approach consists of 5 educational sessions lasting between 90 and 120 minutes, carried out every other day. Cognitive, emotional, and physical dimensions were addressed in all sessions, with particular attention to the psychosocial factors associated with people who have CNP. The proposed HEP with a biopsychosocial approach emphasizes emotional management, especially stress, without neglecting the importance of physical and recreational exercises for the individual's return to social activities. The objective of this program was to achieve a clinically relevant reduction in perceived pain intensity and functional disability as well as an improvement in quality of life in the short and medium term. ClinicalTrials.gov NCT02703506; https://clinicaltrials.gov/study/NCT02703506. DERR1-10.2196/56632.

Altered structure and functional connection of subcortical gray matter in female patients with classical trigeminal neuralgia.

The etiology of classical trigeminal neuralgia (CTN) is still unclear. A better understanding of the cerebral structural and functional changes in female patients with CTN may provide important novel insights into the pathophysiologic mechanisms of female CTN. A total 37 female CTN patients were included and referred to MRI scans, comprising with 19 left CTN and 18 right CTN patients. We analyzed the volume and shape of subcortical gray matter (GM), and the functional connectivity (FC) between the accumbens nucleus (NAc) and whole brain in right and left CTN patients respectively. We found left CTN patients had a reduced right NAc volume compared to controls, similarly, the right CTN had the decreased volume in the left NAc. Vertex-wise shapes of right NAc in left CTN patients showed significant regional shape deformation on the anterior, medial and ventroposterior aspects, in contrast, left NAc of right CTN patients showed significant regional shape deformation on the anterior and posterior aspect. Furthermore, patients with left CTN showed significantly lower FC between the right NAc and right orbitofrontal cortex than control subjects. The volume of NAc in all CTN was significantly related to the perception of present pain intensity. The CTN might be majorly caused by volume reduction in NAc. A greater understanding of the neurobiological basis of pain-related changes in NAc will provide the knowledge for the development of novel NAc based therapeutic targets for pain management or even prevention in CTN patients.

Effects of Executive Functions and Cognitive Variables in Experimentally Induced Acute Pain Perception during a Distraction Task: A Study on Asymptomatic Pain-Free Individuals.

The aim of this study was to investigate the influence of executive functioning and cognitive performance on individual experimentally induced pain perception during distractor tasks in an asymptomatic pain-free population. A total of 59 healthy pain-free subjects (59.3% women, mean age: 46.5 ± 24.7 years) completed a battery test that assessed execution functions (cognitive flexibility, working memory, mental inhibition), attention level, and psychological aspects (anxiety/depressive levels-HADS, pain catastrophizing-PCS, pain anxiety symptoms-PASS 20, sleep quality-PSQI) before conducting two n-back distraction tasks. Pain was experimentally induced with a thermal stimulus that was able to induce moderate pain (70/100 points) and applied to the non-dominant forearm. The thermal stimulus was applied before and during both (one-back and two-back) distraction tasks. The analyses consisted of separated repeated-measures ANOVA that considered the functioning on each test (cognitive flexibility, working memory, mental inhibition, selective attention) and controlled for sociodemographic and psychological aspects by comparing the pain intensity at the baseline and during the one-back and two-back distractor tasks. All ANOVAs found a significant effect of the distraction task, which indicates that the perceived pain intensity scores were lower during the one-back and two-back tasks (p < 0.001) as compared with the baseline. No interaction effect between the distractor tasks and working memory (p = 0.546), mental inhibition (p = 0.16), cognitive flexibility (p = 0.069), or selective attention (p = 0.105) was identified. The current study found that a distraction task decreased the perceived intensity of experimentally induced pain in asymptomatic pain-free individuals and that this effect was not related to executive function or attention levels.

Radiation of pain: Psychophysical evidence for a population coding mechanism in humans.

The spread of pain across body locations remains poorly understood but may provide important insights into the encoding of sensory features of noxious stimuli by populations of neurons. In this psychophysical experiment, we hypothesized that more intense noxious stimuli would lead to spread of pain, but more intense light stimuli would not produce perceptual radiation. Fifty healthy volunteers (27 females, 23 males, ages 14-44) participated in this study wherein noxious stimuli (43, 45, 47 and 49°C) were applied to glabrous (hand) and hairy skin (forearm) skin with 5s and 10s durations. Also, visual stimuli displayed on the target bodily area were utilized as a control. Participants provided pain (and light) spatial extent ratings as well as pain (and light) intensity ratings. In the extent rating procedure, participants adjusted the extent of the square displayed on the screen with the extent of pain (or light) which they experienced. Pain extent ratings showed statistically significant radiation of pain indicated by 12.42× greater spatial spread of pain (pain extent) than the area of the stimulation with 49°C (p<0.001), in contrast to visual ratings which closely approximated the size of the stimulus (1.22×). Pain radiation was more pronounced in hairy than glabrous skin (p<0.05) and was more pronounced with longer stimulus duration (p<0.001). Pain intensity explained only 14% of the pain radiation variability. The relative independence of the pain radiation from pain intensity indicates that distinct components of population coding mechanisms may be involved in the spatial representation of pain versus intensity coding.

Perception of Pain Intensity and Quality in Patients Treated with Conventional Fixed Orthodontic Appliances Versus Clear Removable Aligners: A Pilot Study

Perception of Pain Intensity and Quality in Patients Treated with Conventional Fixed Orthodontic Appliances Versus Clear Removable Aligners: A Pilot Study

Altered Corticobrainstem Connectivity during Spontaneous Fluctuations in Pain Intensity in Painful Trigeminal Neuropathy.

Chronic neuropathic pain can result from nervous system injury and can persist in the absence of external stimuli. Although ongoing pain characterizes the disorder, in many individuals, the intensity of this ongoing pain fluctuates dramatically. Previously, it was identified that functional magnetic resonance imaging signal covariations between the midbrain periaqueductal gray (PAG) matter, rostral ventromedial medulla (RVM), and spinal trigeminal nucleus are associated with moment-to-moment fluctuations in pain intensity in individuals with painful trigeminal neuropathy (PTN). Since this brainstem circuit is modulated by higher brain input, we sought to determine which cortical sites might be influencing this brainstem network during spontaneous fluctuations in pain intensity. Over 12 min, we recorded the ongoing pain intensity in 24 PTN participants and classified them as fluctuating (n = 13) or stable (n = 11). Using a PAG seed, we identified connections between the PAG and emotional-affective sites such as the hippocampal and posterior cingulate cortices, the sensory-discriminative posterior insula, and cognitive-affective sites such as the dorsolateral prefrontal (dlPFC) and subgenual anterior cingulate cortices that were altered dependent on spontaneous high and low pain intensity. Additionally, sliding-window functional connectivity analysis revealed that the dlPFC-PAG connection anticorrelated with perceived pain intensity over the entire 12 min period. These findings reveal cortical systems underlying moment-to-moment changes in perceived pain in PTN, which likely cause dysregulation in the brainstem circuits previously identified, and consequently alter the appraisal of pain across time.

Effectiveness of cognitive reappraisal and distraction for induced acute pain: A laboratory study.

Cognitive reappraisal and distraction modulate pain; however, little is known about their effectiveness at different levels of pain intensity. Thus, the aim of this study has been to analyze the differential efficacy of both strategies to reduce perceived pain intensity and pain unpleasantness in low and moderate pain levels. 3 (emotion regulation strategy: cognitive reappraisal, distraction, and control) × 2 (intensity of the painful stimuli: low and moderate intensity) × 2 (time: pretest and posttest) mixed factorial design. Ninety healthy adults were randomly assigned to one of six experimental conditions. Pain-heat stimuli were administered with an advanced thermal stimulator. All participants completed the experimental pretest and posttest phases; in each phase, 12 pain stimuli were administered. Participants received brief training on how to apply cognitive reappraisal, distraction, and the control condition for the posttest phase. Data were collected from May 2022 to November 2022. Analyses of repeated-measure analysis of variance showed that at posttest cognitive reappraisal and distraction were equally effective in reducing perceived pain intensity in low pain levels, while distraction was more effective than cognitive reappraisal in decreasing perceived pain intensity in moderate pain levels. Both distraction and cognitive reappraisal were effective in decreasing pain unpleasantness regardless of the intensity of the painful stimuli. These findings highlighted the beneficial use of both strategies in the short term for pain relief, distraction being more effective in moderate pain levels. Applying both strategies to everyday situations that may cause short-term acute pain could be of great clinical relevance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Is there a relationship between somatosensory impairment and the perception of pain in stroke survivors? An exploratory study.

Pain and somatosensory impairments are commonly reported following stroke. This study investigated the relationship between somatosensory impairments (touch detection, touch discrimination and proprioceptive discrimination) and the reported presence and perception of any bodily pain in stroke survivors. Stroke survivors with somatosensory impairment ( N = 45) completed the Weinstein Enhanced Sensory Test (WEST), Tactile Discrimination Test, and Wrist Position Sense Test for quantification of somatosensation in both hands and the McGill Pain Questionnaire, visual analog scale and the Neuropathic Pain Symptom Inventory (NPSI) for reporting presence and perception of pain. No relationship was observed between somatosensory impairment (affected contralesional hand) of touch detection, discriminative touch or proprioceptive discrimination with the presence or perception of pain. However, a weak to moderate negative relationship between touch detection in the affected hand (WEST) and perception of pain intensity (NPSI) was found, suggesting that stroke survivors with milder somatosensory impairment of touch detection, rather than severe loss, are likely to experience higher pain intensity [rho = -0.35; 95% confidence interval (CI), -0.60 to -0.03; P = 0.03]. Further, a moderate, negative relationship was found specifically with evoked pain (NPSI) and touch detection in the affected hand (rho = -0.43; 95% CI, -0.72 to -0.02; P = 0.03). In summary, our findings indicate a weak to moderate, albeit still uncertain, association, which prevents making a definitive conclusion. Nevertheless, our findings contribute to our understanding of the complexities surrounding the experience of pain in survivors of stroke and provide direction for future studies.

Cognitive reserve and well-being in migraine patients: a multidimensional approach to migraine assessment in an Italian tertiary headache center

Background: Migraine is a painful neurological condition affecting emotional, cognitive, and daily life functioning. Cognitive reserve (CR) is a protective factor against neurological damage and deterioration, but its proxies have been under-investigated in migraine. The present crosssectional study aims to investigate the relationship between CR and several self-reported health measures in migraine; and how these health measures differ between CR grades. Methods: Data were collected from an Italian tertiary center between 2022 and 2023. One hundred and eighty eligible outpatients aged from 18 to 75 years were administered a protocol consisting of: the Migraine Disability Assessment; Brief Pain Inventory (BPI); Numeric Rating Scale; Short Form-36; Self-Rating Anxiety Scale; Self-rating Depression Scale (SDS). In addition, years of illness, frequency and intensity of migraine attacks, and Cognitive Reserve Index as a gradable measure of CR, were also collected. Spearman correlation and ANOVAs were performed, setting p significance at &lt;0.05. Results: A negative correlation between perceived pain intensity, attacks, and socio-behavioral proxies of CR emerged. Higher CR was also associated with fewer headache attacks (rs=-0.176; p=0.019). Lower intensity was found to be specifically related to leisure time (rs=-0.084; p=0.049). ANOVAs highlighted differences across graded CR levels in headache-related indices, including psychological and functional status (BPI-interference: F=4.302; p=0.026; SDS: F=3.887; p=0.033; enjoyment of life: F=3.672; p=0.043), also post-hoc confirmed. Conclusions: Overall, our results suggest a link between CR levels and headache-related measures, emphasizing the importance of life-long coping strategies and healthy habits to decrease pain perception. In particular, individuals with low CR reporting higher levels of pain may benefit from integrated assessment and tailored treatment options to experience. Further studies may delve into the CR threshold hypothesis in the context of headache to identify high-risk categories of patients and foster their symptom management.

The Effectiveness of Islamic Spiritual Therapy on the Perception of Pain Intensity and Catastrophic Pain in Female Patients with Chronic Pain

Background Chronic pain is an important medical problem that is associated with significant negative effects in many aspects of life. Based on prior studies, certain religious behaviors and having religion-based beliefs help coping with chronic diseases. this research aimed to investigate the effectiveness of Islamic spiritual therapy on the perception of pain intensity and catastrophizing of pain in patients with pain. Methods The research population included all female patients suffering from chronic pain who referred to physiotherapy and pain clinics in Shiraz in 2022; finally, 30 female patients were selected from 3 clinics using available sampling method. After meeting the inclusion criteria, they entered into the treatment process. In the pretest stage, research questionnaires including Pain catastrophizing questionnaire (pcs) (1995) and Pain Intensity Perception Questionnaire were completed and randomly assigned. The participants underwent 10 sessions of Islamic spirituality therapy, each lasted 45 min; during this time, the control group did not receive any intervention. After the end of the treatment program, the questionnaires were administered again to both groups in the form of a post-test. The data were analyzed using multivariate analysis of covariance (MANCOVA) in SPSS version 22. Result the average values of pain intensity and pain catastrophizing exhibited a reduction in the post-assessment in contrast to the pre-assessment. This disparity demonstrated statistical significance within the experimental cohort, whereas the difference between the mean values of the pre- and post-assessment in the control group were not statistically significant. It affirmed the efficacy of the intervention on the experimental group. Conclusions Based on the findings of this study, Islamic spiritual therapy approaches decrease pain intensity and pain catastrophizing in women with chronic pain and represents new horizons in clinical interventions and thus could be used as an effective interventional method to reduce psychosocial problem and increase pain tolerance.

Educational telerehabilitation program for women with pelvic floor dysfunctions after gynecological pelvic cancer treatment: protocol study for a randomized and controlled clinical trial

BackgroundEducational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative treatment for pelvic floor (PF) dysfunction. The purpose is to evaluate the impact of a telerehabilitation and self-care program on PF dysfunctions, reports of urinary incontinence (UI), and physical–emotional factors of participants post-treatment for gynecological pelvic cancer.MethodsTwo-arm randomized clinical trial: an intervention group (IG) will evaluate the effect of a telerehabilitation program on women undergoing clinical practice of radiotherapy for the treatment of gynecological pelvic cancer and a control group (CG) will maintain the routine. Primary outcome is the prevalence of reports of UI, which will be assessed using the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF). The secondary outcomes will be the severity and impact of UI on quality of life, location and perception of pain intensity, presence and intensity of dyspareunia, vaginal stenosis, fecal incontinence (FI), and levels of physical activity. Statistical analysis will be performed by intention-to-treat, and multivariate mixed effects analysis will be used to compare results.DiscussionActivities in the context of telerehabilitation using PFMT and self-care can represent a viable and effective solution to minimize the side effects of gynecological cancer treatment and improve women’s quality of life.

THE IMPACT OF DEPRESSION AMONG PATIENTS WITH CHRONIC LOW BACK PAIN

This scientific article has the objectives to examine the impact of depression on people experiencing chronic low back pain. Recognizing the bidirectional relationship between these conditions, the study aims to elucidate the various consequences of depressive symptoms on pain perception, functional impairment and overall quality of life among patients with chronic low back pain. Material and methods: A systematic review of the scientific literature was conducted to identify relevant studies, clinical trials and meta-analyses published between 1990 and 2023. The search included electronic databases such as PubMed, MEDLINE and PsycINFO. Results: Literature synthesis reveals that depression significantly amplifies the symptomatology of chronic low back pain, influencing various areas of a patient’s life. Key findings include decreased pain threshold by exacerbating the perception of pain intensity and duration, slowing the recovery and rehabilitation process, and decreasing health-related quality of life, highlighting the need for a multidisciplinary approach to both conditions. Conclusion: The article highlights the pervasive and interconnected nature of depression and chronic low back pain. The issues presented highlight the profound impact of depression on patients with chronic low back pain, highlighting the importance of integrated interventions that address both physical and mental health aspects of those affected. Keywords: depression, chronic low back pain, rehabilitation, pain threshold.

INVESTIGATION OF CLINICAL FACTORS AFFECTING PERCEIVED PAIN INTENSITY IN FEMALE PATIENTS WITH KNEE OSTEOARTHRITIS

Objective: The present study aimed to identify the clinical variables influencing perceived pain intensity at rest, during activity, and at night in female patients with knee osteoarthritis (OA). Method: One hundred-six female patients with knee OA (mean age, 58.50±9.48 years; mean BMI, 30.73±5.53 kg/m2) were included. The Visual Analogue Scale (VAS), active range of motion (AROM), strength of the iliopsoas, gluteus medius, quadriceps femoris, and hamstring muscles, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-12 (SF-12) were outcome measures. A multivariate or univariate regression analysis was conducted to examine the relationship between the VAS ratings and AROM, muscle strength, WOMAC, SF-12, and Kellgren-Lawrence classification. Results: The mean values for VAS-rest, VAS-activity, and VAS-night were 3.02±2.32, 6.62±1.96, and 3.89±2.72, respectively. A significant correlation was found between VAS-rest and quadriceps femoris muscle strength, as well as the WOMAC score. Similarly, VAS-activity showed a significant association with hip flexion and knee extension AROM, quadriceps femoris muscle strength, Grade 3 or Grade 4 OA, physical component score of SF-12, and WOMAC score (p

The effect of unpredictability on the perception of pain: a systematic review and meta-analysis.

Despite being widely assumed, the worsening impact of unpredictability on pain perception remains unclear because of conflicting empirical evidence, and a lack of systematic integration of past research findings. To fill this gap, we conducted a systematic review and meta-analysis focusing on the effect of unpredictability on pain perception. We also conducted meta-regression analyses to examine the moderating effect of several moderators associated with pain and unpredictability: stimulus duration, calibrated stimulus pain intensity, pain intensity expectation, controllability, anticipation delay, state and trait negative affectivity, sex/gender and age of the participants, type of unpredictability (intensity, onset, duration, location), and method of pain induction (thermal, electrical, mechanical pressure, mechanical distention). We included 73 experimental studies with adult volunteers manipulating the (un)predictability of painful stimuli and measuring perceived pain intensity and pain unpleasantness in predictable and unpredictable contexts. Because there are insufficient studies with patients, we focused on healthy volunteers. Our results did not reveal any effect of unpredictability on pain perception. However, several significant moderators were found, ie, targeted stimulus pain intensity, expected pain intensity, and state negative affectivity. Trait negative affectivity and uncontrollability showed no significant effect, presumably because of the low number of included studies. Thus, further investigation is necessary to clearly determine their role in unpredictable pain perception.

Effects of functional polymorphisms of opioid receptor mu 1 and catechol-O-methyltransferase on the neural processing of pain.

Pain is reconstructed by brain activities and its subjectivity comes from an interplay of multiple factors. The current study aims to understand the contribution of genetic factors to the neural processing of pain. Focusing on the single-nucleotide polymorphism (SNP) of opioid receptor mu 1 (OPRM1) A118G (rs1799971) and catechol-O-methyltransferase (COMT) val158met (rs4680), we investigated how the two pain genes affect pain processing. We integrated a genetic approach with functional neuroimaging. We extracted genomic DNA information from saliva samples to genotype the SNP of OPRM1 and COMT. We used a percept-related model, in which two different levels of perceived pain intensities ("low pain: mildly painful" vs "high pain: severely painful") were employed as experimental stimuli. Low pain involves a broader network relative to high pain. The distinct effects of pain genes were observed depending on the perceived pain intensity. The effects of low pain were found in supramarginal gyrus, angular gyrus, and anterior cingulate cortex (ACC) for OPRM1 and in middle temporal gyrus for COMT. For high pain, OPRM1 affected the insula and cerebellum, while COMT affected the middle occipital gyrus and ACC. OPRM1 primarily affects sensory and cognitive components of pain processing, while COMT mainly influences emotional aspects of pain processing. The interaction of the two pain genes was associated with neural patterns coding for high pain and neural activation in the ACC in response to pain. The proteins encoded by the OPRM1 and COMT may contribute to the firing of pain-related neurons in the human ACC, a critical center for subjective pain experience.

Cognitive, behavioral, and psychological phenotypes in small fiber neuropathy: A case–control study

ObjectiveSmall fiber neuropathy (SFN) is a well-defined chronic painful condition causing severe individual and societal burden. While mood disorders have been described, cognitive and behavioral profiles of SFN patients has not been investigated. MethodsThirty-four painful SFN patients underwent comprehensive cognitive, behavioral, psychological, quality of life (QoL), and personality assessment using validated questionnaires. As control samples, we enrolled 36 patients with painful peripheral neuropathy (PPN) of mixed etiology and 30 healthy controls (HC). Clinical measures of neuropathic pain, duration, frequency, and intensity of pain at the time of assessment were recorded. Between-group and correlation analyses were performed and corrected for multiple comparisons. ResultsNo differences in clinical measures were found between SFN and PPN, and all groups had similar cognitive profiles. SFN patients showed higher levels of anxiety and alexithymia (p < .005) compared to PPN and HC, considering also pain intensity. Maladaptive coping strategies characterized both patient groups, but only SFN revealed higher levels of acceptance of pain (p < .05). Pain intensity and neuropathic symptoms were associated with mood, low QoL and catastrophism (p < .001), particularly, the higher the perceived pain intensity, the higher the use of maladaptive coping strategies (p < .001). The personality assessment revealed significant feelings of worthlessness and somatization traits both in SFN and PPN (p < .002 vs HC). Discussionsour results suggest that SFN patients had a normal-like cognitive profile, while their behavioral profile is characterized by mood disorders, alexithymia, maladaptive coping strategies, and poor QoL, as other chronic pain conditions, possibly related to pain intensity. Personality assessment suggests that somatization and feelings of worthlessness, which may worsen the neuropsychological profile, deserve clinical attention when considering patients' therapeutic approaches. At the same time, the high level of acceptance of pain is promising for therapeutic approaches based on psychological support.

Pain Education in the Wellness, Training Performance, and Pain Intensity of Youth Athletes: An Experimental Study.

Although pain management programs reduce pain and improve wellness perception in the general population, few studies have explored these effects in athletes. This study evaluated the effects of an educational program about pain neuroscience on wellness, training performance, and pain in youth athletes. Differences according to sex were also explored. For 12 weeks, 52 athletes were randomly assigned to an intervention group (IG: educational program about healthy sports habits and pain neuroscience) or a control group (CG: education on healthy sports habits only). Before the start of the study and weekly until its end, wellness, training performance, and pain intensity were monitored via a questionnaire. After the intervention, IG decreased stress (p = 0.028) compared to the baseline, and a higher number of training sessions were performed without health problems (76.6%) compared to the number in the CG (63.0%) (χ2 = 8.31, p = 0.004). Regarding pain, the IG perceived lower pain than the CG did (p = 0.028). Females in the IG had lower pain than those in the CG did (p < 0.05), without differences in other variables or in males (p > 0.05). An educational program that includes pain neuroscience may help youth athletes improve their wellness status, pain intensity perception, and training session performance.

Time-varying phase synchronization of resting-state functional magnetic resonance imaging reveals a shift toward self-referential processes during sustained pain.

Growing evidence has suggested that time-varying functional connectivity between different brain regions might underlie the dynamic experience of pain. This study used a novel, data-driven framework to characterize the dynamic interactions of large-scale brain networks during sustained pain by estimating recurrent patterns of phase-synchronization. Resting-state functional magnetic resonance imaging signals were collected from 50 healthy participants before (once) and after (twice) the onset of sustained pain that was induced by topical application of capsaicin cream. We first decoded the instantaneous phase of neural activity and then applied leading eigenvector dynamic analysis on the time-varying phase-synchronization. We identified 3 recurrent brain states that show distinctive phase-synchronization. The presence of state 1, characterized by phase-synchronization between the default mode network and auditory, visual, and sensorimotor networks, together with transitions towards this brain state, increased during sustained pain. These changes can account for the perceived pain intensity and reported unpleasantness induced by capsaicin application. In contrast, state 3, characterized by phase-synchronization between the cognitive control network and sensory networks, decreased after the onset of sustained pain. These results are indicative of a shift toward internally directed self-referential processes (state 1) and away from externally directed cognitive control processes (state 3) during sustained pain.

Psychophysiological responses to a multimodal physiotherapy program in fighter pilots with flight-related neck pain: A pilot trial.

The physical and cognitive demands of combat flying may influence the development and persistence of flight-related neck pain (FRNP). The aim of this pilot study was to analyse the effect of a multimodal physiotherapy program which combined supervised exercise with laser-guided feedback and interferential current therapy on psychophysiological variables in fighter pilots with FRNP. Thirty-one fighter pilots were randomly assigned to two groups (Intervention Group: n = 14; Control Group: n = 17). The intervention consisted of 8 treatment sessions (twice per week) delivered over 4 weeks. The following primary outcomes were assessed: perceived pain intensity (Numeric Pain Rating Scale-NPRS) and Heart Rate Variability (HRV; time-domain, frequency-domain and non-linear variables). A number of secondary outcomes were also assessed: myoelectric activity of the upper trapezius and sternocleidomastoid, pain catastrophizing (Pain Catastrophizing Scale-PCS) and kinesiophobia (TSK-11). Statistically significant differences (p≤0.05) within and between groups were observed for all outcomes except for frequency domain and non-linear HRV variables. A significant time*group effect (one-way ANOVA) in favour of the intervention group was found for all variables (p<0.001). Effect sizes were large (d≥0.6). The use of a multimodal physiotherapy program consisting of supervised exercise with laser-guided feedback and interferential current appears to show clinical benefit in fighter pilots with FRNP. ClinicalTrials.gov: NCT05541848.